Journal of Orthopaedic Trauma

OBJECTIVES: Dual implants for distal femur periprosthetic fractures (DFPF) is a growing area of interest for these challenging fractures with dual plating (DP) emerging as a viable construct for these injuries. In the current study we review our experience with DP constructs. DESIGN: Retrospective case series with comparison group. SETTING: Level 1 academic trauma centerPatients/Participants: Adults >50 years old sustaining comminuted OTA/AO 33-A2 or 33-A3 DFPF treated with either DP or a single distal femur locking plating (DFLP)...

OBJECTIVE: To quantify work impairment and economic losses due to lost employment, lost work time (absenteeism), and lost productivity while working (presenteeism) after a lateral compression pelvic ring fracture. Secondarily, we compared productivity loss of patients treated with surgical fixation versus nonoperative management. DESIGN: A secondary analysis of a prospective, multicenter trial. SETTING: Two level 1 academic trauma centers...

OBJECTIVE: To determine if time from hospital admission to surgery for acetabular fractures using an anterior intrapelvic (AIP) approach affected blood loss. DESIGN: Multicenter retrospective study. SETTING: Three level 1 trauma centers at 2 academic institutions. PATIENTS: 195 adult (age >18) patients with adequate records to complete analysis and no pre-existing coagulopathy. INTERVENTION: AIP approach without other significant same day procedures (irrigation and debridement and external fixation were the only other allowed procedures)...

OBJECTIVE: To analyze the relationship between surgeon experience with the sinus tarsi approach (STA) and outcomes in the treatment of displaced intra-articular calcaneus fractures (DIACF). SETTING: Single level 1 trauma center. DESIGN: Retrospective.Patients/Participants: 103 consecutive DIACF (OTA/AO 82C; Sanders II-IV) treated operatively using STA from 2015 to 2021. INTERVENTION: Open management using the STA performed by two fellowship-trained orthopaedic traumatologists...

OBJECTIVES: To determine change in stiffness and horizontal translation of a geriatric extra-articular proximal tibia fracture model after intramedullary nailing with distal (long) segment blocking screws versus proximal (short) segment blocking screws. METHODS: Unstable extra-articular proximal tibia fractures (OTA/AO 41-A3) were created in twelve geriatric tibias. Intramedullary nails were locked with a standard construct (4 proximal screws and 2 distal screws)...

OBJECTIVES: The purpose of this study was to quantify social media usage among Orthopaedic Trauma Association (OTA) members. METHODS: All active OTA members were searched for involvement among common social media platforms. Surgeons were then classified as "active" on any given social media site if they posted within the last 6 months. Surgeons were also identified by the region they practiced in, gender, and their practice setting (academic vs private). Lastly, a surgeon's score and number of reviews from common physician review websites was examined...

OBJECTIVE: To identify technical factors associated with nonunion after operative treatment with lateral locked plating. DESIGN: Retrospective cohort study. SETTING: Ten Level 1 trauma centers. PARTICIPANTS: Six hundred fifteen adult patients with supracondylar distal femur fractures (OTA/AO Type 33A or C). INTERVENTION: Lateral locked plating. MAIN OUTCOME MEASUREMENTS: Surgery for nonunion...

OBJECTIVES: Health literacy is often poor among trauma patients. We introduced an educational mobile application to newly injured patients. We hypothesized that patients who utilized the app would be more informed about their injury and treatment recommendations, and that app users would demonstrate greater adherence to treatment recommendations. DESIGN: Prospective, cohort study. SETTING: Level 1 trauma centerPatients/participants: Adult patients with acute orthopaedic injury...

OBJECTIVE: Acute compartment syndrome (ACS) is a true emergency. Even with urgent fasciotomy there is often muscle damage and need for further surgery. Although ACS is not uncommon, no validated classification system exists to aid in efficient and clear communication. The aim of this study was to establish and validate a classification system for the consequences of ACS treated with fasciotomy. METHODS: Using a modified Delphi method, an international panel of ACS experts was assembled to both establish a grading scheme for the disease and then validate the classification system...

OBJECTIVE: To evaluate operatively treated intertroch fracture patients in order to determine the optimal follow-up to ensure complete fracture healing and recognize complications. DESIGN: This was a retrospective cohort review of patients, presenting with an intertrochanteric hip fracture, treated with a cephallomedullary nail (CMN) or sliding hip screw.(SHS). SETTING: Patients were treated at an Academic Level 1 trauma center. The trauma database matched with CPT codes 27244 and 27245 to identify patients over the age of 60, treated with CMN or SHS...

OBJECTIVES: 1) Determine effects of computed tomography (CT) on reproducibility of olecranon fracture classification. 2) Determine effects of CT utilization on inter-observer agreement regarding management of olecranon fractures. 3) Evaluate factors associated with articular impaction. METHODS: Seven surgeons retrospectively evaluated radiographs of 46 olecranon fractures. Each fracture was classified according to Colton, Mayo, OTA/AO systems. Observers determined if articular impaction was present and provided treatment plans...

OBJECTIVES: To determine whether muscle-to-adipose ratio (MAR) along the course of a Kocher-Langenbeck (KL) incision is more accurate at predicting post-operative wound complications following acetabuluar fixation than waist-hip ratio (WHR) or body mass index (BMI). DESIGN: Retrospective case series. SETTING: Level-1 Trauma Center.Patients/Participants: Patients who sustained an acetabular fracture and had fixation through a KL approach. INTERVENTION: The calculation of the MAR...

OBJECTIVES: To determine the impact of acute compartment syndrome (ACS) and identify cost-drivers of 1-year total treatment costs for operative tibial plateau fractures. DESIGN: Retrospective review. SETTING: Level 1 Trauma Center. PATIENTS: 337 patients with tibial plateau fractures, 24 of which were complicated by ACS. OUTCOMES: The primary outcome was total treatment cost over the first year for operatively treated tibial plateau fractures...

OBJECTIVES: To establish reproducible measurements of the sustentaculum tali (ST) fragment regarding fracture classification and patient-related factors. DESIGN: Retrospective. SETTING: Trauma center, University Hospital. PATIENTS: A retrospective analysis of the 142 fractured calcanei of 122 patients (101 men and 21 women) treated at our institution between 2012 to 2020 was performed. As control, 62 unaffected calcanei were used...

OBJECTIVE: To determine if there is evidence of heritable risk for nonunion using a large, state-wide population database. DESIGN: Database. SETTING: Level 1 Trauma Center. POPULATION: All Utah residents from 1996 - 2021 that sustained a long bone fracture and their family members. OUTCOMES: The primary outcome was nonunion and the prevalence of nonunion among the patients' first-, second-, and third-degree relatives...

OBJECTIVES: To identify patient-related factors and fracture characteristics influencing the functional outcomes of non-operatively treated radial head fractures and to determine function at one year. DESIGN: Prospective cohort study. SETTING: Academic level 1 trauma center. PATIENTS/PARTICIPANTS: Consecutive isolated radial head fractures fitting the inclusion criteria between May 2013 and July 2016. INTERVENTION: Nonoperative treatment of isolated radial head fractures...

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The evolution of fracture fixation designs over the past 100 years is coupled with incredible advances in materials and manufacturing technology. Failures are unavoidable and should be evaluated from the perspective of refining our technology and technique to improve patient outcomes. Failure after intramedullary fixation of hip fractures is multifactorial with contributions from an unsuccessful surgery, some preventable, some unavoidable, and rarely, design and manufacturing errors. However, whenever implants are disseminated to large population groups with variable individual anatomy, physiology, and associated comorbidities, unexpected and unpredicted weaknesses in the design and surgical technique will be discovered...

OBJECTIVES: To evaluate insertional damage on explanted cephalomedullary nails and to differentiate typical from atypical wear to characterize outliers. DESIGN: Therapeutic. SETTING: Level II trauma center. PARTICIPANTS: Patients who underwent removal of an implanted cephalomedullary nail for any reason from 2015 to 2023. METHODS: Inspection of implants was performed at ×1000 magnification with a light microscope...

OBJECTIVE: To establish the background rate of breakage of cephalomedullary nails. DATA SOURCES: MEDLINE, PubMed, and Web of Science were searched on April 3, 2023. STUDY SELECTION: All English-language studies that examined trochanteric with or without subtrochanteric fractures and identified cephalomedullary nail breakage as an outcome measure and a breakage rate could be derived were included. Implants captured were predominantly the TFNA, TFN, and PFN by DePuy Synthes, various versions of the Gamma nail by Stryker, the Zimmer Natural Nail by Zimmer Biomet, and the Intertan by Smith and Nephew...