Journal of Orthopaedic Trauma

OBJECTIVE: Describe the technique and results of a new sagittal plane computed tomography (CT) based angular measure for predicting stability following posterior wall acetabular fractures (PWF). DESIGN: Retrospective review. SETTING: Academic Level II Trauma center. PATIENTS: Fifty-eight consecutive patients with PWF (AO/OTA class 62A.1), 98% were high energy injuries. INTERVENTION: A new sagittal CT (sCT) measure of PWF based upon the angle subtending the joint center, cranial and caudal fracture exits...

OBJECTIVES: Isolated femoral shaft fractures can be treated preoperatively with skeletal traction (TXN) or maintenance of a position of comfort (COMF). The goal of this retrospective review was to determine if preoperative opioid consumption differs significantly between these forms of treatment. DESIGN: Case-control retrospective study. SETTING: Two academic level 1 trauma centers. PATIENT SELECTION CRITERIA: Patients presenting to the emergency department with isolated OTA/AO 32A-C femoral shaft fractures from 2017-2020...

OBJECTIVES: The purposes of this study were to assess clinical and radiographic outcomes following Plate-assisted Bone Segment Transport (PABST) in large bone defects of the lower extremities. DESIGN: Retrospective study of prospectively collected data. SETTING: Level-1 trauma center located in Germany. PATIENT SELECTION CRITERIA: Patients who underwent PABST and were at least one year postoperatively were included. OUTCOME MEASURES AND COMPARISONS: Demographic data were collected...

OBJECTIVES: To compare three fluoroscopic methods for determining femoral rotation. METHODS: Native femoral version was measured by computed tomography in 20 intact femurs from 10 cadaveric specimens. Two Steinmann pins were placed into each left femur above and below a planned transverse osteotomy which was completed through the diaphysis. Four surgeons utilized the true lateral (TL), neck-horizontal angle (NH), and lesser trochanter profile (LTP) techniques to correct the injured femur's rotation using the intact right femur as reference, yielding 120 measurements...

OBJECTIVE: To determine the postoperative trajectory and recovery of patients who undergo Lisfranc ORIF using PROMIS physical function (PF) and pain interference (PI). DESIGN: Retrospective cohort study. SETTING: Level 1 trauma center. PATIENT SELECTION CRITERIA: Patients who underwent Lisfranc ORIF between January 2002 and December 2022 with documented PROMIS PF and/or PI scores after surgery. OUTCOME MEASURES AND COMPARISONS: PROMIS PF and PI were mapped over time up to 1 year after surgery...

OBJECTIVE: The purpose was to describe the frequency of orthopaedic trauma and post-surgical complications associated with psychiatric diagnoses. DESIGN: Query of TriNetx Analytics Network. SETTING: Participating hospitals. PATIENT SELECTION CRITERIA: Those ≥ 18 years old with psychiatric illness and orthopaedic traumaOutcome measures and comparisons: Fractures and post-operative complications were described. A 1:1 propensity score matching function was utilized...

OBJECTIVES: To compare cost, hospital related outcomes, and mortality between angioembolization (AE) and preperitoneal pelvic packing (PPP) in the setting of pelvic ring or acetabulum fractures. METHODS: Design: Retrospective database review. SETTING: The National Inpatient Sample, years 2016-2020. PATIENT SELECTION CRITERIA: Hospitalized adult patients who underwent AE or PPP in the setting of a pelvic ring or acetabulum fracture...

OBJECTIVES: Investigation of femoral intra-medullary pressures during reamed antegrade nailing and to determine whether fracture level and/or complexity affect peak pressures. METHODS: Design: Prospective, non-randomized observational cohort. SETTING: Single level I trauma centre. PATIENT SELECTION CRITERIA: Included were patients presenting with femur fractures (OTA/AO 31A3; 32A; 32B; 32C; 33A2; 33A3), requiring antegrade intra-medullary nail fixation...

OBJECTIVES: To evaluate the current standard of care regarding empirical antimicrobial therapy in fracture related infections (FRI). METHODS: Design: Retrospective cohort study. SETTING: Level I Trauma Center. PATIENT SELECTION CRITERIA: Adult patients treated for FRI with surgical debridement and empirical antibiotics between September 1st 2014 and August 31st 2022. Patients were excluded if less than five tissue samples for culture were taken, culture results were negative or there was an antibiotic free window of less than three days before debridement...

OBJECTIVE: Determine the postoperative outcomes in solid-organ transplant (SOT) patients undergoing operative treatment of lower extremity fractures. METHODS: Design: Retrospective comparative study. SETTING: Academic Level 1 Trauma center. PATIENT SELECTION CRITERIA: Patients who underwent SOT and operative treatment for lower extremity fracture from 2013-2021 were identified, excluding pathologic fractures.Outcome Measures and Comparisons: postoperative complications, length of stay, time to death, 90-day and 1-year readmission rates, readmission causes, discharge location, and immunosuppressive regiments...

OBJECTIVES: To assess if a suprapatellar (SP) approach, when compared to an infrapatellar (IP) approach, yielded less patient reported anterior knee pain and higher patellofemoral joint function at 6 weeks and 12 months post operatively, when treating tibial fractures with intramedullary nailing. DESIGN: Prospective, parallel group randomized control trial. SETTING: Tertiary level one trauma care centre, Brisbane, Australia. PATIENTS SELECTION CRITERIA: Skeletally mature patients with an acute diaphyseal tibial fracture (AO/OTA 41A2/3, 42 A1- 43A3) amenable to an IMN were included...

OBJECTIVE: During ankle fracture surgery, goals include accurate reduction and fixation of the tibiofibular joint and fibular length. Bilateral postoperative computed tomography (CT) can be performed to assess syndesmotic reduction, the talar dome angle and fibular length.. The study aim is to compare side-to-side differences of the fibular rotation and fibular length using bilateral CT's of uninjured ankles. METHODS: We included patients with bilateral CT scans of uninjured ankles and measured external rotation using the Nault talar dome method and fibular length using the coronal method of Prior et al...

OBJECTIVES: Postoperative delirium is an acute neurocognitive complication that can have adverse effects on outcomes of geriatric patients after undergoing hip fracture surgery. The objective of this study was to examine the efficacy of preoperative steroids in preventing postoperative delirium after hip fracture surgery. METHODS: Data Sources: A systematic review and meta-analysis was performed using PubMed, SPORTDiscus, CINAHL, MEDLINE, and Web of Science from database inception until September 28th, 2023...

OBJECTIVES: To evaluate patients with tarsometatarsal fractures and dislocations and describe complications and secondary operations. METHODS: Design: Retrospective cohort study. SETTING: Level 1 trauma center. PATIENT SELECTION CRITERIA: Consecutive adults treated acutely for Lisfranc injuries with reduction and fixation using standard techniques of rigid medial fixation and flexible lateral fixationOutcome Measures and Comparisons: Complications: infections, wound healing problems, nonunion, malunion, and post-traumatic arthrosis (PTA) and secondary unplanned procedures after minimum two-year radiographic follow-up...

OBJECTIVES: To identify risk factors for reoperation to promote union or to address deep surgical site infection (DSSI) in periprosthetic distal femur fractures (PPDFs) treated with lateral distal femoral locking plates (LDFLPs). METHODS: Design: Multicenter retrospective cohort study. SETTING: Ten Level-I trauma centers. PATIENT SELECTION CRITERIA: Patients with OTA/AO 33A or 33C PPDFs PPDFs who underwent surgical fixation between January 2012 and December 2019 exclusively using LDFLPs were eligible for inclusion...

As the technology of three-dimensional (3D) printing becomes more refined and accessible, multiple applications of its use are becoming more commonplace in upper extremity surgery. 3D-printed models have been beneficial in preoperative planning of complex cases of acute trauma or malunions, contributing to spatial understanding or even contouring of implants. Custom guides can also be created to assist intraoperatively with precise placement of osteotomies or arthroplasty implants. Finally, custom 3D implants have been described for cases of bone loss in the upper extremity...

3D printing and modeling has continued to grow in popularity over the past decade because the technology has matured and become more affordable and widely available. The main indications for nonbiological reconstruction of large bone defects are principally those patients where the candidate is unlikely to be successful if reconstructed by other means. Bespoke, custom, patient-specific implants can be designed to very effectively address bone loss, incorporating design elements that are particular to the needs of any given unique clinical condition...

Treatment of traumatic critical-sized bone defects remains a challenge for orthopaedic surgeons. Autograft remains the gold standard to address bone loss, but for larger defects, different strategies must be used. The use of 3D-printed implants to address lower extremity trauma and bone loss is discussed with current techniques including bone transport, Masquelet, osteomyocutaneous flaps, and massive allografts. Considerations and future directions of implant design, augmentation, and optimization of the peri-implant environment to maximize patient outcome are reviewed...

The surgical management of critical bone defects remains challenging. Regardless of whether bone loss is acute or the result of staged surgical resection, current surgical management often requires advanced reconstructive techniques, many of which require multiple surgical procedures and consistent patient involvement with applied internal or external orthopaedic devices. The utilization of three-dimensional (3D) printing technology has continued to expand across orthopaedic subspecialties; in orthopaedic trauma, custom metallic implants are being used in the management of critical bone defects...

3D printing technologies have evolved tremendously over the last decade for uses in orthopaedic surgical applications, including being used to manufacture implants for spine, upper extremity, foot and ankle, oncologic, and traumatic reconstructions. Materials used for 3D-printed orthopaedic devices include metals, degradable and nondegradable polymers, and ceramic composites. There are 2 primary advantages for use of 3D printing technologies for orthopaedics: first, the ability to create complex porous lattices that allow for osseointegration and improved implant stability and second, the enablement of complex geometric designs allowing for patient-specific devices based on preoperative imaging...