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OTA International
Number of Followers: 0  Open Access journalISSN (Print) 2574-2167 Published by LWW Wolters Kluwer  [330 journals]
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- Ankle fracture surgery in patients experiencing homelessness: a national
evaluation of one-year rates of reoperation
Authors: Fischer; Fielding S.; Shahzad, Hania; Khan, Safdar N.; Quatman, Carmen E.
Abstract:
Objectives: To evaluate the impact of homelessness on surgical outcomes following ankle fracture surgery.Design: Retrospective cohort study.Setting: Mariner claims database.Patients/Participants: Patients older than 18 years who underwent open reduction and internal fixation (ORIF) of ankle fractures between 2010 and 2021. A total of 345,759 patients were included in the study.Intervention: Study patients were divided into two cohorts (homeless and nonhomeless) based on whether their patient record contained International Classification of Disease (ICD)-9 or ICD-10 codes for homelessness/inadequate housing.Main Outcome Measures: One-year rates of reoperation for amputation, irrigation and debridement, repeat ORIF, repair of nonunion/malunion, and implant removal in isolation.Results: Homeless patients had significantly higher odds of undergoing amputation (adjusted odds ratio [aOR] 1.59, 95% confidence interval [CI] 1.08–2.27, P = 0.014), irrigation and debridement (aOR 1.22, 95% CI 1.08–1.37, P < 0.001), and repeat ORIF (aOR 1.16, 95% CI 1.00–1.35, P = 0.045). Implant removal was less common in homeless patients (aOR 0.65, 95% CI 0.59–0.72, P < 0.001). There was no significant difference between homeless and nonhomeless patients in the rate of nonunion/malunion repair (aOR 0.87, 95% CI 0.63–1.18, P = 0.41).Conclusions: Homelessness is a significant risk factor for worse surgical outcomes following ankle fracture surgery. The findings of this study warrant future research to identify gaps in surgical fracture care for patients with housing insecurity and underscore the importance of developing interventions to advance health equity for this vulnerable patient population.Level of Evidence: Prognostic Level III.
PubDate: Thu, 16 May 2024 00:00:00 GMT-
- Late surgical correction after complex unstable pelvic fracture 61 C3
(OTA/AO) of an 18-year-old woman
Authors: Rikhter; Oleksandr
Abstract:
Surgical fixation of pelvic fractures is often necessary to restore fracture stability and improve patient outcomes. However, early operative management of pelvis fractures is not widely available in many health systems, resulting in conservative treatment approaches. Conservative approaches can lead to uncorrected pelvic deformities, which are challenging to treat and increase the risk of serious complications such as malunion. Treatment of pelvic malunion requires specialized care, access to necessary equipment, and a clearly defined treatment protocol. However, there is a lack of literature describing treatment algorithms for pelvic fracture malunion. This case report aims to incrementally fill this gap in the literature and highlight a logical step-by-step approach for reconstruction of pelvic malunion. This report is a single case of an 18-year-old woman who sustained complex unstable pelvic fracture, indicated for a 3-step reconstruction at a hospital with limited resources but access to computed tomography scan and some specialized pelvis reduction instruments. Postoperative imaging of the pelvis indicated satisfactory reduction and stable fixation of the pelvic reconstruction. After surgery, the patient was able to perform full axial load with no reported pain. This report provides a detailed description of each step of the operative management of a pelvic malunion case with clearly defined sequences, reduction tools, and positioning maneuvers necessary. Demonstrated in this case report, strategic preoperative planning is critical to successfully treating pelvic malunion and improving patient outcomes. This case report provides the necessary information on the management of pelvic reconstruction to inform other surgeons in underserved regions.
PubDate: Fri, 26 Apr 2024 00:00:00 GMT-
- Venous thromboembolism testing practices after orthopaedic trauma:
prophylaxis regimen does not influence testing patterns
Authors: Haac; Bryce E.; O'Hara, Nathan N.; Haut, Elliott R.; Manson, Theodore T.; Slobogean, Gerard P.; O'Toole, Robert V.; Stein, Deborah M.; ADAPT Investigators
Abstract:
Objectives: To determine venous thromboembolism (VTE) testing patterns in an orthopaedic trauma population and to evaluate for differences in VTE surveillance by prophylaxis regimen through a secondary analysis of the ADAPT trial.Design: Prospective randomized trial.Setting: Level I trauma center.Patients: Three hundred twenty-nine adult (18 years and older) trauma patients presenting with an operative extremity fracture proximal to the metatarsals/carpals or any pelvic or acetabular fracture requiring VTE prophylaxis.Intervention: VTE imaging studies recorded within 90 days post injury.Main Outcome Measurements: Percentage of patients tested for VTE were compared between treatment groups using Fisher's exact test. Subsequently, multivariable regression was used to determine patient factors significantly associated with risk of receiving a VTE imaging study.Results: Sixty-seven patients (20.4%) had VTE tests ordered during the study period. Twenty (29.9%) of these 67 patients with ordered VTE imaging tests had a positive finding. No difference in proportion of patients tested for VTE by prophylaxis regimen (18.8% on aspirin vs. 22.0% on LMWH, P = 0.50) was observed. Factors associated with increased likelihood of VTE testing included White race (adjusted odds ratio [aOR]: 2.61, 95% CI: 1.26–5.42), increased Injury Severity Score (aOR for every 1-point increase: 1.10, 95% CI: 1.05–1.15), and lower socioeconomic status based on the Area Deprivation Index (aOR for every 10-point increase: 1.14, 95% CI: 1.00–1.30).Conclusions: VTE surveillance did not significantly differ by prophylaxis regimen. Patient demographic factors including race, injury severity, and socioeconomic status were associated with differences in VTE surveillance.Level of Evidence: Level I, Therapeutic.
PubDate: Mon, 15 Apr 2024 00:00:00 GMT-
- Fasciotomy and rate of amputation after tibial fracture in adults: a
population-based cohort study
Authors: Bihari; Aurelia; McClure, J. Andrew; Inculet, Clayton; Del Balso, Christopher; Vinden, Christopher; Schemitsch, Emil; Sanders, David; Lawendy, Abdel-Rahman
Abstract:
Objectives: Limb amputation is a possible outcome of acute compartment syndrome. We undertook this study to investigate the occurrence of fasciotomy and amputation in patients with tibial fractures in the Ontario adult population, aiming to evaluate variables that may be associated with each of these outcomes.Design: Retrospective, population-based cohort study (April 1, 2003–March 31, 2016).Setting: Canadian province of Ontario.Participants: Patients with tibial fracture, aged 14 years and older.Intervention(s): Fasciotomy after tibial fracture.Main Outcome(s) and Measure(s): The primary outcomes were fasciotomy and amputation within 1 year of fasciotomy. Secondary outcomes included repeat surgery, new-onset renal failure, and mortality, all within 30 days of fasciotomy.Results: We identified 76,299 patients with tibial fracture; the mean (SD) age was 47 (21) years. Fasciotomy was performed in 1303 patients (1.7%); of these, 76% were male and 24% female. Patients who were younger, male, or experienced polytrauma were significantly more likely to undergo fasciotomy. Limb amputation occurred in 4.3% of patients undergoing fasciotomy, as compared with 0.5% in those without fasciotomy; older age, male sex, presence of polytrauma, and fasciotomy were associated with an increased risk of amputation (age odds ratio [OR] of 1.03 [95% CI, 1.02–1.03], P < 0.0001; sex OR of 2.04 [95% CI, 1.63–2.55], P < 0.0001; polytrauma OR of 9.37 [95% CI, 7.64–11.50], P < 0.0001; fasciotomy OR of 4.35 [95% CI, 3.21–5.90], P < 0.0001), as well as repeat surgery within 30 days (sex OR of 1.54 [95% CI, 1.14–2.07], P = 0.0053; polytrauma OR of 4.24 [95% CI, 3.33–5.38], P < 0.0001).Conclusions: Among tibial fracture patients, those who were male and who experienced polytrauma were at significantly higher risk of undergoing fasciotomy and subsequent amputation. Fasciotomy was also significantly associated with risk of amputation, a finding that is likely reflective of the severity of the initial injury.
PubDate: Mon, 15 Apr 2024 00:00:00 GMT-
- Isolated injury, Charlson Comorbidity Index, and transfer from another
facility are associated with delay in antibiotic administration: a
retrospective study of 963 patients with open fractures
Authors: Pease; Tyler J.; Ducas, G. Wells; Raffetto, Michael L.; Bernard, Andrew C.; Martin, Jalen A.; Matuszewski, Paul E.
Abstract:
Purpose: To identify factors associated with delays in administration and pharmacy and nursing preparation of antibiotics for patients with open fractures.Design: Retrospective review.Setting: Level I trauma center.Patients: Nine hundred sixty-three adults with open fractures administered antibiotics.Main Outcome Measurements: Delay in antibiotic administration greater than 66 minutes from arrival and significant pharmacy-related and nursing-related delay.Results: Isolated injury, Charlson Comorbidity Index, and transfer from another facility were associated with delay in antibiotic administration greater than 66 minutes. Injury Severity Score, transfer, and trauma team activation were associated with pharmacy-related or nursing-related delay.Conclusion: Interventions to reduce antibiotic administration time for open fractures should focus on early identification of open fractures and standardization of antibiotic protocols to ensure timely administration even in complex or resource-scarce care situations.Level of Evidence: Prognostic level III.
PubDate: Wed, 27 Mar 2024 00:00:00 GMT-
- Locked plate constructs are not necessarily stiffer than nonlocked
constructs: A biomechanical investigation of locked versus nonlocked
diaphyseal fixation in a human cadaveric model of nonosteoporotic and
osteoporotic distal femoral fractures
Authors: Ricci; William M.; Dvorzhinskiy, Aleksey; Zheng, Yanming; Walker, Zakiyyah; Anthony, Mary; Holbrook, Jeffrey; Jones, Bob; Cartner, Jacob; Tornetta, Paul III
Abstract:
Objectives: The objective of this study was to compare the biomechanical properties of locked and nonlocked diaphyseal fixation in a model of distal femur fractures using osteoporotic and nonosteoporotic human cadaveric bone.Methods: A supracondylar osteotomy was created to mimic a fracture (OTA/AO 33A3) in osteoporotic (n = 4) and nonosteoporotic (n = 5) cadaveric distal femurs. The left and right femurs of each pair were instrumented with a distal femoral locking plate and randomly assigned to have diaphyseal fixation with either locked or nonlocked screws. The construct was cyclically axially loaded, and construct stiffness and load to failure were evaluated.Results: In osteoporotic bone, locked constructs were more stiff than nonlocked constructs (mean 143 vs. 98 N/mm when all time points combined, P < 0.001). However, in nonosteoporotic bone, locked constructs were less stiff than nonlocked constructs (mean 155 N/mm vs. 185 N/mm when all time points combined, P < 0.001). In osteoporotic bone, the average load to failure was greater in the locked group than in the nonlocked group (mean 1159 vs. 991 N, P = 0.01). In nonosteoporotic bone, the average load to failure was greater for the nonlocked group (mean 1348 N vs. 1214 N, P = 0.02). Bone mineral density was highly correlated with maximal load to failure (R2 = 0.92, P = 0.001) and stiffness (R2 = 0.78, P = 0.002) in nonlocked constructs but not in locked constructs.Conclusions: Contrary to popular belief, locked plating constructs are not necessarily stiffer than nonlocked constructs. In healthy nonosteoporotic bone, locked diaphyseal fixation does not provide a stiffer construct than nonlocked fixation. Bone quality has a profound influence on the stiffness of nonlocked (but not locked) constructs in distal femur fractures.
PubDate: Wed, 27 Mar 2024 00:00:00 GMT-
