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ORTHOPEDICS AND TRAUMATOLOGY (150 journals)                     

Showing 1 - 152 of 152 Journals sorted alphabetically
Acta Orthopaedica     Open Access   (Followers: 32)
Advances in Orthopedics     Open Access   (Followers: 9)
American Journal of Orthodontics and Dentofacial Orthopedics     Hybrid Journal   (Followers: 9)
American Journal of Orthopedics     Partially Free   (Followers: 3)
Archives of Orthopaedic and Trauma Surgery     Hybrid Journal   (Followers: 9)
Archives of Osteoporosis     Hybrid Journal   (Followers: 1)
Arthritis und Rheuma     Hybrid Journal  
Arthroplasty Today     Open Access   (Followers: 1)
Australasian Musculoskeletal Medicine     Full-text available via subscription   (Followers: 5)
BMC Musculoskeletal Disorders     Open Access   (Followers: 29)
Bone & Joint 360     Full-text available via subscription   (Followers: 18)
Bone Research     Hybrid Journal   (Followers: 2)
Burns & Trauma     Open Access   (Followers: 11)
Cartilage     Hybrid Journal   (Followers: 5)
Case Reports in Orthopedic Research     Open Access  
Case Reports in Orthopedics     Open Access   (Followers: 6)
Chinese Journal of Traumatology     Open Access  
Cleft Palate-Craniofacial Journal     Hybrid Journal   (Followers: 8)
Clinical Medicine Insights : Arthritis and Musculoskeletal Disorders     Open Access   (Followers: 3)
Clinical Orthopaedics and Related Research     Hybrid Journal   (Followers: 78)
Clinical Trials in Orthopedic Disorders     Open Access   (Followers: 1)
Concussion     Open Access  
Craniomaxillofacial Trauma and Reconstruction     Hybrid Journal   (Followers: 1)
Current Orthopaedic Practice     Hybrid Journal   (Followers: 14)
Current Reviews in Musculoskeletal Medicine     Open Access   (Followers: 13)
Der Orthopäde     Hybrid Journal   (Followers: 6)
Die Wirbelsäule     Hybrid Journal  
Duke Orthopedic Journal     Open Access   (Followers: 5)
East African Orthopaedic Journal     Full-text available via subscription  
EFORT Open Reviews     Open Access   (Followers: 1)
Egyptian Orthopaedic Journal     Open Access   (Followers: 1)
EMC - Técnicas Quirúrgicas - Ortopedia y Traumatología     Full-text available via subscription  
EMC - Tecniche Chirurgiche - Chirurgia Ortopedica     Full-text available via subscription  
Ergonomics     Hybrid Journal   (Followers: 22)
European Journal of Orthopaedic Surgery & Traumatology     Hybrid Journal   (Followers: 9)
European Journal of Podiatry / Revista Europea de Podología     Open Access   (Followers: 1)
European Spine Journal     Hybrid Journal   (Followers: 24)
Foot & Ankle International     Hybrid Journal   (Followers: 10)
Foot & Ankle Orthopaedics     Open Access   (Followers: 3)
Gait & Posture     Hybrid Journal   (Followers: 17)
Geriatric Orthopaedic Surgery Rehabilitation     Open Access   (Followers: 5)
Global Spine Journal     Open Access   (Followers: 12)
Hip International     Hybrid Journal  
Indian Journal of Orthopaedics     Open Access   (Followers: 8)
Informationen aus Orthodontie & Kieferorthopädie     Hybrid Journal  
Injury     Hybrid Journal   (Followers: 20)
International Journal of Orthopaedic and Trauma Nursing     Hybrid Journal   (Followers: 11)
International Journal of Orthopaedic Surgery     Open Access   (Followers: 5)
International Journal of Orthopaedics     Open Access   (Followers: 2)
International Journal of Research in Orthopaedics     Open Access  
International Musculoskeletal Medicine     Hybrid Journal   (Followers: 7)
International Orthopaedics     Hybrid Journal   (Followers: 18)
JAAOS : Global Research & Reviews     Open Access   (Followers: 1)
JBJS Journal of Orthopaedics for Physician Assistants     Hybrid Journal  
JBJS Reviews     Full-text available via subscription   (Followers: 11)
JOR Spine     Open Access   (Followers: 3)
Journal de Traumatologie du Sport     Full-text available via subscription   (Followers: 2)
Journal für Mineralstoffwechsel & Muskuloskelettale Erkrankungen     Hybrid Journal  
Journal of Bone and Joint Diseases     Open Access   (Followers: 4)
Journal of Bone and Joint Infection     Open Access   (Followers: 1)
Journal of Brachial Plexus and Peripheral Nerve Injury     Open Access   (Followers: 4)
Journal of Cachexia, Sarcopenia and Muscle     Open Access   (Followers: 2)
Journal of Children's Orthopaedics     Open Access   (Followers: 10)
Journal of Clinical Orthopaedics and Trauma     Hybrid Journal   (Followers: 5)
Journal of Experimental Orthopaedics     Open Access   (Followers: 8)
Journal of Hand Surgery (European Volume)     Hybrid Journal   (Followers: 44)
Journal of Head Trauma Rehabilitation     Hybrid Journal   (Followers: 17)
Journal of Musculoskeletal Research     Hybrid Journal   (Followers: 9)
Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie     Hybrid Journal  
Journal of Orthodontic Science     Open Access   (Followers: 2)
Journal of Orthopaedic & Sports Physical Therapy     Full-text available via subscription   (Followers: 69)
Journal of Orthopaedic Association of South Indian States     Open Access   (Followers: 5)
Journal of Orthopaedic Diseases and Traumatology     Open Access   (Followers: 5)
Journal of Orthopaedic Reports     Full-text available via subscription   (Followers: 12)
Journal of Orthopaedic Research     Hybrid Journal   (Followers: 29)
Journal of Orthopaedic Science     Hybrid Journal   (Followers: 4)
Journal of Orthopaedic Surgery     Open Access   (Followers: 1)
Journal of Orthopaedic Surgery and Research     Open Access   (Followers: 8)
Journal of Orthopaedic Translation     Open Access  
Journal of Orthopaedic Trauma     Hybrid Journal   (Followers: 15)
Journal of Orthopaedics     Full-text available via subscription   (Followers: 3)
Journal of Orthopaedics and Allied Sciences     Open Access   (Followers: 9)
Journal of Orthopaedics and Spine     Open Access   (Followers: 3)
Journal of Orthopaedics and Traumatology     Open Access   (Followers: 16)
Journal of Orthopaedics, Trauma and Rehabilitation     Open Access   (Followers: 6)
Journal of Orthopedics & Rheumatology     Open Access  
Journal of Orthopedics, Traumatology and Rehabilitation     Open Access   (Followers: 6)
Journal of Pediatric Orthopaedics     Hybrid Journal   (Followers: 15)
Journal of Prosthetics and Orthotics     Hybrid Journal   (Followers: 14)
Journal of Scleroderma and Related Disorders     Hybrid Journal  
Journal of the American Academy of Orthopaedic Surgeons     Hybrid Journal   (Followers: 12)
Journal of the American Podiatric Medical Association     Full-text available via subscription   (Followers: 8)
Journal of Traumatic Stress     Hybrid Journal   (Followers: 25)
Knee Surgery, Sports Traumatology, Arthroscopy     Hybrid Journal   (Followers: 27)
Multiple Sclerosis and Related Disorders     Hybrid Journal   (Followers: 8)
Musculoskeletal Care     Hybrid Journal   (Followers: 19)
Musculoskeletal Science and Practice     Hybrid Journal   (Followers: 3)
Nigerian Journal of Orthopaedics and Trauma     Open Access  
North American Spine Society Journal (NASSJ)     Open Access   (Followers: 3)
OA Orthopaedics     Open Access   (Followers: 7)
Obere Extremität     Hybrid Journal   (Followers: 1)
Open Journal of Orthopedics     Open Access   (Followers: 3)
Open Journal of Orthopedics and Rheumatology     Open Access  
Open Journal of Trauma     Open Access  
Open Orthopaedics Journal     Open Access  
Operative Orthopädie und Traumatologie     Hybrid Journal  
Operative Techniques in Orthopaedics     Full-text available via subscription   (Followers: 6)
Orthopädie & Rheuma     Full-text available via subscription  
Orthopädie und Unfallchirurgie up2date     Hybrid Journal  
Orthopaedic Journal of Sports Medicine     Open Access   (Followers: 14)
Orthopaedic Nursing     Hybrid Journal   (Followers: 11)
Orthopaedic Proceedings     Partially Free  
Orthopaedic Surgery     Open Access   (Followers: 1)
Orthopaedics & Traumatology: Surgery & Research     Full-text available via subscription   (Followers: 6)
Orthopaedics and Trauma     Full-text available via subscription   (Followers: 28)
Orthopedic Clinics of North America     Full-text available via subscription   (Followers: 5)
Orthopedic Research and Reviews     Open Access   (Followers: 6)
Orthopedic Reviews     Open Access   (Followers: 7)
Orthopedics     Full-text available via subscription   (Followers: 6)
Orthoplastic Surgery     Open Access  
Osteoarthritis and Cartilage     Full-text available via subscription   (Followers: 20)
Osteoarthritis and Cartilage Open     Open Access  
Osteologie     Hybrid Journal  
Osteoporosis and Sarcopenia     Open Access  
OTA International     Open Access  
Paediatric Orthopaedics and Related Sciences     Open Access   (Followers: 3)
Pain Management in General Practice     Full-text available via subscription   (Followers: 12)
Prosthetics and Orthotics International     Hybrid Journal   (Followers: 8)
Revista Brasileira de Ortopedia     Hybrid Journal  
Revista Chilena de Ortopedia y Traumatología / Chilean Journal of Orthopaedics and Traumatology     Open Access  
Revista Colombiana de Ortopedia y Traumatología     Full-text available via subscription  
Revista Cubana de Ortopedia y Traumatologí­a     Open Access  
Revista de la Asociación Argentina de Ortopedia y Traumatología     Open Access  
Revista Española de Cirugía Ortopédica y Traumatología     Full-text available via subscription   (Followers: 1)
Revista Portuguesa de Ortopedia e Traumatologia     Open Access  
Revue de Chirurgie Orthopédique et Traumatologique     Full-text available via subscription   (Followers: 3)
Romanian Journal of Orthopaedic Surgery and Traumatology     Open Access  
SA Orthopaedic Journal     Open Access   (Followers: 2)
SICOT-J     Open Access   (Followers: 1)
Spine     Hybrid Journal   (Followers: 73)
Spine Journal     Hybrid Journal   (Followers: 26)
Sport-Orthopädie - Sport-Traumatologie - Sports Orthopaedics and Traumatology     Full-text available via subscription   (Followers: 3)
Strategies in Trauma and Limb Reconstruction     Open Access   (Followers: 1)
Techniques in Orthopaedics     Hybrid Journal   (Followers: 6)
Therapeutic Advances in Musculoskeletal Disease     Hybrid Journal   (Followers: 5)
Trauma     Hybrid Journal   (Followers: 5)
Trauma (Travma)     Open Access  
Trauma und Berufskrankheit     Hybrid Journal  
Traumatology     Full-text available via subscription   (Followers: 1)
Traumatology and Orthopedics of Russia     Open Access  
Zeitschrift für Orthopädie und Unfallchirurgie     Hybrid Journal   (Followers: 2)
Ортопедия, травматология и протезирование     Open Access  

           

Similar Journals
Journal Cover
Journal of Orthopaedic Trauma
Journal Prestige (SJR): 1.451
Citation Impact (citeScore): 2
Number of Followers: 15  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0890-5339 - ISSN (Online) 1531-2291
Published by LWW Wolters Kluwer Homepage  [297 journals]
  • The Ethics of Explanted Orthopaedic Hardware Return to Requesting Patients

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      Authors: Mavrommatis; Sophia; Postema, Don C.; Cole, Peter A.
      Abstract: No abstract available
      PubDate: Mon, 01 Aug 2022 00:00:00 GMT-
       
  • Radiation Exposure Among Orthopaedic Trauma Surgeons: Deconstructing
           Commonly Held Myths and Misperceptions

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      Authors: Raffetto; Michael L.; Blum, Laura E.; Abbenhaus, Eric J.; Hautala, Gavin S.; Lemieux, Bryan; Pease, Tyler; Wright, Raymond D.; Moghadamian, Eric S.; Aneja, Arun; Blair, James A.; Matuszewski, Paul E.
      Abstract: imageObjectives: To review and evaluate the validity of common perceptions and practices regarding radiation safety in orthopaedic trauma.Design: Retrospective study.Setting: Level 1 trauma center.Subjects: N/A.Intervention: The intervention involved personal protective equipment.Main Outcome Measurements: The main outcome measurements included radiation dose estimates.Results: Surgeon radiation exposure estimates performed at the level of the thyroid, chest, and pelvis demonstrate an estimated total annual exposure of 1521 mR, 2452 mR, and 1129 mR, respectively. In all cases, wearing lead provides a significant reduction (90% or better) in the amount of radiation exposure (in both radiation risk and levels of radiation reaching the body) received by the surgeon. Surgeons are inadequately protected from radiation exposure with noncircumferential lead. The commonly accepted notion that there is negligible exposure when standing greater than 6 feet from the radiation source is misleading, particularly when cumulative exposure is considered. Finally, we demonstrated that trauma surgeons specializing in pelvis and acetabular fracture care are at an increased risk of exposure to potentially dangerous levels of radiation, given the amount of radiation required for their caseload.Conclusion: Common myths and misperceptions regarding radiation in orthopaedic trauma are unfounded. Proper use of circumferential personal protective equipment is critical in preventing excess radiation exposure.
      PubDate: Mon, 01 Aug 2022 00:00:00 GMT-
       
  • Radiation Exposure Among Orthopaedic Trauma Surgeons: Deconstructing
           Commonly Held Myths and Misperceptions

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      Authors: Bosse; Michael J.
      Abstract: No abstract available
      PubDate: Mon, 01 Aug 2022 00:00:00 GMT-
       
  • Is It Safe to Prep the External Fixator In Situ During Staged ORIF of
           Bicondylar Tibial Plateau Fractures' A Retrospective Comparative
           Cohort Study

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      Authors: Stenquist; Derek S.; Yeung, Caleb M.; Guild, Theodore; Weaver, Michael J.; Harris, Mitchel B.; Von Keudell, Arvind G.
      Abstract: imageObjectives: To compare the risk of deep infection and unplanned reoperation after staged open reduction internal fixation (ORIF) of bicondylar tibial plateau (BTP) fractures whether elements of the temporizing external fixator were prepped into the surgical field or completely removed before definitive fixation.Design: Retrospective comparative cohort study.Setting: Two academic Level 1 trauma centers.Patients/Participants: One hundred forty-seven OTA/AO 41-C (Schatzker 6) BTP fractures treated with a 2-stage protocol of acute spanning ex-fix followed by definitive ORIF between 2001 and 2018.Intervention: Seventy-eight fractures had retained elements of the original ex-fix prepped in situ during surgery for definitive internal fixation, and 69 had the ex-fix construct completely removed before prepping and draping.Main Outcome Measures: Deep infection and unplanned reoperation.Results: Among 147 patients treated with staged ORIF, the overall deep infection rate was 26.5% and the reoperation rate was 33.3%. There were high rates of deep infection (26.9% vs. 26.1%, P = 0.909) and unplanned reoperation (30.8% vs. 36.2%, P = 0.483) in both groups, but no difference whether the ex-fix was prepped in or completely removed. Within the retained ex-fix group, there was no difference in infection with retention of the entire ex-fix compared with only the ex-fix pins (28.1% vs. 26.1%, P = 0.842).Conclusions: We observed high complication rates in this cohort of OTA/AO 41C BTP fractures treated with staged ORIF, but prepping in the ex-fix did not lead to a significant increase in rates of infection or reoperation. This study provides the treating surgeon with clinical data about a common practice used to facilitate definitive fixation of unstable BTP fractures.Level of Evidence: Therapeutic Level III. See Instructions for
      Authors for a complete description of levels of evidence.
      PubDate: Mon, 01 Aug 2022 00:00:00 GMT-
       
  • Outcomes of Patients With Large Versus Small Bone Defects in Open Tibia
           Fractures Treated With an Intramedullary Nail: A Descriptive Analysis of a
           Multicenter Retrospective Study

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      Authors: Obremskey; William T.; Tornetta, Paul III; Luly, Jason; Morshed, Saam; O'Toole, Robert V.; Hsu, Joseph R.; Mitchell, Stuart L.; Mackenzie, Ellen J.; Frey, Katherine P.; Castillo, Renan C.; Bosse, Michael J.; Scharfstein, Daniel O.; on behalf of METRC
      Abstract: imageObjectives: To compare outcomes in patients with open tibia shaft fractures based on defect size.Design: Retrospective review.Setting: Eighteen trauma centers.Population: The study included 132 patients with diaphyseal tibia bone defects>1 cm and ≥50% cortical loss treated with intramedullary nail.Outcomes: The primary outcome was number of secondary surgeries to promote healing (bone graft, revision fixation, or bone transport). Additional outcomes included occurrence of secondary surgeries (bone graft, infection, amputation, and flap failure) and proportion healed at one year. Results are compared by “radiographic apparent bone gap” of
      PubDate: Mon, 01 Aug 2022 00:00:00 GMT-
       
  • Long-Term Outcomes of Multiligament Knee Injuries

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      Authors: Zhang; Tina; Shasti, Keyan; Dubina, Andrew; Schneider, Matheus B.; Aneizi, Ali; Packer, Jonathan D.; O'Toole, Robert V.; Sciadini, Marcus F.; Henn, R. Frank III
      Abstract: imageObjective: To characterize long-term outcomes of multiligament knee injuries (MLKIs) using patient-reported outcome measures, physical examination, and knee radiographs.Design: Retrospective clinical follow-up.Methods: Twenty knees (18 patients) were evaluated at a mean follow-up of 13.1 years (range 11–15 years). The primary outcome measure was the Internal Knee Documentation Committee score. Patients also completed secondary patient-based outcome assessments including Patient-Reported Outcomes Measurement Information System computer adaptive testing, Short Form-36, and Tegner activity score. Sixteen knees (14 patients) also had physical examination and bilateral knee radiographs assessed with the Kellgren-Lawrence score.Results: The mean Internal Knee Documentation Committee score was 56 points, which was significantly lower than the age-matched normative value of 77 (P = 0.004) and exceeds the minimum clinically important difference of 12 points. Most secondary outcome scores were worse than normative population values. Posttraumatic arthritis was present in 100% of MLKIs that had radiographs. Comparing operative versus nonoperative management, there were no statistical differences in patient demographics, injury characteristics, physical examination, or imaging, but surgical patients had better Short Form-36 Social Functioning (89 vs. 63, P = 0.02) and Tegner scores (4.5 vs. 2.9, P = 0.05).Conclusion: The long-term outcomes of MLKIs are generally poor, and posttraumatic radiographic evidence of arthritis seems to be universal. Operative management of these injuries may improve long-term outcomes. Clinicians should be aware of these results when counseling patients.Level of Evidence: Therapeutic Level IV. See Instructions for
      Authors for a complete description of levels of evidence.
      PubDate: Mon, 01 Aug 2022 00:00:00 GMT-
       
  • A Critical Analysis of Lateral Versus Central Endpoint in Distal Tibia
           Nailing: Does It Affect Alignment'

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      Authors: Brodke; Dane J.; Upfill-Brown, Alexander; Devana, Sai K.; Eichenlaub, Emily K.; Mahoney, Jonathan M.; Orbach, Mattan R.; Bucklen, Brandon S.; Kelley, Benjamin V.; Mayer, Erik N.; Shi, Brendan Y.; Lee, Christopher
      Abstract: imageObjectives: To evaluate the effect of a traditional “center-center” end point for distal tibia nailing in comparison with a lateral-of-center end point on fracture malalignment in a cadaver model.Methods: Nine matched pairs of human cadaveric lower-extremity specimens were used to model the effect of nail end point on fracture alignment in extra-articular distal tibia fractures. After simulation of the fracture through a standardized osteotomy, 1 member of each pair was fixed with an intramedullary nail using a “center-center” end point, whereas a lateral-of-center end point was used for the other member of the pair. Specimens were stripped of soft tissue, and digital calipers were used to measure fracture translation and gap medially, laterally, anteriorly, and posteriorly. Coronal plane angulation at each fracture was measured on the final mortise image.Results: The average coronal angulation was 7.0 degrees of valgus (with a SD of 4.1) in central-end point specimens versus 0.2 degrees of valgus (SD = 1.5) in lateral-end point specimens (P < 0.001). Lateral-end point specimens also demonstrated significantly less fracture gap medially (mean 0.2 vs. 3.1 mm for central-end point specimens, P < 0.001), anteriorly (mean 0.1 vs. 1.3 mm, P = 0.003), and posteriorly (mean 0.3 vs. 2.2 mm, P = 0.003). Lateral-end point specimens also showed less lateral translation (mean 0.6 vs. 1.6 mm, P = 0.006).Conclusions: Lateral-of-center nail end points may help surgeons restore native alignment in extra-articular distal tibia fractures and avoid valgus malalignment.
      PubDate: Mon, 01 Aug 2022 00:00:00 GMT-
       
  • Risk Factors for Infection and Subsequent Adverse Clinical Results in the
           Setting of Operatively Treated Pilon Fractures

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      Authors: Yeramosu; Teja; Satpathy, Jibanananda; Perdue, Paul W. Jr; Toney, Clarence B.; Torbert, Jesse T.; Cinats, David J.; Patel, Tejas T.; Kates, Stephen L.
      Abstract: imageObjective: To determine patient-specific and injury-specific factors that may predict infection and other adverse clinical results in the setting of tibial pilon fractures.Design: Retrospective chart review.Setting: Level 1 academic trauma center.Patients: Two hundred forty-eight patients who underwent operative treatment for tibial pilon fractures between 2010 and 2020.Intervention: External fixation and/or open reduction and internal fixation.Main Outcome Measurements: Fracture-related infection rates and specific bacteriology, risk factors associated with development of a fracture-related infection, and predictors of adverse clinical results.Results: Two hundred forty-eight patients were enrolled. There was an infection rate of 21%. The 3 most common pathogens cultured were methicillin-resistant Staphylococcus aureus (20.3%), Enterobacter cloacae (16.7%), and methicillin-resistant Staphylococcus aureus (15.5%). There was no significant difference in age, sex, race, body mass index, or smoking status between those who developed an infection and those who did not. Patients with diabetes mellitus (P = 0.0001), open fractures (P = 0.0043), and comminuted fractures (OTA/AO 43C2 and 43C3) (P = 0.0065) were more likely to develop a fracture-related infection. The presence of a polymicrobial infection was positively associated with adverse clinical results (P = 0.006). History of diabetes was also positively associated with adverse results (P = 0.019).Conclusions: History of diabetes and severe fractures, such as those that were open or comminuted fractures, were positively associated with developing a fracture-related infection after the operative fixation of tibial pilon fractures. History of diabetes and presence of a polymicrobial infection were independently associated with adverse clinical results.Level of Evidence: Prognostic Level III. See Instructions for
      Authors for a complete description of levels of evidence.
      PubDate: Mon, 01 Aug 2022 00:00:00 GMT-
       
  • Evaluation of a Novel Multidisciplinary Preoperative Workup Strategy for
           Geriatric Hip Fractures

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      Authors: Steffensmeier; Andrew; Hoge, Connor; Shah, Nihar; Matar, Robert; Rice, Morgan; Grawe, Erin; Held, Justin; Budde, Bradley; Laughlin, Richard; Sagi, H. Claude
      Abstract: imageObjective: To determine the financial and clinical impact of a standardized, multidisciplinary team for surgical clearance and optimization in geriatric hip fracture patients.Design: Retrospective case series.Setting: Level-1 trauma center.Patients: One hundred twenty-four geriatric patients (age>65 years old) in the preprotocol group (cohort 1; January 2017–December 2018) and 98 geriatric patients in the postprotocol group (cohort 2; October 2019–January 2021) with operative hip fractures.Intervention: Implementation of a multidisciplinary team protocol consisting of Anesthesiology, Internal Medicine and Orthopedic Surgery departments for the assessment of medical readiness and optimization for surgical intervention in geriatric hip fractures.Main Outcome Measures: Rate of cardiology consultation, need for cardiac workup (echocardiography stress testing, heath catheterization), time to medical readiness (TTMR), time to surgery, case-cancellation rate, length of stay (LOS), and total hospitalization charges.Results: Following implementation of the new protocol, there were significant (P < 0.001) decreases in TTMR (19 vs. 11 hours), LOS (149 vs. 120 hours), case cancellation rate, and total hospital charges ($84,000 vs. $62,000). There were no significant differences with respect to in-hospital complications or readmission rates/mortality rates at 1 year.Conclusions: Following implementation of a protocolized, multidisciplinary approach to optimizing geriatric fracture patients, we were able to demonstrate a reduction in unnecessary preoperative testing, TTMR for surgery, case cancellation rate, LOS, and total hospitalization charge—without a concomitant increase in complications or mortality. This study highlights that standardization of the perioperative care for geriatric hip fracture patients can provide effective patient care while also lowering financial and logistical burden in care for these injuries.Level of Evidence: Therapeutic Level III. See Instructions for
      Authors for a complete description of levels of evidence.
      PubDate: Mon, 01 Aug 2022 00:00:00 GMT-
       
  • Intraoperative Comparative Femoral Rotation Imaging: Do not Overlook
           Parallax

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      Authors: Kagan; Benjamin D.; Roberts, Michael S.; Haimes, Mark A.; Blankstein, Michael; Schottel, Patrick C.
      Abstract: imageObjective: To investigate the degree of error due to parallax during intraoperative rotational imaging involving the distal femur.Methods: Twelve, fresh-frozen, lower-extremity cadaveric specimens were studied. The limbs were positioned supine and rotated until the posterior femoral condyles were superimposed using a C-arm. The C-arm was then repositioned to place the femoral condyles at the anterior and posterior margins of the image intensifier. The rotation necessary to resuperimpose the femoral condyles due to parallax was recorded. A second C-arm was then used from the contralateral side to simulate the rotational imaging technique to determine the magnitude and directionality of combined parallax.Results: All 12 specimens demonstrated parallax, resulting in rotational discrepancies. Compared with central field of view alignment, the mean rotational discrepancy was 5.6 and 5.5 degrees for anterior and posterior positions, respectively. Contralateral imaging resulted in an additive effect with rotational differences of 9.0 and 12.6 degrees for bilateral anterior and posterior positions, respectively.Conclusions: Parallax causes rotational discrepancies with fluoroscopic imaging of the distal femur when the posterior femoral condyles are off-center in the imaging field of view. If femoral condyles are not centered when obtaining intraoperative rotational imaging of the uninjured and injured femurs, parallax can result in potentially clinically significant rotational deformity even if the femurs seem perfectly matched at the conclusion of surgery. We recommend perfectly centering of the posterior femoral condyles in the imaging field of view when obtaining lateral images of the distal femur to prevent this potentially overlooked contribution to malrotation.
      PubDate: Mon, 01 Aug 2022 00:00:00 GMT-
       
  • Results of Low Distal Femur Periprosthetic Fractures

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      Authors: Virkus; Walter; Lieder, Charles; Jang, Yohan; Rea, Parker; Gaski, Greg
      Abstract: imageObjectives: To compare retrograde intramedullary nail (RIMN) and open reduction internal fixation (ORIF) in very distal periprosthetic distal femur fractures (PDFFs) to determine whether RIMN is an acceptable option for these fractures that are often considered too distal for IMN due to limited bone stock.Design: Retrospective comparative series.Setting: Level 1 trauma center.Patients: Patients were treated with fracture fixation for a very distal PDFF, defined as the fracture extending to the anterior flange of the implant or distal. Fifty-six patients met inclusion criteria, with 8 excluded for less than 12 months of follow-up.Intervention: The intervention involved fracture fixation with RIMN or ORIF.Main Outcome Measurements: The primary outcome was unplanned return to surgery. Secondary outcomes included fracture union, radiographic alignment, visual analog score, and Patient-Reported Outcome Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference.Results: The mean follow-up period was 27 months. Twelve patients were treated with ORIF and 36 with RIMN. Twenty-one fractures were at the flange, and 27 extended distal to the flange. There were no differences between fixation methods for reoperation, deep infection, nonunion, malunion, visual analog score pain score, and PROMIS Pain Interference score. The mean PROMIS PF score was higher in the RIMN group compared with that in the ORIF group. There were 5 reoperations in the RIMN group (14%) and 3 in the ORIF group (25%).Conclusions: This is the largest series, to the best of our knowledge, of a subset of very distal PDFFs. The results suggest that RIMN may be an acceptable treatment option for these very difficult fractures.Level of Evidence: Therapeutic Level III. See Instructions for
      Authors for a complete description of levels of evidence.
      PubDate: Mon, 01 Aug 2022 00:00:00 GMT-
       
  • Clinical and Radiological Outcome of Vancouver B2 Fracture Treated With
           Open Reduction and Internal Fixation. A Multicenter Cohort Analysis

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      Authors: Biberthaler; Peter; Pflüger, Patrick; Wurm, Markus; Hanschen, Marc; Kirchhoff, Chlodwig; Aderinto, Joseph; Whitwell, George; Giannoudis, Peter V.; Kanakaris, Nikolaos
      Abstract: imageObjectives: To determine whether open reduction and internal fixation (ORIF) of periprosthetic Vancouver B2 fractures can lead to successful fracture healing in selected patients, when attention is given to the surgical exposure and the creation of a balanced extramedullary construct.Design: Retrospective.Setting: Two Level-1 trauma centers in Germany and United Kingdom.Methods: Patients with a B2 fracture receiving solely ORIF using a polyaxial locking plate were included for analysis. Patients with other fracture types, or treated with other methods, or with follow-up less than 12 months were excluded. Clinical characteristics, including the Charlson index, the American Society for Anesthesiologists score, and their preinjury functional levels, were recorded. Main outcome measures were 1-year mortality, revision rate, and radiological healing according to the Beals–Tower criteria.Results: A total of 32 patients (mean age ,79 ± 12 years) were enrolled. Six patients died within the first year (1-year mortality: 19%), and 5 were unavailable for follow-up studies. The remaining 21 patients had a mean follow-up of 30 months. Of 21, 20 had an excellent/good result using the criteria of Beals–Tower. One patient required revision surgery due to loosening and secondary subsidence of the stem.Conclusion: ORIF can be offered to selected patients suffering from B2 fractures, especially if their functional demand is limited, and perioperative risk high for revision arthroplasty. In this challenging cohort of patients, ORIF was a safe and effective therapeutic option.Level of Evidence: Therapeutic Level IV. See Instructions for
      Authors for a complete description of levels of evidence.
      PubDate: Mon, 01 Aug 2022 00:00:00 GMT-
       
  • Suture Augmentation Neutralizes Deforming Muscular Forces in a Simulated
           2-Part Osteoporotic Proximal Humeral Fracture Model

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      Authors: Scolaro; John A.; Chalmers, Christen E.; Wright, David J.; Patel, Nilay; McGarry, Michelle; Lee, Thay Q.
      Abstract: imageObjectives: To evaluate the contribution that tension-relieving sutures, placed between a proximal humeral locking plate and the rotator cuff muscles, had on preventing varus malalignment in an osteoporotic 2-part proximal humerus fracture model.Methods: A 2-part fracture model was created in 8 cadaveric specimens and then fixed with a lateral locking plate. A custom shoulder testing system was used to increase loading through the supraspinatus (SS) tendon to drive varus deformity. Trials were performed with no suture placement; SS only; SS and subscapularis (SB); and SS, SB, and infraspinatus. The primary outcome was contribution of each point of suture fixation to prevention of varus collapse.Results: Suture augmentation to the SS, SB, and infraspinatus significantly decreased humeral head varus collapse when compared with the plate alone at nearly all loads (P < 0.05). There were no significant differences in humeral head varus collapse between the 3 suture constructs.Conclusions: In our biomechanical evaluation of a simulated osteoporotic 2-part proximal humerus fracture with incompetent medial calcar, tension-relieving sutures placed between a lateral locked plate and the rotator cuff tendons prevented varus malalignment.
      PubDate: Mon, 01 Aug 2022 00:00:00 GMT-
       
  • Public Insurance Payment Does Not Compensate Hospital Cost for Care of
           Long-Bone Fractures Requiring Additional Surgery to Promote Union

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      Authors: Roddy; Erika; von Kaeppler, Ericka P.; Chan, Matthew C.; Shearer, David W.; Kandemir, Utku; Morshed, Saam
      Abstract: imageObjectives: To quantify the total hospital costs associated with the treatment of lower extremity long-bone fracture aseptic and septic unhealed fracture, to determine if insurance adequately covers these costs, and to examine whether insurance type correlates with barriers to accessing care.Design: Retrospective cohort study.Setting: Academic Level II trauma center.Patients: All patients undergoing operative treatment of OTA/AO classification 31, 32, 33, 41, 42, and 43 fractures between 2012 and 2020 at a single Level II trauma center with minimum of 1-year follow-up.Main Outcome Measures: The primary outcome was the total cost of treatment for all hospital-based episodes of care. Distance traveled from primary residence was measured as a surrogate for barriers to care.Results: One hundred seventeen patients with uncomplicated fracture healing, 82 with aseptic unhealed fracture, and 44 with septic unhealed fracture were included in the final cohort. The median cost of treatment for treatment of septic unhealed fracture was $148,318 [interquartile range(IQR) 87,241–256,928], $45,230 (IQR 31,510–68,030) for treatment of aseptic unhealed fracture, and $33,991 (IQR 25,609–54,590) for uncomplicated fracture healing. The hospital made a profit on all patients with commercial insurance, but lost money on all patients with public insurance. Among patients with unhealed fracture, those with public insurance traveled 4 times further for their care compared with patients with commercial insurance (P = 0.004).Conclusions: Septic unhealed fracture of lower extremity long-bone fractures is an outsized burden on the health care system. Public insurance for both septic and aseptic unhealed fracture does not cover hospital costs. The increased distances traveled by our Medi-Cal and Medicare population may reflect the economic disincentive for local hospitals to care for publicly insured patients with unhealed fractures.Level of Evidence: Economic Level V. See Instructions for
      Authors for a complete description of levels of evidence.
      PubDate: Mon, 01 Aug 2022 00:00:00 GMT-
       
  • Effect of a Multimodal Analgesic Protocol on Short-Term and Long-Term
           Opioid Use After Orthopaedic Trauma

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      Authors: Oyler; Douglas R.; Slade, Emily; Slavova, Svetla; Matuszewski, Paul E.; Lei, Feitong; Herndon, Brooke; Johnson, Shannon; Moghadamian, Eric S.
      Abstract: imageObjective: To determine whether the use of a multimodal analgesic protocol reduced short-term and long-term opioid use in patients hospitalized after orthopaedic trauma.Design: Retrospective pre–post intervention study.Setting: Regional, academic, Level 1 trauma center in Central Kentucky.Patients/Participants: Patients were hospitalized after orthopaedic injury before (n = 393) and after (n = 378) the implementation of a multimodal analgesic protocol.Intervention: The intervention involved a multimodal analgesic protocol consisting of acetaminophen, ibuprofen/ketorolac, gabapentinoids, skeletal muscle relaxants, and standardized doses of opioids plus standardized pain management education before hospital discharge.Main Outcome Measurements: End points included discharge opioid prescription, days' supply and daily morphine milligram equivalent (MME), and long-term opioid use after hospitalization. Opioid use in the 90 days before and after hospitalization was assessed using state prescription drug monitoring program data.Results: Discharge opioid prescription rates were similar in the intervention and control cohorts [79.9% vs. 78.4%, odds ratio (OR) 1.30 (0.83–2.03), P = 0.256]. Patients in the intervention cohort received a shorter days' supply [5.7 ± 4.1 days vs. 8.1 ± 6.2 days, rate ratio 0.70 (0.65–0.76), P < 0.001] and lower average daily MME [34.8 ± 24.9 MME vs. 51.5 ± 44.0 MME, rate ratio 0.68 (0.62–0.75), P < 0.001]. The incidence of long-term opioid use was also significantly lower in the intervention cohort [7.7% vs. 12.0%, OR 0.53 (0.28–0.98), P = 0.044].Conclusions: Implementation of a multimodal analgesic protocol was associated with reductions in both short-term and long-term opioid use, including long-term opioid therapy, after orthopaedic trauma.Level of Evidence: Therapeutic Level III. See Instructions for
      Authors for a complete description of levels of evidence.
      PubDate: Mon, 01 Aug 2022 00:00:00 GMT-
       
  • Routine Postoperative Computed Tomography Scans Following Posterior Pelvic
           Fixation of Pelvic Ring Fractures: A Survey of (OTA) Orthopaedic
           Traumatologists

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      Authors: Thompson; David M.; Ricci, Alfred Gianni; Floyd, John C. P.; Jardaly, Achraf H.; Ziran, Bruce H.; Harris, Robert M.
      Abstract: imageObjective: To assess practices related to ordering computed tomography (CT) scans routinely after posterior pelvic ring fixation and revision surgery rates.Design: A 20-question cross-sectional survey.Participants: Fellowship-trained orthopaedic traumatologists.Main Outcome Measurements: (1) Percentage of surgeons ordering a routing postoperative CT after posterior pelvic ring fixation, (2) Revision surgery rates based on routine CT scan results.Results: Responses were received from 57 surgeons. Practices varied regarding postoperative CT scans, with 20 surgeons (35%, group A) routinely ordering them and 37 surgeons (65%, group B) not ordering them on all patients. Group A were younger and with less years of experience than those in Group B. Most group A surgeons report a revision surgery rate of
      PubDate: Mon, 01 Aug 2022 00:00:00 GMT-
       
  • Technical Note on Placement of Low-Profile Triangular Osteosynthesis for
           Unstable Posterior Pelvic Ring Injuries

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      Authors: Steelman; Kevin; Bray, Ryan; Vaidya, Rahul
      Abstract: imageSummary: Triangular osteosynthesis is a technique used to stabilize posterior pelvic ring injuries. Conventional triangular fixation can be problematic for several reasons, including the need for advanced skill sets to place instrumentation, difficulty with pelvic reduction and placing the connecting construct, and prominent instrumentation. The purpose of this study is 2-fold: (1) to describe in detail a technique for lumbopelvic fixation using implants that are easy to connect, allow distraction for complex lumbosacral displacements, and are placed in a location minimizing soft tissue prominence and (2) to present our initial case series using this technique. We present a retrospective review of 18 consecutively treated patients with this technique. Inclusion criteria were patients with complete disruption through the sacrum or sacroiliac joint from blunt trauma (OTA/AO type C injuries). Outcomes included pelvic reduction/malreduction, wound healing, and complications. Fourteen patients underwent unilateral fixation (81%), and 4 patients underwent bilateral fixation (19%). All patients (18 of the 18) had a well-reduced pelvis after fixation. No patient (0%) required a return trip to the operating room for loss of reduction/malreduction, wound breakdown, or implant failure. This study presents an updated technique for a low-profile triangular osteosynthesis construct with straightforward application for unstable posterior pelvic ring injuries. This technique does not require rod bending, results in a consistently more recessed iliac screw and connecting rod, and can be used in a wide variety of unstable posterior pelvic ring injuries, including comminuted sacral fractures, L5/S1 facet fractures, and vertical shear injuries.
      PubDate: Mon, 01 Aug 2022 00:00:00 GMT-
       
 
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