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Journal of Orthopaedic Trauma
Journal Prestige (SJR): 1.451
Citation Impact (citeScore): 2
Number of Followers: 20  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0890-5339 - ISSN (Online) 1531-2291
Published by LWW Wolters Kluwer Homepage  [301 journals]
  • Introduction—JOT Care Controversies

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      Authors: Working; Zachary M.
      Abstract: No abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • A Systematic Review and Analysis of the Quality of Randomized Controlled
           Trials Comparing Infrapatellar and Suprapatellar Approach for Nailing of
           Tibial Fractures

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      Authors: Chan; Andrew; Pisquiy, John; Piscoya, Andres S.; Clark, DesRaj; Dunn, John C
      Abstract: imageObjectives: To evaluate the quality of evidence presented in prospective randomized controlled trials (RCTs) regarding suprapatellar versus infrapatellar approaches to tibia intramedullary nails using grading systems other than Oxford Levels of Evidence (LOE).Data Sources: A systematic review was performed using the phrases “tibial nail OR tibia OR intramedullary” AND “suprapatellar OR infrapatellar” AND “approach OR insertion” to search the PubMed database between 1999 and 2018 filtering for English language and full articles.Study Selection: Included articles were prospective trials that compared infrapatellar and suprapatellar approaches to tibial intramedullary nails in adult patients.Data Extraction: Studies were evaluated and scored by 2 independent observers using 3 different systems: Oxford LOE, Modified Coleman Methodology Score, and Revised Consolidated Standards of Reporting Trials (CONSORT).Data Synthesis: Comparison for grading between observers was compared with a correlation coefficient and kappa statistic.Conclusions: RCTs are historically regarded as the gold standard for establishing principles of evidence-based medicine. However, our evaluation of the evidence shows that though they followed the Oxford LOE, RCTs were considered poor by the other 2 methods. The majority of studies that were included in our review were considered poor using the Modified Coleman and CONSORT systems. Half the articles supported suprapatellar tibial nailing over the infrapatellar approach, whereas other half demonstrated equivocal results between the 2 techniques. This study highlights the importance of evaluating studies judiciously regardless of their study design or level of evidence.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Combined Orthopaedic and Vascular Injuries With Ischemia: A Multicenter
           Analysis

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      Authors: Shahien; Amir A.; Sullivan, Matthew; Firoozabadi, Reza; Lu, Keyin; Cannada, Lisa; Timmel, Mark; Ali, Ashley; Bramlett, Kasey; Marcantonio, Andrew; Flynn, Megan; Vallier, Heather; Nicolay, Rick; Mullis, Brian; Goodwin, Alexandra; N. Miller, Anna; Krause, Peter; Mir, Hassan R.; Tornetta, Paul III
      Abstract: imageObjectives: To review a large, multicenter experience to identify the current salvage and amputation rates of these combined injuries and, where possible, the variables that predict amputation.Design: Retrospective.Setting: Nine trauma centers.Patients: This study involved 199 patients presenting to 9 trauma centers with orthopaedic and vascular injuries resulting in ischemic limbs for whom the orthopaedic service was involved with the decision for salvage versus amputation.Results: We reviewed 199 patients, 17–85 years of age. One hundred seventy-two of the injuries were open. Thirty-eight patients (19%) were treated with amputation upon admission as they were deemed to be unsalvageable. Of the remaining 161 patients who had attempted salvage, 36 (30%) required late amputation. Closed injuries were successfully salvaged in 25 of 27 cases (93%). The highest rate of amputation was in tibia fractures with a combined amputation rate of 62%. In those attempted to be salvaged, 21 of 48 (44%) required amputation. The ischemia time for successful salvage was significantly less, P = 0.03. One hundred twenty-four patients had their definitive vascular repair before the bony reconstruction. There were 15 vascular complications, of which 13 (86%) had the definitive vascular repair performed before the definitive osseous repair, although this was not statistically significant.Conclusions: In this series of combined orthopaedic and vascular injuries, we found a high rate of acute and late amputations. It is possible that other protocols, such as shunting and stabilizing the osseous injury, before vascular repair may benefit limb salvage, although this needs more study.Level of Evidence: Prognostic Level III. See Instructions for
      Authors for a complete description of levels of evidence.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Smith–Petersen Versus Watson–Jones Approach Does Not Affect Quality of
           Open Reduction of Femoral Neck Fracture

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      Authors: Patterson; Joseph T.; Ishii, Keisuke; Tornetta, Paul III; Leighton, Ross K.; Friess, Darin M.; Jones, Clifford B.; Levine, Ari; Maclean, Jeffrey J.; Miclau, Theodore III; Mullis, Brian H.; Obremskey, William T.; Ostrum, Robert F.; Reid, J. Spence; Ruder, John A.; Saleh, Anas; Schmidt, Andrew H.; Teague, David C.; Tsismenakis, Antonios; Westberg, Jerald R.; Morshed, Saam
      Abstract: imageObjective: To compare immediate quality of open reduction of femoral neck fractures by alternative surgical approaches.Design: Retrospective cohort study.Setting: Twelve Level 1 North American trauma centers.Patients: Eighty adults 18–65 years of age with isolated, displaced, OTA/AO type 31-B2 or -B3 femoral neck fractures treated with internal fixation.Intervention: Thirty-two modified Smith–Petersen anterior approaches versus 48 Watson–Jones anterolateral approaches for open reduction performed by fellowship-trained orthopaedic trauma surgeons.Main outcome: Reduction quality as assessed by 3 senior orthopaedic traumatologists as “acceptable” or “unacceptable” on AP and lateral postoperative radiographs.Results: No difference was observed in the rate of acceptable reduction by modified Smith–Petersen (81%) versus Watson–Jones (81%) approach (risk difference null, 95% confidence interval −17.4% to 17.4%, P = 1.00) with 90.4% panel agreement (Fleiss' weighted κ = 0.63, P < 0.01). Stratified analyses did not identify a significant difference in the rate of acceptable reduction between approaches when stratified by Pauwels angle, basicervical or transcervical fracture location, or posterior comminution. The Smith–Petersen approach afforded a better reduction when preoperative skeletal traction was not applied (RR = 1.67 [95% CI 1.10–2.52] vs. RR = 0.87 [95% CI 0.70–1.08], P = 0.006).Conclusions: No difference was observed in the quality of open reduction of displaced femoral neck fractures in young adults when a Watson–Jones anterolateral approach versus a modified Smith–Petersen anterior approach was performed by orthopaedic trauma surgeons.Level of Evidence: Therapeutic Level III. See Instructions for
      Authors for a complete description of levels of evidence.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Gluteus Minimus Debridement During Acetabular Fracture Surgery Does Not
           Prevent Heterotopic Ossification—A Comparative Study

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      Authors: Chen; Michael J.; Tigchelaar, Seth S.; Wadhwa, Harsh; Frey, Christopher S.; Bishop, Julius A.; Gardner, Michael J.; Bellino, Michael J.
      Abstract: imageObjectives: To compare rates of heterotopic ossification (HO) after acetabular fracture surgery, through a posterior approach, with and without gluteus minimus muscle (GMM) debridement.Design: Retrospective comparative study.Setting: Single academic Level I trauma center.Patients: Ninety-four patients in the GMM preserved group and 42 patients in the GMM debrided group met inclusion criteria.Intervention: GMM preservation or debridement during acetabular fracture surgery through a single-posterior approach.Main Outcome Measurements: Primary outcomes were incidence and severity of HO. Reoperation for HO excision was assessed. Other risk factors for severe HO (Brooker class III–IV) were secondarily assessed using multivariable logistic regression analyses. Odds ratios (ORs) with 95% confidence intervals were calculated. The significance was set at P-value ≤ 0.05.Results: There was no difference in the incidence or severity of HO between the debrided and preserved groups. Rates of reoperation for HO excision were comparable. American Society of Anesthesiologists physical status class (OR = 3.3), head injury (OR = 4.6), and abdominal injury (OR = 4.5) were associated with severe HO.Conclusion: GMM debridement was not associated with a decreased incidence of HO after acetabular fracture surgery. American Society of Anesthesiologists class is a novel risk factor associated with severe HO formation.Level of Evidence: Therapeutic Level III. See Instructions for
      Authors for a complete description of levels of evidence.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Femoral Neck Shaft Angle and Management of Proximal Femur Fractures: Is
           the Contralateral Femur a Reliable Template'

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      Authors: Rogers; Miranda J.; King, Taylor L.; Kim, Jaewhan; Adeyemi, Temitope F.; Higgins, Thomas F.; Maak, Travis G.
      Abstract: imageObjectives: To (1) assess interrater reliability of a novel technique for measurement of neck shaft angle (NSA); (2) use pelvic anteroposterior (AP) radiographs of unaffected hips to assess variability of NSA; and (3) evaluate the side-to-side variability of NSA to determine reliability of using the contralateral hip as a template.Design: Retrospective cohort study.Setting: Academic Level 1 regional trauma center.Patients/Participants: Four hundred six femora (203 patients) with standing AP pelvis radiographs were selected. Exclusions included lack of acceptable imaging, congenital abnormalities, or prior hip surgery.Intervention: An AP pelvis radiograph in the standing position.Main Outcome Measurements: Bilateral NSA measurements obtained in a blinded fashion between 2 reviewers. Pearson coefficients and coefficient of determination assessed correlations and variability between left and right NSA. Concordance correlation coefficients assessed the interrater reliability between measurements performed by the 2 reviewers.Results: Two hundred three patients (406 femora) were assessed. Male patients had a lower overall NSA mean of 131.56 degrees ± 4.74 than females with 133.61 degrees ± 5.17. There was no significant difference in NSA side-to-side in females (P = 0.18), 0.3 degrees [95% confidence interval (−0.15 to 0.75)], or males (P = 0.68), 0.19 degrees [95% confidence interval (−0.74 to 1.12)]. There was a strong linear relationship between left and right femora (r2 = 0.70). Forty-one percent of patients fell within the 131–135 degrees range bilaterally. Eighty-eight percent of patients had 10 degrees difference.Conclusions: There is no significant variability between bilateral femora in males and females. Use of this measurement method and contralateral NSA for proximal femur fracture planning is supported.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Debate Update: Surgery After 48 Hours of Admission for Geriatric Hip
           Fracture Patients Is Associated With Increase in Mortality and
           Complication Rate: A Study of 27,058 Patients Using the National Trauma
           Data Bank

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      Authors: Danford; Nicholas C.; Logue, Teresa C.; Boddapati, Venkat; Anderson, Matthew J.J.; Anderson, Forrest L.; Rosenwasser, Melvin P.
      Abstract: imageObjective: To determine the association between surgical timing and short-term morbidity and mortality in elderly patients who sustain hip fractures using a national trauma database (OTA/AO 31A1-3, 31B1-3).Design: Retrospective cohort study.Setting: Level I–IV trauma centers in the United States.Patients/Participants: All patients ≥65 years of age who underwent surgery for hip fracture from 2011 to 2013.Intervention: Time to surgery of 48 hours from admission.Main outcome measurements: Primary outcome was mortality by hospital discharge. Secondary outcomes were complications of myocardial infarction, cardiac arrest, acute respiratory distress syndrome (ARDS), unplanned reintubation, pneumonia, stroke, severe sepsis, and intensive care unit length of stay.Results: Twenty-seven thousand fifty-eight patients were included in the study. Relative to the 48 hours cohort were at increased risk for mortality (OR 1.89, 95% CI 1.52–2.33, P < 0.001), ARDS (OR 2.57, 95% CI 1.94–3.39, P < 0.001 for ARDS), myocardial infarction (OR 2.19, 95% CI 1.64–2.94, P < 0.0001), pneumonia (OR 2.04, 95% CI 1.71–2.44, P < 0.001), severe sepsis (OR 2.34, 95% CI 1.52–3.58, P = 0.003), and intensive care unit stay (OR 2.48, 95% CI 2.25–2.74, P < 0.0001). A subgroup analysis showed that healthier patients (modified Charlson Comorbidity Index less than 5) who had surgery>48 hours were not at increased risk of mortality.Conclusions: For elderly patients with hip fractures, delaying surgery for more than 48 hours may be associated with increased short-term morbidity and mortality. This association may be pronounced for patients with more medical comorbidities.Level of Evidence: Therapeutic Level III. See Instructions for
      Authors for a complete description of levels of evidence.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Monitored Anesthesia Care and Soft-Tissue Infiltration With Local
           Anesthesia: An Anesthetic Option for High-Risk Patients With Hip Fractures
           

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      Authors: Konda; Sanjit R.; Ranson, Rachel A.; Dedhia, Nicket; Tong, Yixuan; Saint-Cyrus, Evens; Ganta, Abhishek; Egol, Kenneth A.
      Abstract: imageObjectives: To examine the feasibility of a novel anesthetic option for hip fracture fixation with short cephalomedullary nails.Design: Retrospective cohort study.Setting: The study setting involved an urban, academic Level 1 trauma center, a tertiary care academic medical center, and an orthopaedic specialty hospital.Patients/Participants: Twenty recent and 40 risk-matched (1:1:1 by anesthesia type) historical hip fracture patients were included in the study.Intervention: All patients with an OTA/AO 31.A1-3 intertrochanteric hip fracture presenting from October 1, 2019 to March 31, 2020 treated with a short cephalomedullary nail underwent a new intraoperative anesthesia protocol using monitored anesthesia care (MAC) and soft-tissue infiltration with local anesthesia (STILA).Main Outcome Measurements: Intraoperative measures, postoperative pain scores, narcotic and acetaminophen use, hospital quality measures, and inpatient cost.Results: A total of 60 patients (20 each: MAC, general, and spinal) were identified. There were differences among the groups regarding mean minimum and maximum intraoperative heart rate with MAC-STILA protocol demonstrating the best maintenance of normal heart rate parameters (60–100 beats per minute). For the first 3 hours postoperatively, MAC-STILA patients reported consistently lower pain scores (visual analog scale 1). Through 48 hours postoperatively, MAC-STILA narcotic usage was similar to that of the spinal cohort and approximately 5 times less than the general cohort. There were no differences in procedural time, length of stay, minor or major complications, inpatient and 30-day mortality, or 30-day readmissions, or postoperative ambulatory distance. There was no difference in inpatient cost among cohorts.Conclusions: This feasibility study demonstrates safety for the MAC-STILA protocol with comparison to spinal and general anesthesia. The MAC-STILA protocol is a viable option for treatment of OTA/AO 13.A1-3 intertrochanteric fractures with a short cephalomedullary nail and may be the preferred method for patients with severe medical comorbidities or relative contraindications to general and/or spinal anesthesia.Level of Evidence: Therapeutic Level III. See Instructions for
      Authors for a complete description of Levels of Evidence.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Does Provisional Minifragment Fixation Prevent Compression With Dynamic
           Compression Plating' A Biomechanical Analysis

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      Authors: Wheatley; Benjamin M.; Schimoler, Patrick J.; Hempen, Eric C; Miller, Mark Carl; Westrick, Edward; Altman, Gregory T.
      Abstract: imageObjectives: To compare the compressive force generated by a 3.5-mm compression plate with and without provisional fixation using a 2.0-mm minifragment plate.Methods: Fourth generation composite large humeral sawbones underwent transection and were divided into 2 groups. The first group underwent fixation with a 3.5-mm compression plate; the second group underwent provisional fixation with a 2.0-mm plate followed by definitive fixation using a 3.5-mm plate. Using a load cell, the compressive force generated was measured after insertion of each of 2 eccentrical placed screws and the total compression recorded.Results: There was no difference in the force generated after each successive compression screw (P = 0.59 and 0.58, respectively). Likewise, there was no significant difference in the total compression generated when the preload was accounted for (P = 0.93).Conclusion: Provisional minifragment fixation does not have any adverse effect on the forces generated during compression plating. These findings suggest that provisional minifragment plates do not need to be removed before definitive fixation.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Predicting the Behavior of Humeral Shaft Fractures: An Independent
           Validation Study of the Radiographic Union Score for HUmeral Fractures and
           Value of Assessing Fracture Mobility

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      Authors: Dekker; Andrew P.; Chuttha, Simran; Tambe, Amol A.; Clark, David I.
      Abstract: imageObjectives: To externally validate the Radiographic Union Score for HUmeral fractures (RUSHU) and to quantify the predictive relationship of fracture motion on physical examination to nonunion.Design: Retrospective cohort study.Setting: Single institutional center (University teaching hospital).Patients: Ninety-two consecutive patients undergoing nonoperative treatment of a diaphyseal humeral shaft fracture were identified over a 4-year period. The average age of the population was 62 years and 42% of the cohort was men.Intervention: Clinical examination for fracture stability was routinely performed on patients by the treating physicians. Radiographic assessment of fracture callus (RUSHU score) at 6 weeks was retrospectively determined. Patients were followed up until union.Main Outcome Measurements: Stability was graded as motion at the fracture site or the humerus moving as a single functional unit.Results: Fractures with a RUSHU score ≤7 were 14 times more likely to proceed to nonunion at 6 months (78% sensitivity, 80% specificity). The time to union was 49 weeks for a RUSHU score of ≤7 versus 16 weeks for a RUSHU score of ≥8. The number of operations needed to avoid one nonunion was 1.7. Fractures mobile at 6 weeks were 6.5 times more likely to proceed to nonunion at 6 months (77% specificity, 67% sensitivity). Mobile fractures had a longer time to union (41 weeks) than nonmobile fractures (17 weeks).Conclusion: The RUSHU score and clinical assessment of fracture mobility are effective and valid tools in identifying patients at risk of developing nonunion of humeral shaft fractures and can enhance early decision making in fracture management.Level of Evidence: Prognostic Level III. See Instructions for
      Authors for a complete description of levels of evidence.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Outpatient Surgical Fixation of Proximal Humerus Fractures Can Be
           Performed Without Increased Rates of Short-Term Complications or
           Readmissions

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      Authors: Bovonratwet; Patawut; Suhardi, Vincentius J.; Andarawis-Puri, Nelly; Ricci, William M.; Fu, Michael C.
      Abstract: imageObjective: To delineate differences in short-term complications between outpatient versus inpatient open reduction and internal fixation (ORIF) of proximal humerus fractures.Design: Retrospective database review.Setting: Hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program database.Patients: Patients in the National Surgical Quality Improvement Program database with proximal humerus fractures from 2005 to 2017.Intervention: Proximal humerus fracture ORIF.Main Outcome Measurements: Thirty-day readmission, reoperation, thromboembolic events, and other complications.Results: In total, 920 outpatient and 2490 inpatient ORIF cases were identified. The proportion of outpatient proximal humerus fracture ORIF increased throughout the years from 6.67% in 2007 to 34.89% in 2017. Each outpatient case was propensity-score-matched with one inpatient case by age, sex, functional status, American Society of Anesthesiologists classification, smoking status, diabetes mellitus type, hypertension, chronic obstructive pulmonary disease, and dyspnea on exertion. After matching, there were 920 outpatient and 920 inpatient cases. Statistical analysis revealed no significant difference in complications including reoperation (1.63% vs. 2.50%), thromboembolic events (0.65% vs. 0.65%), and 30-day readmissions (2.93% vs. 2.69%) between outpatient versus matched inpatient procedures (all P> 0.05). The only significant finding was a lower rate of blood transfusion in outpatient procedures (0.54%) compared with inpatient procedures (4.02%) (P < 0.001).Conclusions: The perioperative outcomes assessed here support the conclusion that ORIF for proximal humerus fractures can be performed in the outpatient setting without increased rates of 30-day perioperative complications or readmissions compared with inpatient procedures. However, it is worth noting that the majority of outpatient cases were younger than the average geriatric proximal humerus fracture patient.Level of Evidence: Therapeutic Level III. See Instructions for
      Authors for a complete description of levels of evidence.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Gunshot Fractures of the Forearm: A Multicenter Evaluation

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      Authors: Veltre; David R.; Tornetta, Paul III; Krause, Peter; George, Mary P.; Vallier, Heather; Nguyen, Mai P.; Reich, Michael S.; Cannada, Lisa; Eng, Michael; Miller, Anna N.; Goodwin, Alexandra; Mir, Hassan R.; Clark, Charles; Sandberg, Ben; Westberg, Jerald R.; Mullis, Brian H.; Behrens, Jonathan P.; Firoozabadi, Reza
      Abstract: imageObjectives: To evaluate a large series of open fractures of the forearm after gunshot wounds (GSWs) to determine complication rates and factors that may lead to infection, nonunion, or compartment syndrome.Design: Multicenter retrospective review.Setting: Nine Level 1 Trauma Centers.Patients/Participants: One hundred sixty-eight patients had 198 radius and ulna fractures due to firearm injuries. All patients were adults, had a fracture due to a firearm injury, and at least 1-year clinical follow-up or follow-up until union. The average follow-up was 831 days.Intervention: Most patients (91%) received antibiotics. Formal irrigation and debridement in the operating room was performed in 75% of cases along with either internal fixation (75%), external fixation (6%), or I&D without fixation (19%).Main Outcome Measures: Complications including neurovascular injuries, compartment syndrome, infection, and nonunion.Results: Twenty-one percent of patients had arterial injuries, and 40% had nerve injuries. Nine patients (5%) developed compartment syndrome. Seventeen patients (10%) developed infections, all in comminuted or segmental fractures. Antibiotics were not associated with a decreased risk of infection. Infections in the ulna were more common in fractures with retained bullet fragments and bone loss. Twenty patients (12%) developed a nonunion. Nonunions were associated with high velocity firearms and bone defect size.Conclusions: Open fractures of the forearm from GSWs are serious injuries that carry high rates of nonunion and infection. Fractures with significant bone defects are at an increased risk of nonunion and should be treated with stable fixation and proper soft-tissue handling. Ulna fractures are at a particularly high risk for deep infection and septic nonunion and should be treated aggressively. Forearm fractures from GSWs should be followed until union to identify long-term complications.Level of Evidence: Prognostic Level IV. See Instructions for
      Authors for a complete description of levels of evidence.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Complications and Soft-Tissue Coverage After Complete Articular, Open
           Tibial Plafond Fractures

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      Authors: Olson; Jeffrey J.; Anand, Krishna; Esposito, John G.; von Keudell, Arvind G.; Rodriguez, Edward K.; Smith, R. Malcolm; Weaver, Michael J.
      Abstract: imageObjectives: To evaluate the incidence of nonunion and wound complications after open, complete articular pilon fractures. Second, to study the effect that both timing of fixation and timing of flap coverage have on deep infection rates.Design: Retrospective case series.Setting: Three Academic Level 1 Trauma Centers.Patients: One hundred sixty-one patients with open OTA/AO type 43C distal tibia fractures treated with open reduction internal fixation (ORIF) between 2002 and 2018. The mean (SD) age was 46 (14) years, 70% male, with median (interquartile range) follow-up of 2.1 (1.3–5.0) years (minimum 1 year). There were 133 (83%) type 3A and 28 (17%) type 3B open fractures.Intervention: Fracture fixation: acute, primary (24 hours). Soft-tissue coverage: rotational or free flap.Main Outcome Measurement: Primary outcomes included deep infection and nonunion. Secondary outcomes included rates of soft-tissue coverage and reoperation.Results: Acute fixation (
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Incidence of Surgical Site Infections and Acute Kidney Injuries After
           Topical Antibiotic Powder Application in Orthopaedic Trauma Surgery

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      Authors: Balabanova; Alla; Chu, Xiangquan; Chambers, Lori; Mauffrey, Cyril; Parry, Joshua A.
      Abstract: imageObjectives: To compare the incidence of deep surgical site infections (SSI) and acute kidney injuries (AKI) in patients who did and did not receive topical antibiotics during the open treatment of fractures.Design: Retrospective comparative cohort.Setting: Level 1 trauma center.Patients/Participants: Three hundred ninety-six patients undergoing open fixation of fractures.Intervention: The topical antibiotic group included 78 (20%) patients. Vancomycin only was used in 28 (7%) patients with the median dose (interquartile range) of 1 g (1–2 g) and vancomycin/tobramycin was used in 48 (12%) patients with a median dose (interquartile range) of 2 g (1–2 g)/1.2 g (1.2–1.2 g).Main Outcome Measurements: Deep SSI requiring debridement and AKI (>50% increase in creatinine compared with preoperative level).Results: There was no detectable difference in SSI between the topical antibiotic and control groups (13% vs. 10%, odds ratio (OR) 1.3, 95% confidence interval (CI) 0.6 to 2.9). Variables associated with SSI on multivariate analysis included open fracture (OR 3.2, CI 1.5 to 6.5) and an American Society of Anesthesiologists classification of>2 (OR 2.7, CI 1.3 to 5.3). There was no detectable difference in AKI between the topical antibiotic and control groups (1 (2%) vs. 7 (5%); OR 0.3, CI 0.04 to 3).Conclusion: There was no detectable difference, with wide confidence intervals, in SSI and AKI between the topical antibiotic and control groups. Further studies need to be conducted to evaluate the relationship between topical antibiotics and clinical outcomes in orthopaedic trauma surgery.Level of Evidence: Therapeutic Level III. See Instructions for
      Authors for a complete description of levels of evidence.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • A Machine Learning Algorithm to Identify Patients at Risk of Unplanned
           Subsequent Surgery After Intramedullary Nailing for Tibial Shaft Fractures
           

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      Authors: Machine Learning Consortium on behalf of the SPRINT Investigators
      Abstract: imageObjectives: In the SPRINT trial, 18% of patients with a tibial shaft fracture (TSF) treated with intramedullary nailing (IMN) had one or more unplanned subsequent surgical procedures. It is clinically relevant for surgeon and patient to anticipate unplanned secondary procedures, other than operations that can be readily expected such as reconstructive procedures for soft tissue defects. Therefore, the objective of this study was to develop a machine learning (ML) prediction model using the SPRINT data that can give individual patients and their care team an estimate of their particular probability of an unplanned second surgery.Methods: Patients from the SPRINT trial with unilateral TSFs were randomly divided into a training set (80%) and test set (20%). Five ML algorithms were trained in recognizing patterns associated with subsequent surgery in the training set based on a subset of variables identified by random forest algorithms. Performance of each ML algorithm was evaluated and compared based on (1) area under the ROC curve, (2) calibration slope and intercept, and (3) the Brier score.Results: Total data set comprised 1198 patients, of whom 214 patients (18%) underwent subsequent surgery. Seven variables were used to train ML algorithms: (1) Gustilo–Anderson classification, (2) Tscherne classification, (3) fracture location, (4) fracture gap, (5) polytrauma, (6) injury mechanism, and (7) OTA/AO classification. The best-performing ML algorithm had an area under the ROC curve, calibration slope, calibration intercept, and the Brier score of 0.766, 0.954, −0.002, and 0.120 in the training set and 0.773, 0.922, 0, and 0.119 in the test set, respectively.Conclusions: An ML algorithm was developed to predict the probability of subsequent surgery after IMN for TSFs. This ML algorithm may assist surgeons to inform patients about the probability of subsequent surgery and might help to identify patients who need a different perioperative plan or a more intensive approach.Level of Evidence: Prognostic Level II. See Instructions for
      Authors for a complete description of levels of evidence.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Cling Wrap Technique: An Inexpensive and Simple Way to Seal Negative
           Pressure Wound Therapy on External Fixation Devices

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      Authors: Annacontini; Luigi; Verdura, Vincenzo; Cecchino, Liberato R.; Lembo, Fedele; Florio, Andrea M.; Parisi, Domenico; Nicoletti, Giovanni F.; Portincasa, Aurelio
      Abstract: imageSummary: Negative pressure therapy is often applied to treat limb traumas with or without bone exposure. However, sealing a negative pressure dressing in the presence of an external fixation device may be complicated and time consuming. In this technique, we attempted to maintain vacuum conditions by preventing air leakage around the screws using plastic drape and cling wrap as the final layer over the external fixation device. To prevent rupturing of the wrap, the prominences of the pins and rods were covered using cotton wool roll. This novel solution is also effective for complex and extended wounds, with no need for additional dressing changes and no occurrence of complications for approximately 4 days. Furthermore, it is an inexpensive, quick, and readily available technique requiring minimal training to perform. It is also adaptable to any anatomical region, allowing the inspection of the limb when required.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
 
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