J Bone Joint Surg Am. 2025 Apr 1. doi: 10.2106/JBJS.24.01406. Online ahead of print.

ABSTRACT

Adaptive learning is a powerful educational tool that uses computer algorithms to personalize and streamline an individual's learning experience. These algorithms allow for continual assessment and real-time customization of the delivery of educational content based on a specific learner's knowledge base; such algorithms mimic a 1-to-1 learning model. The current symposium describes the application of adaptive learning to orthopaedics, as well as the development of an online educational platform that utilizes this promising technology.

PMID:40168460 | DOI:10.2106/JBJS.24.01406

Int Orthop. 2025 Apr 2. doi: 10.1007/s00264-025-06503-6. Online ahead of print.

ABSTRACT

PURPOSE: Effective patient comprehension is critical for informed consent, particularly in Total Hip Arthroplasty (THA), a globally prevalent procedure. This study evaluates the efficacy of an informational video to improve the patients' understanding, self-perceived knowledge, and emotional comfort in the context of THA informed consent. This randomized controlled trial investigates the impact of an additional informational video on (I) the patients' understanding, (II) self-precepted knowledge and (III) emotional comfort during the informed consent process for THA.

METHODS: Participants were randomized to receive either the standard informed consent procedure or the standard procedure supplemented with an informational video. The effect of the video was tested with post-consent questionnaires.

RESULTS: The informational video significantly (p = 0.014) improved the patients' understanding from 78.6% to 86.5%. Self-precepted knowledge and Emotional comfort was not effected by the video (p = 0.986; p = 0.333).

CONCLUSIONS: The informational video significantly improved patient comprehension during the informed consent process before THA.

PMID:40169412 | DOI:10.1007/s00264-025-06503-6

Int Orthop. 2025 Apr 1. doi: 10.1007/s00264-025-06511-6. Online ahead of print.

ABSTRACT

PURPOSE: The aim is to showcase the urgent need for improved data infrastructure and international collaboration by highlighting the barriers to comprehensive orthopaedic documentation and quantifying the scope and nature of scholarly research on Gaza's healthcare crisis.

METHODS: Data was collected through integration of observational field notes, informal interviews, patient record reviews and a bibliometric analysis of peer-reviewed articles on the 2023-2025 armed escalations in Gaza.

RESULTS: The review of patient documentation during surgical missions in Gaza revealed significant gaps in critical clinical information, including surgical history, microbiology data, and postoperative instructions, which hindered patient care. Frequent damage to records due to resource shortages and bombardments, along with issues in retrieving imaging data, further exacerbated these challenges. Bibliometric analysis showed that most studies were retrospective, focusing on trauma care and limb salvage, reflecting the difficulty of conducting prospective research in a conflict zone. Of the 114 publications reviewed, only three (2.6%) met inclusion criteria, with two of them involving Gaza-based Palestinian authors, despite barriers like power outages, limited journal access, and resource constraints.These findings highlight the resilience of Gaza's healthcare workers and the need for improved infrastructure, standardized documentation, and international partnership to enhance patient outcomes and strengthen global orthopaedic research.

CONCLUSION: Orthopaedic documentation in Gaza is hampered by the compound impacts of recurrent conflict, infrastructural decay, and constrained academic output. Observational findings reveal the fragility of paper-based systems, while a bibliometric survey underscores the paucity of locally driven, empirical research. International efforts are needed to overcome these barriers for improved data infrastructure.

PMID:40167759 | DOI:10.1007/s00264-025-06511-6

Injury. 2025 Mar 22:112278. doi: 10.1016/j.injury.2025.112278. Online ahead of print.

ABSTRACT

BACKGROUND: Trauma is the leading cause of death and disability in children globally. Studies indicate that severe traumatic brain injury (TBI) negatively affects quality of life (QoL) in children, but little is known about QoL after injury in children without TBI. This study aimed to investigate QoL in this group six months post-discharge.

METHODS: Trauma patients aged 13-17 years admitted to a major Scandinavian trauma center were eligible if they met the following criteria: received by a trauma team, ISS > 9, required ICU monitoring, and hospital stay > 4 days. Patients with moderate to severe head injuries (AIS > 2) were excluded. Eighteen consenting adolescents were interviewed six to nine months after discharge.

RESULTS: The main finding was that most participants were "coping well after experienced injuries." A minority reported challenges in daily life, including fatigue and difficulty in keeping up. Few used regular painkillers, and most were unconcerned about long-term consequences. However, many felt that more structured follow-up post-discharge would have been helpful.

CONCLUSION: Among 18 moderate to severely injured adolescents, we found that the majority were coping well. Strong social relationships and involvement in school and social activities was important in all interviews. While several experienced fatigue and challenges in keeping up, the negative impact on daily life was manageable at the time of the interviews.

PMID:40164532 | DOI:10.1016/j.injury.2025.112278

Injury. 2025 Mar 25;56(6):112302. doi: 10.1016/j.injury.2025.112302. Online ahead of print.

ABSTRACT

OBJECTIVES: Management of civilian gunshot wound (GSW) fractures is controversial, with limited data on infection risk and controversy regarding treatment. While lower-energy GSWs are considered lower risk than other open fractures, complication rates remain high. This study aimed to identify risk factors for infection in operatively treated ballistic fractures.

METHODS: After institutional review board approval, we identified 2136 GSW-related fractures from 01/01/2012 to 12/31/2021 at our level one trauma center. After excluding articular, hand, foot, injuries through viscera and pre-existing infections, 110 patients with 125 long bone fractures were retrospectively reviewed. The primary outcome was infection requiring reoperation. Statistical analysis included Mann-Whitney U, T-tests, Pearson's Chi-square, ROC analysis, and Youden's index.

RESULTS: Sixteen patients (14.5 %) developed infections requiring reoperation. The cohort had a mean age of 30 years, 90 % male, BMI 27.7 ± 7.2 kg/m², Charlson comorbidity index <1, and 37 % smokers. Increased infection risk was associated with admission glucose (p < 0.001) and length of stay (p < 0.001). Admission glucose >156 mg/dL increased odds of infection sixfold (OR 6.1, 95 % CI 2.0-19.0), while a hospital stay >10 days increased odds of infection twentyfold (OR 21.1, 95 % CI 5.3-82.7). Transfusion (p = 0.004), abdominal (p = 0.007), and chest trauma (p = 0.010) also correlated with infection risk. No significant associations were found with nicotine use, Charlson comorbidity index, or BMI.

CONCLUSIONS: Operatively treated long bone injuries had a 14.5 % infection rate. Elevated admission glucose and prolonged hospital stay significantly increased infection risk, particularly in polytrauma patients. Identifying high-risk patients, promoting early mobilization, and ensuring glycemic control may help reduce infections. Further research is needed to develop targeted prevention strategies.

LEVEL OF EVIDENCE: 3 (Retrospective Comparative Study).

PMID:40163958 | DOI:10.1016/j.injury.2025.112302

Injury. 2025 Mar 25;56(6):112282. doi: 10.1016/j.injury.2025.112282. Online ahead of print.

ABSTRACT

OBJECTIVE: Fragility fractures in the elderly population is increasing due to the global aging population. Rehabilitation following hip fracture surgery plays a crucial role in restoring functional independence and quality of life. There are currently limited bedside rehabilitation tool for geriatric hip fracture patients. A novel tool (Time-Up and Flex [TUF]) was designed with the aim to allow patients perform bedside rehab exercises, provide objective feedback and enhance recovery.

DESIGN: A single centre, double-blinded, prospective validation study. A 3D printed TUF tool measures time taken to actively flex the operated hip to 30° on post-operative days [POD] 1, 7 and 14. The time is compared against subjective (Numerical Patient Reported Pain Scale [NPRS]) and objective outcomes (Tinetti Scale [TS], Functional Ambulation Category [FAC]). Assessors of the TUF score are blinded to the assessors of patient report outcome measures.

RESULTS: Mean time for TUF were 12.7 s (seconds), 9.5 s and 6.7 s, NPRS were 7.3, 4.8, 3.2, TS were 9.8, 14.1, 18.6, FAC were 1.2, 2.0, 3.1 on POD1, 7 and 14 respectively. Coefficient of correlation for TUF time against NPRS was 0.729 (p < 0.05), TUF time against TS was -0.721 (p < 0.05), TUF time against FAC -0.688 (p < 0.05). A decrease in TUF time correlated to a statistically significant decrease in NPRS, increase in TS and FAC. The calculated Cohen's D and Cronbach Alpha for TUF tool supported its ability to produce consistent and valid results.

CONCLUSION: TUF tool is valid and correlates with patient's subjective and objective outcomes. It has a good predictor value for the patient's pain, mobility and future falls risk. TUF tool has potential to be incorporated into geriatric hip fracture rehabilitation pathway in the future.

PMID:40163957 | DOI:10.1016/j.injury.2025.112282

Int Orthop. 2025 Mar 31. doi: 10.1007/s00264-025-06515-2. Online ahead of print.

ABSTRACT

PURPOSE: In orthopaedic surgery, achieving optimal exposure for acetabular and pelvic ring fractures with minimal invasiveness remains a challenge. This study compares bone exposure in key pelvic zones using an endoscopic approach versus the AIP (Modified Stoppa) in cadaveric specimens.

MATERIALS AND METHODS: We dissected ten adult cadaveric bodies, obtained from our institution's body donation program, using an extraperitoneal endoscopic dissection on one side and an AIP approach on the other. Bone areas were marked at each step of dissection by drill holes to measure the bone exposure surface for each zone (true and false pelvis) between the laparoscopic and open approaches. A Student's t test was used to compare the exposure areas obtained.

RESULTS: The average age of the cadavers was 83 years, with a balanced representation of genders (60% male, 40% female). Comparison of zones between endoscopy and AIP found for Zone 1: 1.4 cm2 (range - 3.813 to 1.013) for AIP with no statistical significance. For Zone 2: 0.5 cm2 (range - 1.9141 to 2.9141) for AIP with no statistical significance. For Zone 3: 0,6 cm2 (range - 1.0243 to 2.2243) for AIP with no statistical significance. And for Zone 4: 3.5 cm2 (1.874; 5.126) for endoscopy with statistical significance (p = 0.001).

CONCLUSION: Our study demonstrates that the endoscopic method provides comparable visualization of the different pelvic zones compared to the open method (AIP), with enhanced access to Zone 4, a crucial area in managing acetabulum and pelvic ring fractures.

LEVEL OF EVIDENCE: Level V, cadaveric study.

PMID:40163078 | DOI:10.1007/s00264-025-06515-2

Injury. 2025 Mar 24;56(6):112300. doi: 10.1016/j.injury.2025.112300. Online ahead of print.

ABSTRACT

- A 49yo woman was involved in a car crash. She suffered an isolated, open, left both bones forearm mid-diaphyseal fracture. She had a sling applied at the scene but had a 16-hour transport time from an isolated rural location. She was found to have no other injuries upon her careful work-up at the Level 1 emergency department. The injury had not compromised the distal neurovascular status of the limb. The ER staff admitted the patient to the orthopedic team. The patient had an evaluation by a senior resident and their assessment was that this was a grade 3A open fracture of the dorsum of the mid forearm (Figure 1 and Figure 2). By the time surgery could be initiated at the Trauma center, fully 36 hours had passed. Most of the delay at the Trauma center was due to other very significant injuries in the Trauma room that day. PAST MEDICAL HISTORY AND SOCIAL HISTORY: - She is a married woman and lives with her husband and a university aged teenager. She has been a nonsmoker. She has no medical problems that she sees a physician about. She works as a secretary but presently is unemployed. She has only had obstetrical surgery, has no allergies and takes no medications. She is a regular wine drinker.

PMID:40158403 | DOI:10.1016/j.injury.2025.112300

Injury. 2025 Mar 24:112286. doi: 10.1016/j.injury.2025.112286. Online ahead of print.

NO ABSTRACT

PMID:40157870 | DOI:10.1016/j.injury.2025.112286

Injury. 2025 Mar 20:112277. doi: 10.1016/j.injury.2025.112277. Online ahead of print.

NO ABSTRACT

PMID:40157869 | DOI:10.1016/j.injury.2025.112277

Injury. 2025 Mar 22;56(4):112291. doi: 10.1016/j.injury.2025.112291. Online ahead of print.

ABSTRACT

Novel and innovative orthopedic devices are needed to address clinical challenges in orthopedic practice. Obtaining regulatory authorization for such devices, however, can prove challenging. An inherent dilemma exists between innovation to address unmet needs and imitation to demonstrate substantial equivalence to a predicate device, which is required for the less burdensome 510(k) pathway. This article provides both an overview of highly innovative orthopedic devices over the last 10 years as well as considerations for FDA regulatory pathways and programs available to manufacturers of such devices. A review of 20 innovative orthopedic devices receiving Breakthrough Device Designation and/or a De Novo classification found that devices had diverse features and applications, but did possess shared technological trends including bioresorption, flexible components, and new substance/material use. A review of all new orthopedic devices authorized through the three major regulatory pathways in the last 10 years was also conducted. Spinal devices represented the largest share of recent orthopedic devices (38 % of 510(k) clearances and 25 % of De Novo classifications). Across all three pathways, decision time was on average around 30 % shorter for orthopedic devices with a Breakthrough Device Designation versus those without, though differences were not significant. New orthopedic devices authorized in the last 10 years were found to be highly reliant on the 510(k) pathway, with a 99 % utilization rate. However, the FDA Breakthrough Devices Program and De Novo pathway offer opportunities specific to innovative technologies, such as expedited review and potential market competition protection, as demonstrated through specific case studies in this review. As these FDA initiatives continue to evolve and manufacturers continue to take advantage of these opportunities, orthopedic device development, which has primarily prioritized incremental innovation, may too evolve to produce more breakthrough innovations.

PMID:40157338 | DOI:10.1016/j.injury.2025.112291

Injury. 2025 Mar 20;56(6):112274. doi: 10.1016/j.injury.2025.112274. Online ahead of print.

ABSTRACT

The long-term effects of injuries have significant implications for forensic practice. There is a dearth of research highlighting long-term psychological problems resulting from various injuries in under-researched populations like Mozambique. This study employed multiple logistic regression analyses on the 2022-2023 Mozambique Demographic and Health Survey (DHS) data to determine injury types predictive of emotional trauma, limb function loss, and chronic pain as continuing health problems. The data from the Accidents and Injury module was used for all participants. The injuries analyzed included broken bones, wounds, internal injuries, and burns. Additionally, we investigated the predictive capacity of unintentional and violent injuries on emotional trauma as a continuing health problem. The total number of injured people (whether due to traffic or non-traffic accidents) was 419. The proportion of unintentional injuries was much higher than violent injuries (86.4% vs 7.7%). Our results indicated that burn injuries were strongly associated with emotional trauma (Odds Ratio (OR) = 4.15, 95% CI: [1.24-13.84], P = 0.021), broken-bone injuries predicted both limb function loss (OR = 2.67, 95% CI: [1.17- 6.09], P = 0.02) and emotional trauma (OR = 3.73, 95% CI: [1.51-9.22], P = 0.005), internal injuries predicted chronic pain (OR = 2.52, 95% CI: [1.18-5.38], P = 0.018), and violent injuries predicted emotional trauma (OR = 4.41, 95% CI: [1.16-16.67], P = 0.03). These findings enhance comprehension of how injury types predict long-term psychological complications in Mozambique and provide valuable insights regarding the enduring consequences of various injuries in similar populations.

PMID:40157228 | DOI:10.1016/j.injury.2025.112274

Int Orthop. 2025 Mar 29. doi: 10.1007/s00264-025-06484-6. Online ahead of print.

ABSTRACT

PURPOSE: Despite the increasing understanding of femoroacetabular impingement (FAI), the impact of specific patient characteristics, including inflammatory pathologies like axial spondyloarthritis (axSpA), on its pathophysiology and clinical outcomes following treatment remains inadequately defined. Therefore, the purpose of this scoping review was to evaluate the relationship between FAI and sacroiliac (SI) joint abnormalities and FAI and axSpA.

METHODS: The study was conducted following the framework established by Arksey and O'Malley and Levac et al., adhering to the PRISMA scoping review extension checklist. A systematic search was performed across MEDLINE, EMBASE, and Cochrane Library databases for articles published until August 2024. A total of 120 articles were screened and eight finally met the inclusion criteria.

RESULTS: The review analysed data from the eight retrospective studies with a total of 1,723 patients. We found that the prevalence of SI joint abnormalities in patients with FAI can be as high as 25-28%. Furthermore, the prevalence of FAI morphology in patients with axial spondyloarthritis can be as high as 20-37%. Finally, patients undergoing hip arthroscopy for FAI with axSpA and/or SI joint abnormalities have lower postoperative outcome scores reported in comparison with those patients who do not have these comorbidities.

CONCLUSION: Over a quarter of patients with FAI can have concomitant radiographic SI joint abnormalities. We cannot overemphasise the importance of assessing the spine, specifically the SI joint, and ruling out symptoms emanating from the SI joint in all patients with FAI. There is clearly a knowledge gap in understanding the underlying pathophysiology linking FAI and axSpA. We require further research to elucidate the underlying mechanisms of this relationship, standardise evaluation methods, and explore long-term outcomes in this cohort of patients.

PMID:40156722 | DOI:10.1007/s00264-025-06484-6

Int Orthop. 2025 Mar 29. doi: 10.1007/s00264-025-06514-3. Online ahead of print.

ABSTRACT

We discuss the study by Xiao Han et al., titled " Comprehensive Comparison Between Conservative Therapy and Surgical Management for Completely Displaced and Comminuted Mid-Shaft Clavicle Fractures " The authors compared outcomes between conservative and surgical treatments in 105 patients, finding higher union rates, faster healing, and no malunion in the surgical group, albeit with a notable incidence of postoperative numbness. While long-term functional outcomes were comparable, surgery offered quicker recovery of strength and return to work. However, as a retrospective study, potential selection bias exists-more active, younger patients tended to undergo surgery, while older patients with comorbidities opted for conservative care. The absence of propensity score matching (PSM) further limits comparability. Moreover, the relatively short follow-up (mean: 21.24 months) restricts insights into long-term complications. Previous long-term studies suggest surgical benefits may wane over time. Future randomized, long-term, and cost-focused studies would be valuable to guide treatment decisions more robustly.

PMID:40155447 | DOI:10.1007/s00264-025-06514-3

Injury. 2025 Mar 3;56(4):112241. doi: 10.1016/j.injury.2025.112241. Online ahead of print.

ABSTRACT

BACKGROUND: To compare the outcome of pararectus, ilioinguinal, and intrapelvic approaches in patients with acetabular fracture and to rank the best, second best, and third best surgical approach.

METHODS: A literature search was conducted in PubMed, Epistemonikos, and Embase up to 30 November 2024. A network meta-analyses was conducted to assess the outcomes of pararectus, ilioinguinal, and intrapelvic surgical approaches. Random-effects models with mean differences (MDs) and odds ratios (ORs) were calculated for continuous and binary variables, respectively, all with 95 % confidence intervals (CIs).

RESULTS: A total of 30 primary studies (2,348 patients) were included. There was no statistically significant difference between the pararectus and intrapelvic approach in overall complications (OR 0.86, 95 % CI 0.47 to 1.58). The pararectus approach had 0.51 lower odds for overall complications compared with the ilioinguinal approach (OR 0.51, 95 % CI 0.28 to 0.94). The intrapelvic approach had 0.59 lower odds for overall complications compared with the ilioinguinal approach (OR 0.59, 95 % CI 0.37 to 0.94). There was no statistically significant difference between the pararectus and intrapelvic approach in reduction quality (OR 1.32, 95 % CI 0.89 to 1.95). The pararectus approach had 2.02 higher odds for reduction quality compared with the ilioinguinal approach (OR 2.02, 95 % CI 1.30 to 3.15). The intrapelvic approach had 1.53 higher odds for reduction quality compared with the ilioinguinal approach (OR 1.53, 95 % CI 1.12 to 2.10). There was no statistically significant difference between the pararectus and intrapelvic approach in intraoperative blood loss (MD -31.38, 95 % CI -105.62 to 42.85). The pararectus approach had a 207.35 mL lower intraoperative blood loss compared with the ilioinguinal approach (MD -207.35, 95 % CI -288.52 to -126.18). The intrapelvic approach had a 175.97 mL lower intraoperative blood loss compared with the ilioinguinal approach (MD -175.97, 95 % CI -233.51 to -118.42).

CONCLUSION: This is the first study to rank the three anterior surgical approaches for acetabular fractures. The findings establish that while the pararectus and intrapelvic approaches are comparable, the ilioinguinal approach ranks third. The superior outcomes of the pararectus and intrapelvic approaches in complications, operative efficiency, and reduction quality highlight their importance in surgical practice.

PMID:40154238 | DOI:10.1016/j.injury.2025.112241

Injury. 2025 Mar 14;56(4):112268. doi: 10.1016/j.injury.2025.112268. Online ahead of print.

ABSTRACT

BACKGROUND: Time to union in civilian firearm injuries is variable and not well described in the literature. This study measures the time to union for femoral and tibial shaft fractures treated with an intramedullary nail (IMN). Time to union is compared across open, closed, or ballistic trauma (BT) fractures. The goal of the study is to answer the questions: (1) Do tibial shaft fractures heal in specific temporal patterns based on mechanism of injury and (2) Do these temporal healing patterns apply to both the tibia and femur?

PATIENTS AND METHODS: Included patients had tibial or femoral shaft fractures (OTA/AO 32 and 42) treated at an urban level 1 trauma center between 2015 and 2020 with IMN. Patients were eligible if radiographic imaging was available for any four of five follow-up timepoints, absence of preexisting hardware, and BT was from low velocity handgun injuries. Radiographic union scale (RUS) was compared amongst six groups (Open, Closed or BT for Femur and Tibia fractures), at 60-90 days, 91-180 days, 181- 270 days, and 271-365 days and greater than 365 days. Statistical comparison was performed using a two-way ANOVA and Tukey's multiple comparisons.

RESULTS: Included in the study were 114 patients, with 20 patients in each group except the OPEN femur fracture group with 14.

TIBIA: At the 91-180 day time point, CLOSED tibia RUS was significantly higher than for BT and OPEN tibia RUS. At 181-270 days, CLOSED tibia RUS was significantly higher than OPEN tibia. At 271-365 days and >365, CLOSED and BT RUS were significantly higher than OPEN RUS.Femur: At the 91-180 day time point, OPEN femur RUS was significantly lower than CLOSED and BT femur RUS. At later timepoints, all three groups achieved union with mean RUS>10.

DISCUSSION: This study demonstrates that healing of tibial shaft fractures from BT is not significantly different from closed fractures after 180 days post-operatively. Additionally, femoral shaft fractures from a BT healed similarly to closed and open fractures after 180 days post-operatively.

LEVEL OF EVIDENCE: Prognostic Level III.

PMID:40154237 | DOI:10.1016/j.injury.2025.112268

J Bone Joint Surg Am. 2025 Mar 28. doi: 10.2106/JBJS.24.00520. Online ahead of print.

ABSTRACT

BACKGROUND: Pelvic tilt (PT) is an important sagittal parameter to be restored to the normal range in corrective surgery for spinopelvic malalignment. However, the normal value of PT varies among patients. With the introduction of the pelvic inclination angle (PIA), which is the angle subtended by the vertical axis and the line connecting the anterior pubic tubercle and the anterior superior iliac spine, we aimed to determine whether the PIA could reflect the symptom severity and whether normal PIA values exist.

METHODS: The study cohort consisted of patients with spinopelvic malalignment (patient group) and normal healthy adults (normal group). In the patient group, correlation analyses were performed to investigate the relationship between the PIA and other sagittal parameters and between the sagittal parameters and patient-reported outcome measures. In the normal group, correlation analysis was performed to assess the relationship between pelvic incidence (PI) and other sagittal parameters. The radiographic parameters were compared according to PI categories.

RESULTS: There were 162 patients in the patient group, with a mean age of 71.1 years, and 108 in the normal group, with a mean age of 32.1 years. In the patient group, the PIA strongly correlated with the conventional parameters such as PT, PI-lumbar lordosis mismatch, and T1-pelvic angle. The PIA had weak to moderate correlations with all patient-reported outcome measures, of which the correlation coefficients were similar to or greater than those of other sagittal parameters with patient-reported outcome measures. In the normal group, PI showed moderate to strong correlations with all conventional sagittal parameters except for the PIA, which correlated very weakly with PI. Unlike the other sagittal parameters, the PIA did not significantly differ among the PI categories.

CONCLUSIONS: The PIA reflected the symptom severity and had a normal value independent of PI. As an alternative to PT, the PIA can be a clinically useful parameter in evaluating and managing patients with spinopelvic malalignment.

CLINICAL RELEVANCE: As the PIA is independent of PI, it will be more useful in differentiating between patients with normal spinopelvic alignment and those with spinopelvic malalignment and in reflecting the clinical symptoms of patients with spinopelvic malalignment. In addition, by providing a cutoff value of 13.6°, the PIA can be used as a surgical target or to predict postoperative outcomes.

PMID:40153519 | DOI:10.2106/JBJS.24.00520

J Bone Joint Surg Am. 2025 Mar 28. doi: 10.2106/JBJS.24.01031. Online ahead of print.

ABSTRACT

BACKGROUND: The operating room start time (ORST) for pediatric femoral fractures is a health-care quality metric used for hospital rankings and accreditation. Factors affecting ORST remain unclear. This study aimed to evaluate the demographic and clinical factors associated with gold-standard (early) ORST (<18 hours) versus delayed ORST (≥18 hours) for pediatric femoral fractures.

METHODS: A retrospective review was conducted of 216 pediatric patients with a femoral shaft fracture admitted to the emergency department (ED) at a pediatric Level-I trauma hospital from 2021 to 2023. Patient demographic and clinical data were analyzed to identify significant factors associated with ORST. Immediate postoperative outcomes were compared across ORST groups.

RESULTS: In multivariable models, race, ED admission time, comorbidities, and surgery type affected ORST (p < 0.05). Compared with White patients, patients of other racial or ethnic groups, including Hispanic, Black, Asian, and multiracial patients, had 2.4 times higher odds of delayed ORST. Compared with midnight to 6 a.m. ED admissions, the odds of delayed ORST were 6.6 times higher for ED admissions between 6 a.m. and noon and 9.2 times higher for ED admissions between noon and 6 p.m. Patients with comorbidities were 4.7 times more likely to experience delayed surgery compared with healthy patients. Patients who underwent open reduction and internal fixation (ORIF) were 2.5 times as likely as patients who underwent closed reduction (CR) with a spica cast to have delayed ORST. Delayed ORST was associated with longer hospital stay (median, 71 hours) compared with early ORST (median, 41 hours), but not with immediate complications.

CONCLUSIONS: ED admission time, race, method of transfer, comorbidities, and procedure type were associated with ORST for pediatric femoral fractures. Longer ORST led to a disproportionately longer hospital stay.

LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

PMID:40153486 | DOI:10.2106/JBJS.24.01031

J Bone Joint Surg Am. 2025 Mar 28. doi: 10.2106/JBJS.24.00034. Online ahead of print.

ABSTRACT

➢ Risk stratification in orthopaedic surgery is complex and depends on the outcome of interest and multiple interdependent factors. Effective risk stratification has uses for limiting and predicting adverse events in patients undergoing discretionary surgery, avoiding the penalization of surgeons for operating on candidates whose health is situated in more difficult circumstances, and ensuring that inordinate attention is not placed on discrete musculoskeletal pathophysiology when there are other pressing health priorities.➢ For individual patient decision-making, no comprehensive risk-stratification tool currently exists, in part due to the heterogeneity of orthopaedic procedures performed and the diverse patient population treated. The Elixhauser Comorbidity Measure and the Risk Stratification Index 3.0 appear to be most promising.➢ At a population level, risk stratification may be useful in alternative payment models to ensure that hospitals that treat a disproportionate number of high-risk patients are not penalized and that cherry-picking (preferentially selecting only healthier patients with a lower risk of complications) does not occur. Any attempt to risk-stratify may have unintended consequences.➢ Orthopaedic surgeons must be aware of the tools available, their strengths, and their limitations in order to be included in decision-making as payment models and public health policies are implemented.

PMID:40153485 | DOI:10.2106/JBJS.24.00034

J Bone Joint Surg Am. 2025 Mar 28. doi: 10.2106/JBJS.24.01142. Online ahead of print.

NO ABSTRACT

PMID:40153484 | DOI:10.2106/JBJS.24.01142