Injury. 2025 Jan 3;56(2):112141. doi: 10.1016/j.injury.2025.112141. Online ahead of print.

NO ABSTRACT

PMID:39778263 | DOI:10.1016/j.injury.2025.112141

J Bone Joint Surg Am. 2025 Jan 7. doi: 10.2106/JBJS.24.01095. Online ahead of print.

NO ABSTRACT

PMID:39774540 | DOI:10.2106/JBJS.24.01095

Int Orthop. 2025 Jan 8. doi: 10.1007/s00264-024-06399-8. Online ahead of print.

NO ABSTRACT

PMID:39777521 | DOI:10.1007/s00264-024-06399-8

Int Orthop. 2025 Jan 8. doi: 10.1007/s00264-024-06402-2. Online ahead of print.

ABSTRACT

PURPOSE: High Fascial Compartment Pressure (HCP) is one of the most common complications in ankle fractures. This study aimed to investigate the incidence of HCP in pilon fracture and analyze the risk factors of HCP in order to closely monitor its further development into Acute Compartment Syndrome. A nomogram is constructed and validated to predict HCP in patients with pilon fracture.

METHODS: We collected information on 1,863 patients with pilon fracture in the 3rd Hospital of Hebei Medical University Hospital from January 2019 to March 2024. Patients with HCP were assigned to the HCP group and those without HCP to the non-HCP group. The inpatient medical record system was inquired for data collection, including demographics, comorbidities, injury types, and laboratory biomarkers. Variables with a significance level of P < 0.05 in the univariate analysis were included in the multivariate logistic regression analysis. The backward stepwise regression method was applied to identify independent risk factors associated with HCP. The selected predictors were then entered into R software for further analysis, and Nomogram construction.

RESULTS: The rate of HCP was 11.57%. Several predictors of HCP were found, including Body Mass Index (BMI) (p<0.001), Deep Vein Thrombosis (p < 0.001), occurrence of Fracture Blister (FB) (p < 0.001), use of Dehydrating Agent (p < 0.001), duration of limb immobilization (p < 0.001),and Systemic Immune-inflammation Index (SII) (p < 0.001). In addition, BMI (p < 0.001, OR 1.52, 95% CI 1.35 to 1.71), DVT (p < 0.001, OR 4.35, 95% CI 2.51 to 7.52), duration of limb immobilization (p < 0.01, OR 1.66, 95%CI 1.25 to 2.20) and SII (p < 0.01, OR 1.00, 95%CI 1.00 to 1.00) were correlated with increased HCP risk. Meanwhile, FB (p < 0.001, OR 0.23, 95% CI 0.13 to 0.39) and Dehydrating Agent (p < 0.001, OR 0.10, 95% CI 0.06 to 0.19) were associated with decreased HCP risk. The nomogram was established based on six predictors independently related to HCP.

CONCLUSIONS: Our investigation has shown that, compared with tibial diaphyseal fractures, pilon fractures are more prone to HCP because of their high energy injury characteristics. This research also shows BMI, DVT, occurrence of FB, use of Dehydrating Agent, duration of limb immobilization, and SII are independent risk factors for HCP in patients with pilon fracture. We have also devised a nomogram grounded in these identified predictors. In particular, this study found for the first time that SII is an independent risk factor for HCP, which provides a basis for clinical and basic science research on fascial immunology in the future.

PMID:39774930 | DOI:10.1007/s00264-024-06402-2

Int Orthop. 2025 Jan 6. doi: 10.1007/s00264-024-06401-3. Online ahead of print.

ABSTRACT

PURPOSE: Accurate identification of radiographic landmarks is fundamental to characterizing glenohumeral relationships before and sequentially after shoulder arthroplasty, but manual annotation of these radiographs is laborious. We report on the use of artificial intelligence, specifically computer vision and deep learning models (DLMs), in determining the accuracy of DLM-identified and surgeon identified (SI) landmarks before and after anatomic shoulder arthroplasty.

MATERIALS & METHODS: 240 true anteroposterior radiographs were annotated using 11 standard osseous landmarks to train a deep learning model. Radiographs were modified to allow for a training model consisting of 2,260 images. The accuracy of DLM landmarks was compared to manually annotated radiographs using 60 radiographs not used in the training model. In addition, we also performed 14 different measurements of component positioning and compared these to measurements made based on DLM landmarks.

RESULTS: The mean deviation between DLM vs. SI cortical landmarks was 1.9 ± 1.9 mm. Scapular landmarks had slightly lower deviations compared to humeral landmarks (1.5 ± 1.8 mm vs. 2.1 ± 2.0 mm, p < 0.001). The DLM was also found to be accurate with respect to 14 measures of scapular, humeral, and glenohumeral measurements with a mean deviation of 2.9 ± 2.7 mm.

CONCLUSIONS: An accelerated deep learning model using a base of only 240 annotated images was able to achieve low levels of deviation in identifying common humeral and scapular landmarks on preoperative and postoperative radiographs. The reliability and efficiency of this deep learning model represents a powerful tool to analyze preoperative and postoperative radiographs while avoiding human observer bias.

LEVEL OF EVIDENCE: IV.

PMID:39760903 | DOI:10.1007/s00264-024-06401-3

Int Orthop. 2025 Jan 6. doi: 10.1007/s00264-024-06404-0. Online ahead of print.

NO ABSTRACT

PMID:39760902 | DOI:10.1007/s00264-024-06404-0

Injury. 2024 Dec 27;56(2):112087. doi: 10.1016/j.injury.2024.112087. Online ahead of print.

ABSTRACT

PURPOSE: Several concerns regarding gender equality in orthopedic surgery do exists. The aim of this study was to (1) compare operative times, (2) compare mortality rates, (3) investigate gender disparities in hip fracture surgeries, and (4) analyze gender distribution among attending and resident surgeons performing Closed Reduction Internal Fixation (CRIF) and Hemiarthroplasty (HA) METHODS: All patients >75 years old treated for proximal femur fractures in a level-one trauma center in a four-year timeframe were retrospectively enrolled. Exclusion criteria were follow-up <3 years, incomplete data, active patients treated with total hip arthroplasty (THA) and other surgeries performed during the same anesthesia. Patients were grouped according to procedure: 1) Closed Reduction Internal Fixation (CRIF) and 2) Hemiarthroplasty (HA). Gender and level of expertise (residents or attending surgeon) of leading surgeons (male (M), female (F) and non-binary (NB)) was extracted from medical records. Operative time, mortality rates, and the likelihood of performing either CRIF or HA were compared across genders.

RESULTS: A total of 172 leading surgeons (M: 141 (82%); F: 31 (18%); NB: 0 (0%)) performed 1916 surgical procedures (CRIF: 1425 (74.4%); HA: 491 (25.6%)). 14.7% were performed by female surgeons (group 1: 15.5%; group 2: 12.2%; p = 0.076). No gender disparities were observed in the mean operating times for either group 1 (p = 0.759) or group 2 (p = 0.981). Similarly, there were no significant differences in mortality rates between genders in group 1 (p = 0.5779) or group 2 (p = 0.069). Additionally, no significant gender disparities were found in the performance of CRIF (p = 0.636) or HA (p = 0.141). Finally, analysis of gender distribution among attending and resident surgeons across various procedures, including CRIF and HA, revealed no significant differences in gender distribution (CRIF: p = 0.133, HA: p = 0.468, all procedures: p = 0.122).

CONCLUSIONS: Despite orthopedics still being a male-dominated field, gender does not affect surgical outcomes or the likelihood of performing CRIF or HA. However, the focus should shift towards improving inclusivity in surgical education and practice by providing equal opportunities and removing social and educational barriers based on gender.

PMID:39756148 | DOI:10.1016/j.injury.2024.112087

Injury. 2025 Jan 1;56(2):112135. doi: 10.1016/j.injury.2024.112135. Online ahead of print.

ABSTRACT

INTRODUCTION: In city hospitals, subway-related traumatic amputations are a frequent pattern of injury, however there is a paucity of literature on this specific injury pattern. The purpose of this study was to describe the epidemiology of subway-related traumatic amputations, as well as compare them to non-subway traumatic amputations.

PATIENTS AND METHODS: Retrospective review was performed at a single Level-1 trauma center in a metropolitan area. All patients who sustained a traumatic lower-extremity amputation over a seven-year period were included. Demographics, injury, treatment-related information, and complications were collected. Subway and non-subway traumatic amputations were statistically compared. Cohorts were further subdivided into above-knee amputations (AKAs) and below-knee amputations (BKAs) for statistical comparison.

RESULTS: Fifty-seven patients sustained 72 traumatic lower-extremity amputations, including 64 subway-related amputations. Fifteen patients with bilateral lower-extremity amputations all had subway-related injuries. Patients with subway-related injuries were more likely to have a history of alcohol use disorder (58.1 % vs. 0 %; P = 0.002), and experienced longer stays in the intensive care unit (ICU) (8.9 vs. 3.6 days; P = 0.006). Twenty-four amputations (33.3 %) were complicated by wound infection during the initial hospitalization, with wound cultures growing a variety of organisms, most frequently Enterococcus species and Enterobacter cloacae. When subway injuries were separated by AKAs and BKAs, patients with AKAs underwent more irrigation and debridement procedures on average (10.3 vs. 5.8; P = 0.006), had a higher rate of wound infections (58.8 % vs. 25.0 %; P = 0.018), and had longer hospital stays (50.4 vs. 32.2 days; P = 0.047).

CONCLUSION: Subway-related amputations are associated with longer ICU stays and a history of alcohol use disorder compared to non-subway traumatic amputations. Approximately 1/3 of these patients are expected to develop a wound infection, with Enterococcus and Enterobacter species being the most commonly identified organisms. Further research into high-energy, traumatic amputations, including subway injuries, may help improve prognostication of patient outcomes, identify potential in-hospital complications, and proactively direct differences in care compared to the standard for non-subway-related amputations.

LEVEL OF EVIDENCE: Prognostic Level III.

PMID:39754898 | DOI:10.1016/j.injury.2024.112135

Int Orthop. 2025 Jan 4. doi: 10.1007/s00264-024-06395-y. Online ahead of print.

ABSTRACT

PURPOSE: Subclinical peroneal neuropathy without overt foot drop has been linked to increased fall risk in adults, yet remains under reported due to subtle symptoms and lack of awareness. Patients with carpal tunnel syndrome (CTS) often experience other nerve entrapments, prompting this study to evaluate CTS (a proxy for peroneal nerve entrapment) as a significant predictor of time to first fall.

METHODS: Data from the Merative MarketScan Research Databases (2007-2021) were used to identify adult patients using ICD-9/10 codes. Patients were stratified by CTS diagnosis and fall occurrences, with relevant comorbidities recorded. A survival analysis employing the Cox proportional hazards model assessed relationships between CTS, comorbidities, and future fall risk, accounting for changes in health status over time. Age was the time scale with CTS as a time-varying predictor. This approach isolated CTS-associated risk, while considering the natural increase in fall risk with age.

RESULTS: Among 63,187,681 subjects (mean age = 52.82 years ± 7.61), 1,411,695 had a diagnosis of CTS. Of those with CTS, 45,479 patients had a future fall. Univariate analysis showed significant associations between CTS and higher rates of arthritis and diabetes, while heart disease was less prevalent. CTS increased fall risk by 25% (HR 1.25, p < .005). Heart disease was associated with a 10% increase in fall risk (HR 1.10, p < .005), while arthritis and diabetes increased fall risk by 2% (both HR 1.02, p < .005). Kaplan-Meier curve illustrated a steeper decline in survival probability for the CTS group, indicating they experienced falls at younger ages and at a higher rate than those without CTS (χ² = 4386.4, p < .001).

CONCLUSION: Prior diagnosis of CTS is associated with an increased fall risk. Providers should screen CTS patients for fall risk and implement appropriate monitoring strategies. Further investigation on the role of peroneal nerve entrapment in this increased fall risk is warranted. This study identifies a treatable cause of falls, with potential to enhance patient safety and reduce fall-related morbidity.

PMID:39755784 | DOI:10.1007/s00264-024-06395-y

Int Orthop. 2025 Jan 4. doi: 10.1007/s00264-024-06397-w. Online ahead of print.

ABSTRACT

PURPOSE: Trauma and orthopaedic (T&O) surgery relies on medical implants and materials, often resulting in metalwork wastage (prosthesis, screws, nails, and plates). This places an economic strain on healthcare services and the environment. Our primary outcome is to quantify the implant wastage across the literature, and secondarily investigate the associated costs in this specialty.

METHODS: A literature search of three databases (Scopus, PubMed and Embase) was performed using MeSH terms relating to "implant waste" and "trauma and orthopaedic surgery", from January 1980 to November 2023. We included any observational studies that reported patients undergoing T&O surgery, where the wastage or associated costs was reported.

RESULTS: Our search returned 2,145 articles, of which 15 met the final inclusion criteria, encompassing 26,832 procedures. Nine studies reported the extent and cost of waste, six reported the weight of waste and ten concurrently reported the cost. Implant waste events occurred in up to 30% of all T&O procedures, being the most likely to occur in fracture fixation, and cost hospitals between $4,130 and $189,628.41 annually. Screws were the most wasted material, followed by plates and nails. Up to 95% of waste events were caused by human factors.

CONCLUSION: Despite the limited number of studies, there is an economic burden and environmental footprint in T&O surgery services. The main factors contributing to the waste was human error, and contamination. Further research is required to determine methods of mitigating and limiting implant waste in T&O Surgery.

PMID:39754649 | DOI:10.1007/s00264-024-06397-w

Injury. 2024 Dec 23;56(2):112090. doi: 10.1016/j.injury.2024.112090. Online ahead of print.

ABSTRACT

BACKGROUND: Traumatic injury poses significant physical and psychological challenges, often resulting in psychological distress, encompassing symptoms of anxiety, depression and post-traumatic stress. Despite the recognised need for psychological care in trauma rehabilitation, there is limited empirical evidence of effective interventions tailored specifically for individuals with traumatic injuries, leading to a practice-evidence gap.

OBJECTIVES: This review aimed to evaluate the effectiveness of psychological and behavioural interventions for reducing psychological distress in adults following traumatic injury.

METHODS: This systematic review followed a published protocol (CRD4202342946) and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and the Synthesis Without Meta-analysis (SWiM) in systematic reviews reporting items. Peer-reviewed studies were identified through searches of MEDLINE, APA PsycInfo, CINAHL and Embase databases. Eligible studies involved adults aged 18 and older who had experienced physical trauma requiring immediate medical attention. Studies involving participants with neurological injuries and/or military personnel were not included. Both English- and non-English-language articles were considered. Effect direction was employed as the method of synthesis and risk of bias was assessed using the Cochrane Effective Practice and Organisation of Care (EPOC 9) nine-item assessment tool.

RESULTS: A total of six studies met the review eligibility criteria. There was considerable heterogeneity across the interventions in terms of their nature, timing and duration, however all interventions were delivered within 3-months post-injury. Most studies reported positive intervention effects, with no adverse effects reported. Cognitive Behavioural Therapy (CBT) was the most reported intervention across the studies.

CONCLUSIONS: The review findings highlight the preliminary evidence supporting CBT as a viable option for reducing psychological distress following traumatic injury. However, this may be explained by the dominance of CBT in the literature due to its structured nature, availability and suitability for research, potentially limiting the visibility of alternative therapeutic approaches. Further, these findings are constrained by study limitations, including small sample sizes, heterogeneity of injury types and severity, reliance on self-reported outcomes, and limited follow-up data. Future research should aim to include longitudinal follow-up assessments and explore alternative therapeutic approaches to contribute to our understanding of meaningful trauma rehabilitation methods.

PMID:39753048 | DOI:10.1016/j.injury.2024.112090

Int Orthop. 2025 Jan 2. doi: 10.1007/s00264-024-06403-1. Online ahead of print.

ABSTRACT

INTRODUCTION: During 280 years of studies of the anatomy of the distal tibiofibular articulation, there have arisen many unclear issues regarding the description of individual structures and their terminology. These historical inaccuracies were subsequently reflected in the clinical practice.

MATERIALS AND METHODS: A literature search of original publications and historical sources was performed.

RESULTS: The distal tibiofibular articulation is a synovial joint, rather than a syndesmosis, as it is an integral part of the ankle joint. The interosseous tibiofibular ligament (ITFL), described for the first time by a French anatomist Bichat in 1801, is the strongest ligament of the tibiofibular mortise. Unfortunately, this clinically important ligament is not recognized by the current international anatomical nomenclature. The terms anterior inferior (AITFL) and posterior inferior tibiofibular ligaments (PITFL) are historical remnants "reimported" from the American/British literature and should not be used, because the analogous superior ligaments do not exist. The intermalleolar ligament, first described by Weitbrecht in 1742, is a variable, but constant, structure reinforcing the posterior capsule of the ankle joint. The term inferior transverse ligament (IFT) denoting in the English literature the inferior part of the posterior tibiofibular ligament was originally used for the intermalleolar ligament. The IFT ligament is a part of the posterior tibiofibular ligament and there is no reason to stress its importance.

CONCLUSION: The chaos in the anatomy, terminology and depiction of the articulation of the distal tibia and fibula, unparalleled in any other joint of the human body, is the result of historical development. A certain negative role was, in this respect, played also by Basiliensia Nomina Anatomica (1895), that eradicated ITFL and called the distal tibiofibular joint a syndesmosis.

PMID:39747470 | DOI:10.1007/s00264-024-06403-1

Injury. 2024 Dec 28;56(2):112138. doi: 10.1016/j.injury.2024.112138. Online ahead of print.

ABSTRACT

OBJECTIVES: Fracture-related infection (FRI) is a feared complication in orthopaedic trauma surgery. They are associated with multiple surgical interventions and prolonged antibiotic treatment duration, and hence, increased costs. The objective of this study was to assess the costs of FRI treatment in a Tertiary Swiss Trauma Center and to identify the variables associated with increased costs.

PATIENTS AND METHODS: In this retrospective cohort study, 116 patients with an FRI treated in a Swiss tertiary center between 01/2012 and 12/2019 were included. Clinical data and the costs of each hospital stay were evaluated. Predefined variables were categorized as modifiable and non-modifiable factors and examined for their influence on costs and hospital length of stay (LOS) in univariable and multivariable analyses.

RESULTS: The median cost per patient was 39,219 [interquartile range (IQR) 22,657 to 68,588] CHF. The median LOS was 21 [IQR 14 to 36] days. Most patients were male (67%) with a median age of 58 years [40-70]. The median duration of IV antibiotic use was 16 [9-27] days. Costs related to hospitalization (nursing and physiotherapy) accounted for the highest expenses with a relative share of 49%, whereas surgical procedures had a minor impact on the total cost with a relative share of 19%. In the univariable analysis, significant drivers of both costs and LOS were the number of FRI surgeries, the use of negative pressure wound therapy, duration of IV antibiotic treatment, and cases with a change of surgical strategy. After adjustment for patient and treatment factors, duration of IV antibiotics and change of surgical strategy were associated with higher costs.

CONCLUSIONS: This study illustrates the financial burden of FRI in a DRG system and identifies potential drivers for these costs. Since repeated surgeries or unplanned surgical revisions are drivers of costs, optimal pre-operative planning and coordination between the involved disciplines is key to minimize costs. Management in multidisciplinary teams that are specialized in the treatment of these complex and cost-intensive patients may therefore reduce the financial burden.

PMID:39742836 | DOI:10.1016/j.injury.2024.112138

J Bone Joint Surg Am. 2024 Dec 31. doi: 10.2106/JBJS.24.01399. Online ahead of print.

NO ABSTRACT

PMID:39739912 | DOI:10.2106/JBJS.24.01399