Orthopaedic Trauma Surgery Research Articles

Personalized tourniquet pressure versus uniform tourniquet pressure in trauma orthopedic surgery of extremities: a prospective randomized controlled study

BackgroundTourniquets are widely used in limb fracture surgeries. Controversies still exist about the pressure inflated, including unified tourniquet inflation pressure (UTIP) and personalized tourniquet inflation pressure (PTIP). This study evaluated the hemostatic effect between UTIP and PTIP based on systolic blood pressure (SBP) in extremity fracture patients.Materials and methodsPatients with fresh extremity fractures requiring tourniquets during surgeries were prospectively enrolled and randomly assigned to the UTIP and PTIP groups. The inflation pressure was set to 250 mmHg for the upper extremities and 300 mmHg for the lower extremities in the UTIP group and SBP plus 50 mmHg for the upper extremities and SBP plus 100 mmHg for the lower extremities in the PTIP group. The primary outcome was a hemostatic effect evaluated by the surgeon (satisfied or dissatisfied). Other secondary outcomes included postoperative changes in limb swelling and tourniquet-related complications.ResultsA total of 144 patients were enrolled and randomly assigned to the UTIP group or the PTIP group, and each group has 72 patients (36 upper limb and 36 lower limb). Totally, the hemostasis effect of the PTIP group was worse than that of the UTIP group by non-inferiority test. The hemostatic effect of upper limb fractures with SBP plus 50 mmHg for tourniquet inflation pressure was also worse than that with 250mmHg; however, there was no statistically significant difference between 300mmHg and SBP plus 100 mmHg in the lower limb group hemostasis effect due to a lack of power. Also, no difference was observed in the incidence of complications (p = 1.000) and postoperative changes in limb swelling during 2 days after surgery (upper limb: P1 = 0.546, P2 = 0.545; lower limb: P1 = 0.408, P2 = 0.857) between the PTIP and UTIP group.ConclusionIn the surgery of limb fractures, setting SBP + 50mmHg as tourniquet pressure may not be sufficient for upper limbs. Also, we found no difference between the SBP + 100mmHg and the unified 300mmHg for lower limb surgeries.

The role of tranexamic acid for infection prevention after fracture fixation

Despite the measures employed, fracture-related infections remain a concern after fracture fixation worldwide. Recently, the role of tranexamic acid as a protective drug against postsurgical infections in joint replacement and orthopedic trauma surgery has been proposed, where tranexamic acid has been associated with less surgical wounds complications and infectious complications including periprosthetic joint infection. The mechanism through which tranexamic acid exerts a protective effect against peri-implant infection is still the subject of debate. Although some authors hypothesize an indirect effect inhibiting the formation of postoperative hematoma, there are several studies that show a direct antibacterial effect of the drug against the capacity of bacterial aggregation, even avoiding biofilm formation, favoring the immune response of the host and the action of antibiotics. The purpose of this narrative review is to show the current role of tranexamic acid in orthopedic trauma, specifically its relationship with the prevention of infections related to implants.

Impact of Ultrasound-Guided Regional Anesthesia on Pain Management in Orthopedic Trauma Surgery

Background: Effective pain management is critical in orthopedic trauma surgery to enhance recovery, reduce opioid consumption, and minimize complications. Ultrasound-Guided Regional Anesthesia (UGRA) has emerged as a promising technique for improving postoperative outcomes. This study aimed to evaluate the impact of UGRA on pain control, opioid consumption, postoperative complications, and patient satisfaction compared to standard pain management. Methods: This prospective, comparative study was conducted with 60 patients undergoing orthopedic trauma surgery, divided into two groups: Group A (UGRA, n = 30) and Group B (Control, n = 30) at the Department of Anaesthesia, Analgesia, and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Data on pain scores (VAS), opioid consumption, time to first ambulation, postoperative complications, patient satisfaction, and length of hospital stay were collected and analyzed. Statistical comparisons were made using appropriate tests. Results: UGRA significantly reduced pain scores at 1, 6, and 24 hours post-surgery (p < 0.001), with lower opioid consumption (10 ± 5 mg vs. 25 ± 8 mg, p < 0.001). Time to first ambulation was shorter in Group A (24 ± 4 hours vs. 30 ± 5 hours, p < 0.001). UGRA was associated with fewer complications, including nausea/vomiting (6.7% vs. 26.7%, p = 0.034) and respiratory depression (0% vs. 10%). Patient satisfaction was higher in the UGRA group (4.8 ± 0.4 vs. 3.5 ± 0.6, p < 0.001), with a shorter hospital stay (4 ± 1 days vs. 6 ± 2 days, p < 0.001). Conclusion: UGRA provides superior pain control, reduces opioid consumption and complications, and enhances patient satisfaction in orthopedic trauma surgery, contributing to faster recovery and shorter hospital stays.

Low-value surgical innovation under peer-review: A sham study of abstracts on proximal humerus fractures submitted to scientific meetings.

Innovation has in common the promise of benefit for patients; however, past experience has shown that this promise is not always delivered. Instead, low-value innovation might encourage treatment variation and dilute the available body of evidence. This study aims to investigate (1) whether the peer-review process is capable of filtering out low-value innovation appropriately, and (2) whether low-value surgical innovation would be preferred more often than nonoperative innovation by peer-reviewers in the treatment of proximal humeral fractures in the elderly. Two duplicated sham scientific abstracts, respectively introducing a low-value surgical innovation and a valuable nonsurgical innovation, were submitted to nineteen peer-reviewed scientific meetings worldwide for orthopedic trauma surgery with submission deadlines between 01/01/2022 and 31/12/2022. Decision regarding abstract acceptance was compared. There was a high acceptance rate for the abstract introducing low-value surgical innovation (12 out of 19 (63.2 %)), which was higher than that of a nonoperative duplicate (10 out of 19 (52.6 %)), but this difference was not statistically significant (p = 0.5). The majority of the ten meetings that accepted both abstracts placed both in equivalent programmatic tiers (oral presentation (4) and poster presentation (2)). In three meetings, the surgical abstract received superior program placement (oral presentation). In one case, it was the opposite. There is a high acceptance rate for low-value surgical innovation among peer-reviewed scientific meetings. However, we can not conclude that low-value surgical innovation is preferred more often than nonoperative innovation by peer-reviewers as the differences in acceptance rate were small and not statistically significant. The peer-review process may be suitable as value-based medicine emerges. Scientists should be encouraged to pursue value-based innovation.

Effect of mechanical stability of osteosynthesis on infection rates: Timing of temporary and definitive fixation

Fracture related infection (FRI) remains one of the most challenging complications of orthopaedic trauma surgery. Several factors contribute to FRI development but, among those, particularly interesting from the orthopaedic surgeon's perspective is the contribution of mechanical stability and timing of fracture fixation. These are indeed crucial factors both in prevention and treatment of FRI and are directly influenced by the surgeon's work. While the role of stability has been studied and discussed, the pathophysiological process regulating such role and how this influences surgeon's treatment decision making is still debated. The same applies to the ideal timing of temporary or definitive fixation which varies according to the clinical scenario considered.In the present narrative review, we described the influence of mechanical stability on both FRI pathophysiology and on the decision making of FRI treatment. In addition, we analysed the impact of the timing of fracture fixation on the risk of FRI development particularly in those clinical scenarios where it has been shown to be specifically relevant, such as fractures affecting segments with poor soft tissue envelope, open fractures, damage control orthopaedics, and the need for soft tissue coverage.

Analysis of Sex Diversity Within Orthopedic Trauma Surgery Fellowship Programs

Background: Women continue to be underrepresented in orthopedic surgery and in orthopedic fellowship programs, especially in orthopedic trauma. Purpose: We aimed to assess sex diversity among faculty and trainees in orthopedic trauma surgery fellowship programs and investigate whether the presence of female faculty in those programs is associated with the recruitment of female fellows. Methods: This was a cross-sectional analysis of 63 orthopedic trauma surgery fellowship programs. Information regarding program faculty (as of October 2023) and fellows from 2018 to 2024 was gathered. For programs without publicly accessible information, fellowship coordinators were e-mailed for de-identified sex breakdown of fellows categorized by year. The sex of each fellow and faculty member was categorized as male or female and determined by inference from the fellow’s first name and confirmed via Internet search using photos, biographies, and preferred pronouns when available. Results: Of 63 programs with 323 orthopedic trauma faculty, 30 (47.6%) programs had at least 1 female faculty member, with only 4 (6.4%) programs having female fellowship directors. Women made up 12% ( n = 39) of orthopedic trauma faculty. Of 399 total fellows identified over the 6-year period, 67 (16.7%) were women, with a notable increase in the representation of female fellows over time, from 10.8% in 2018 to 25.4% in 2024. Although programs with female faculty had a similar proportion of female fellows over the 6-year period as those without, in the most recent fellowship year (2023–2024), programs with female faculty had a higher proportion of female fellows than those without (38.2% vs 13.5%, respectively). Conclusion: This cross-sectional, observational study suggests that female surgeons remain underrepresented in orthopedic trauma fellowship director roles, although we observed an increasing number of female trainees entering orthopedic trauma surgery fellowship programs in recent years. In the most recent fellowship class studied, programs with female faculty had more than double the proportion of female fellows compared to programs without any female faculty.

Advancing fracture management: the role of minimally invasive osteosynthesis in orthopedic trauma care.

Minimally Invasive Osteosynthesis (MIO) developed to be a key technique in orthopedic trauma surgery, offering a less invasive alternative for managing fractures in various anatomical regions. However, standardized guidelines for its application are lacking. This study aims to establish comprehensive principles for MIO to guide surgeons in treating different types of fractures and its locations. A retrospective analysis including 57 fractures in 53 patients was conducted. All patients were treated with MIO. Study range - March 2017 to January 2022 at a Level-I trauma university hospital. The analysis covered various fracture types, focusing on surgical approaches, reduction techniques, plate insertion methods, and its outcomes. The efficacy and safety of MIO was evaluated by analyzing complications, fracture healing time, and necessary revision surgeries. MIO is a versatile and effective fracture treatment that minimized soft tissue damage and ensured stable osteosynthetic results. Articular fractures typically used a "one way up" plate insertion technique, while non-articular fractures applied an "inside-up-and-down" approach. Low complication rates confirmed the safety and efficiency of MIO. This research established generalized principles for MIO, offering a systematic approach that can be applied for various fracture types and its locations, by overall enhancing the surgical efficiency as well as patient recovery, without compromising outcomes. This study is classified as Level III evidence according to "The Oxford 2011 Levels of Evidence".

Cement Leakage after Augmentation of Osteoporotic Vertebral Bodies.

Cement leakage is the most common complication of vertebral cement augmentation. The present study investigated cement leakage rates in spinal cement augmentation procedures and identified potential risk factors for cement leakage.140 cases (258 vertebrae) in 131 consecutive patients and nine postmortem cases were evaluated. A total of 258 cement-augmented vertebrae were studied. The data for this were obtained from the hospital records of 131 patients who underwent such operations in 2 orthopaedic trauma surgery clinics in the FRG and from the examinations of 9 postmortem cases at the Institute of Forensic Medicine of the University Medical Centre Hamburg-Eppendorf.Cement leaks were identified in 64 of the 140 cases (45.7%). Local cement leaks were the most common type of leak, accounting for 73.4% of leaks (n=47). Venous leaks were evaluated in 15 cases (23.4%) and pulmonary embolisations in 2 cases (3.1%). Within the group of retrospectively studied cases (n=131), only one patient (0.8%) suffered a symptomatic cement leak. Cement augmentation of fractures to lumbar vertebrae and application of large doses of cement were identified as risk factors for cement leakage.Both the data in the literature relevant to the topic and the results of this work demonstrate a high incidence of cement leakage after vertebral body augmentation procedures. Risk factors for cement leakage are described. Despite the low percentage of symptomatic cases, the possible factors influencing cement leakage should be considered and included in the surgical planning when planning and performing cement augmentations on vertebral bodies.

Medicaid Reimbursement for Common Orthopedic Trauma Procedures is 16.0% Less Compared to Medicare with Substantial Variability Between States.

This study seeks to evaluate the variability of Medicaid reimbursement and compare it to Medicare reimbursement using the 20 most commonly billed orthopedic trauma CPT codes nationwide. The authors anticipate significant variability between states and hypothesize that Medicaid payment will be significantly less than Medicare payment. The top 20 most common orthopedic trauma surgery procedural codes were identified from a previous analysis performed by Haglin et al.1 The Centers for Medicare and Medicaid services physician fee schedule was used to determine reimbursement rates from Medicare, and state Medicaid fee schedules were used to determine reimbursement rates for Medicaid. State Medicaid rates were compared to their corresponding Medicare rates to determine a dollar difference. Additionally, the dollar difference for each CPT code was divided by its respective physician relative value unit (RVU). This was utilized to acknowledge the possible variability in the complexity of orthopedic procedures and the related physician effort. The Medicare Wage Index was used to adjust Medicaid rates based on the cost of living for the state as well. Coefficients of variation were calculated to represent overall variability in Medicaid and Medicare reimbursement rates. The mean reimbursement rates for Medicaid were lower for all 20 procedures compared to Medicare. On average, Medicaid reimbursed 16.0% less than Medicare, and 29.6% less when adjusting for cost-of-living. MCD reimbursed at a higher rate than MCR for all procedures in only nine states (Alaska, Arizona, Arkansas, Montana, Nebraska, New Jersey, New Mexico, and North Dakota, and South Dakota) while 38 states reimbursed at a lower rate than MCR, on average. The coefficient of variation ranged from 0.24 to 0.34 for the Medicaid unadjusted group and from 0.35 to 0.46 for the Medicare Wage-Index adjusted group. In contrast, the Medicare group was consistent at 0.06 for all 20 procedures. The average dollar difference across the 20 CPT codes for Medicaid reimbursement compared to Medicare ranged from -$76.89 to -$225.17, and the dollar difference per relative value unit ranged from -$5.96 to -$15.16. This study found a high amount of variation between state Medicaid reimbursement rates and average rates that were significantly lower than Medicare reimbursement rates for the top twenty most utilized orthopedic trauma CPT codes as identified by Haglin et al. The discrepancy in reimbursement was increased when Medicaid rates were adjusted for state cost-of-living. Level III. See Instructions for Authors for a complete description of levels of evidence.

Primary Closure of External Fixator Pin Sites Is Safe After Orthopaedic Trauma Surgery.

To determine if rates of pin site infection and surgical site infection among patients managed with primary closure after external fixator removal were similar to those allowed to heal secondarily. Retrospective cohort. Urban/Suburban Academic Level I Trauma Center. Patients who had received a lower extremity external fixator for provisional management before definitive fixation of lower extremity fractures were included with pin site wounds closed primarily or allowed to heal by secondary intention. The rate of pin tract infection and surgical site infection following primary closure of external fixator pin sites relative to patients whose pin sites were allowed to heal through secondary intention. In total, 256 patients were evaluated: 143 patients (406 pin sites) in the primary closure group and 113 patients (340 in sites) in the secondary closure group. The average age was 49 ± 16 years. Sixty-five percent of included patients were male. There was no difference in pin tract infections between cohorts (primary = 0.5%, secondary = 1.5%, P = 0.26). External fixator duration in the primary closure group was 11.5 ± 8.4 days and 13.0 ± 8.1 days in the secondary closure group (P = 0.15). There was a greater rate of surgical site infections in the secondary intention cohort (15.9% vs. 7.7%, P = 0.047). There was no difference in pin site infection rate after primary pin site closure relative to patients who were allowed to heal through secondary intention. Furthermore, there was a lower rate of surgical site infection after primary closure. These results challenge the dogma of secondary closure for ex fix pin sites, suggesting that debridement and primary closure is a safe option for management of external fixator pin sites and may impart benefit in decreasing infection risk. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Assessing Patient Understanding and Satisfaction in Orthopedic Trauma and Elective Surgery Admissions.

Background When seeking healthcare, patients often struggle to understand the information provided by healthcare professionals regarding their condition and treatment plan. Additionally, patient satisfaction with their experience can vary widely. Improved patient understanding and satisfaction are linked to better outcomes. This study aims to explore the factors influencing patient understanding to help healthcare professionals enhance these aspects. Objective This study evaluated the level of understanding and satisfaction among patients attending outpatient appointments. It also investigated factors influencing understanding by examining differences in results across various patient groups and analyzing these variations. Methods This study was conducted at Queens' Hospital Burton, a level III trauma unit, over a three-week period in September 2023. Patients attending their orthopedic outpatient appointments were given a questionnaire, which included both bipolar 1-5 scale questions and open-ended text response questions. Results Patients generally reported high levels of understanding and satisfaction, averaging 90.34% and 96.20%, respectively. Those seen in a nurse-led clinic demonstrated significantly greater understanding of their condition compared to those seen by a physician (p = 0.0377). Additionally, trauma patients had a significantly higher level of understanding (p = 0.0167) and satisfaction (p = 0.0115). Conclusions To achieve better patient outcomes, it is crucial to optimize both patient understanding and satisfaction. Nurse-led clinics demonstrate higher levels of understanding, so identifying and incorporating the factors that contribute to this success into physician-led clinics is essential. These factors may include differences in communication methods, the resources provided, or the consultation setting. Additionally, the educational methods used with trauma patients appear more effective than those used for elective cases and should be evaluated to determine if they can enhance understanding and outcomes in other settings. Implementing evidence-based strategies for effective patient communication, such as maintaining good eye contact, avoiding medical jargon, and establishing rapport, could improve understanding and satisfaction and ultimately lead to better patient outcomes.

How does trauma secondary to unexpected extreme weather affect orthopaedic surgery departments? : An epidemiological study on the Filomena snowstorm

Trauma secondary to extreme weather events may heavily impact the normal activity of orthopaedic surgery departments, especially in places not prepared to deal with them. The Filomena snowstorm, which happened in January 2021, was one of the greatest snowstorms ever in Spain. During it, the constant influx of trauma patients caused Orthopaedic Emergencies Department (OED) to collapse. The primary objective of this study was to describe the orthopaedic injuries and changes in fracture's epidemiology observed during this exceptional period. Secondary objectives were to analyse the collected variables in order to minimize the future impact of these unexpected extreme weather events. A retrospective cohort study between patients that came to the OED during the snowstorm (Filomena group) and those who came on the same period of the previous year (Control group) was made. The following data were collected: age, sex, injury location, injury mechanism, diagnosis, AO/OTA fracture classification, treatment type (conservative vs surgical) and delay of surgical treatment. Atotal of 1237 patients were included, 655 patients from the Filomena group and 582 from the Control group. One in two patients in the Filomena group sustained afracture (50.7% vs 23.2%). The most frequent diagnosis on the Filomena group was distal radius fracture (16.2%), which was five times more frequent than in the Control group (3.4%). Asignificant increment was also observed in the incidence of ankle (21.7%) and proximal humerus (33%) fractures. In the Filomena group, surgically treated fractures increased by 168%, being more severe, as C‑type fractures were more prevalent (23% vs 13%). Mean delay to surgery was 6.78 days during the snowstorm. Unexpected snowstorms entail an exponential rise in orthopaedic care demand and OED pressures. Asignificant increment in orthopaedic trauma surgery, up to 168% more, particularly distal radius, proximal humerus and ankle fractures, is to be expected, which will imply elective surgery cancellation, hurting patients and increasing costs.

Racial Disparities Exist in 90-Day Unplanned Return to the Emergency Department Following Orthopaedic Trauma Surgery.

Racial disparities in healthcare outcomes exist, including in orthopaedic trauma care. The aim of this study was to determine the impact of race, social deprivation, and payor status on 90-day emergency department (ED) revisits among orthopaedic trauma surgery patients at a Level 1 trauma academic medical center. Retrospective chart review analysis. Level 1 trauma academic center in Durham, NC. Adult patients undergoing orthopaedic trauma surgery between 2017 and 2021. The primary outcome of this retrospective cohort study was 90-day return to the ED. Logistic regression analysis was performed for variables of interest [race, social deprivation (measured by the Area Deprivation Index), and payor status] separately and combined, with each model adjusting for distance to the hospital. Results were interpreted as odds ratios (ORs) of 90-day ED revisits comparing levels of the respective variables. Statistical significance was assessed at α = 0.05. A total of 3120 adult patients who underwent orthopaedic trauma surgery between 2017 and 2021 were included in the analysis. Black race (OR = 1.47; 95% confidence interval [CI]: 1.17-1.84, P < 0.001) and Medicaid coverage (OR = 1.63, 95% CI: 1.20-2.21, P = 0.002) were significantly associated with higher odds of return to ED compared with non-Black or non-Medicaid-covered patients. While ethnic minority (Hispanic/Latino or non-White) was statistically significant while adjusting only for distance to the hospital (OR = 1.23, 95% CI: 1.00-1.50, P = 0.047), it was no longer significant after adjusting for the other sociodemographic variables (OR = 1.13, 95% CI: 0.91-1.39, P = 0.27). The weighted Area Deprivation Index was not associated with a difference in odds of return to ED in any adjusted models. The results highlight the presence of racial and socioeconomic disparities in ED utilization, with Black race and Medicaid coverage significantly associated with higher odds of return to the ED. Future research should delve deeper into comprehending the root causes contributing to these racial and socioeconomic utilization disparities and evaluate the effectiveness of targeted interventions to reduce them. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Establishing surgical volume benchmarks for Orthopaedic Trauma Association (OTA)-accredited fellowship training

IntroductionCase volumes of trauma centers and surgeons influence clinical outcomes following orthopaedic trauma surgery. This study quantifies surgical volume benchmarks for Orthopaedic Trauma Association (OTA)-accredited fellowship training in the United States. MethodsThis was a retrospective cross-sectional study of orthopaedic trauma fellows graduating between 2018 and 2019 to 2022–2023. Case volume percentiles were calculated across categories and variability defined as the fold-difference between 90th and 10th percentiles. Temporal trends were assessed with linear regression. Results446 orthopaedic trauma fellows were included in this study. Mean reported case volume increased from 898 ± 245 in 2018–2019 to 974 ± 329 in 2022–2023 (P = 0.066). Mean case volume was 924 over the study period and mostly consisted of other (418 cases, 45 %), subtrochanteric/intertrochanteric femoral neck (84 cases, 9 %), open fracture debridement (72 cases, 8 %), pelvic ring disruption / fracture (55 cases, 6 %), acetabular fracture (41 cases, 4 %), tibial shaft fracture (39 cases, 4 %), and femoral shaft fracture (38 cases, 4 %) cases. Overall variability in total reported case volume was 2.0. Variability was greatest in distal radius fracture (14.8), amputation (9.5), fasciotomy (8.0), and proximal humerus repair (5.0). ConclusionGraduates from OTA-accredited fellowship training perform 924 cases on average, which exceeds the current minimum requirement of 600 cases. Case volume benchmarks can assist trainees and faculty align training goals with fellowship program strengths. More research is needed to determine evidence-based case minimum requirements for core competency training in orthopaedic trauma surgery.

ChatGPT can yield valuable responses in the context of orthopaedic trauma surgery.

To assess the possibility of using Generative Pretrained Transformer (ChatGPT) specifically in the context of orthopaedic trauma surgery by questions posed to ChatGPT and to evaluate responses (correctness, completenessand adaptiveness) by orthopaedic trauma surgeons. ChatGPT (GPT-4 of 12 May 2023) was asked to address 34 common orthopaedic trauma surgery-related questions and generate responses suited to three target groups: patient, nonorthopaedic medical doctorand expert orthopaedic surgeon. Three orthopaedic trauma surgeons independently assessed ChatGPT's responses by using a three-point response scale with a response range between 0 and 2, where a higher number indicates better performance (correctness, completenessand adaptiveness). A total of 18 (52.9%) of all responses were assessed to be correct (2.0) for the patient target group, while 22 (64.7%) and 24 (70.5%) of the responses were determined to be correct for nonorthopaedic medical doctors and expert orthopaedic surgeons, respectively. Moreover, a total of 18 (52.9%), 25 (73.5%)and 28 (82.4%) of the responses were assessed to be complete (2.0) for patients, nonorthopaedic medical doctorsand expert orthopaedic surgeons, respectively. The average adaptiveness was 1.93, 1.95and 1.97 for patients, nonorthopaedic medical doctors and expert orthopaedic surgeons, respectively. The study results indicate that ChatGPT can yield valuable and overall correct responses in the context of orthopaedic trauma surgery across different target groups, which encompassed patients, nonorthopaedic medical surgeonsand expert orthopaedic surgeons. The average correctness scores, completeness levelsand adaptiveness values indicated the ability of ChatGPT to generate overall correct and complete responses adapted to the target group. Not applicable.

A clinical study of HoloSight Orthopaedic Trauma Surgery Robot-assisted infra-acetabular screw placement for acetabular fractures

To investigate the effectiveness of HoloSight Orthopaedic Trauma Surgery Robot-assisted infra-acetabular screw placement for treatment of acetabular fractures. The clinical data of 23 patients with acetabular fractures treated with open reduction and internal fixation and infra-acetabular screw placement in two medical centers between June 2022 and October 2023 were retrospectively analyzed. According to the the method of infra-acetabular screw placement, the patients were divided into navigation group (10 cases, using HoloSight Orthopaedic Trauma Surgery Robot-assisted screw placement) and freehand group (13 cases, using traditional X-ray fluoroscopy to guide screw placement). There was no significant difference in gender, age, body mass index, cause of injury, time from injury to operation, and Judet-Letournel classification between the two groups ( P>0.05). The time of infra-acetabular screw placement, the fluoroscopy frequency, the guide pin adjustment times, the quality of screw placement, the quality of fracture reduction, and the function of hip joint were compared between the two groups. All patients completed the operation successfully. The time of screw placement, the fluoroscopy frequency, and guide pin adjustment times in the navigation group were significantly less than those in the freehand group ( P<0.05). The quality of screw placement in the navigation group was significantly better than that in the freehand group ( P<0.05). Patients in both groups were followed up 6-11 months, with an average of 7.7 months. There were 9 and 9 cases in the navigation group and the freehand group who achieved excellent and good fracture reduction quality at 1 week after operation, and 12 and 12 cases with excellent and good hip joint function at last follow-up, respectively, and there was no significant difference between the two groups ( P>0.05). The fractures in both groups healed well, and there was no significant difference in healing time ( P>0.05). During the follow-up, there was no complication related to screw placement, such as failure of internal fixation, vascular and nerve injury, incisional hernia. In the treatment of acetabular fractures, compared with the traditional freehand screw placement, the HoloSight Orthopaedic Trauma Surgery Robot-assisted screw placement can reduce the time of screw placement, improve the accuracy of screw placement, and reduce the amount of radiation, which is an efficient, accurate, and safe surgical method.

Intramedullary nailing at different distal tibial fracture levels: A biomechanical study.

Distal tibial fractures remains a significant challenge in orthopedic trauma surgery. As the fracture level approaches the joint, alternative fixation options instead of intramedullary nailing (IMN) come to the fore. The present study aimed to assess the biomechanical stability of IMN at different distal tibial fracture levels and the number of locking screws required. Using a total of 21 sawbone models, 3 different tibial fracture levels (3, 4.5, and 6 cm proximally to the talocrural joint) were created and the fractures were fixed using 2, 3, or 4 distal locking screws. A single compression force at a speed of 30 mm/min with a maximum force of 800 Newton and a cyclic compression force of 60 cycles at a speed of 60 mm/min was applied to all tibia models. The applied weight and displacements from the fracture lines were recorded and evaluated. There was no statistically significant difference in fixation with 2 distal locking screws in groups 1, 2, and 3 (single test P =.9689) (cyclic test P =.8050). Therefore, if 2 distal screws are used, the fracture level does not affect the strength of fixation. In fractures located 6 cm proximal to the talocrural joint, all 4 holes of the nail can be used to insert screws, which provides a stronger fixation. When 2 screws are used, a statistically weaker fixation is obtained than with 3 or 4 screws. However, there is no significant difference between using 3 or 4 screws. Our findings support the use of IMN with 2 distal locking screws as a viable option for the management of distal tibial fractures. We found that it provides sufficient fixation regardless of the fracture level, suggesting that there is no need to choose an alternative fixation technique due to concerns of inadequate fixation as the fracture line moves distally. In cases where more stable fixation is desired, an additional locking screw can be used, but the potential increase in procedure and fluoroscopy time should be considered.

Patient-reported barriers for adherence to prophylactic enoxaparin after orthopedic trauma surgery

IntroductionVenous thromboembolism following orthopedic trauma surgery remains prevalent despite prophylaxis being a standard of care. Enoxaparin injection is a commonly utilized prophylaxis regimen among high-risk patients. Patient-reported rates of nonadherence and barriers to enoxaparin use are not described in the literature. A better understanding of these barriers and their impact on adherence to post-discharge prophylaxis regimens may shed light on persistent outcomes gaps. Materials and methodsSemi-structured interviews were administered to adult patients prescribed prophylactic enoxaparin and presenting to orthopedic surgery outpatient clinic at an urban level 1 trauma center for a post-operative appointment following traumatic injury from April to July 2023. Patients self-reported their age, gender, race, and mobility. Inductive thematic analysis with three-reviewer consensus identified common barriers among responses. Adherence rates were calculated by dividing patients’ estimated number of missed doses over total prescribed doses at the point of inquiry. ResultsWe identified 154 eligible patients through chart review, and 50 enrolled and interviewed. Participants had a mean age of 37 years. Of 50 participants, 20 identified as female; 25 identified as Black or African American, 16 as White, 5 as Hispanic, 2 as Asian, and 2 as multiracial. Twenty-one participants were non-ambulatory at time of interview. Mean and median patient-reported adherence were 64.5 % (SD 35.5) and 70.5 % (IQR 33–100) respectively. Five patients reported complete nonadherence, while 17 patients reported perfect adherence. Every participant reporting complete nonadherence identified as Black or African American, as compared to 8 out of 17 reporting perfect adherence. Despite acknowledging a twice-daily prescription, 17 patients reported once-daily rather than twice-daily use. Inductive thematic analysis revealed the following six barriers to prophylaxis adherence (number of participants reporting): Inconvenience (18 patients), Pain (16), Fear (12), Acquisition (7), Bruising (7), and Mechanism (7). Altogether, 40 patients endorsed at least one barrier to adherence. Discussion & conclusionsMost patients face barriers to adherence with post-discharge prophylactic enoxaparin, and the resultant rates of adherence are low. This may contribute to persistent outcomes gaps in the orthopedic trauma population despite prophylaxis standards. Changes in prescribing patterns and patient engagement techniques may improve post-operative thromboembolic outcomes.

Limited Health Literacy Among Patients With Orthopedic Injuries: A Cross-sectional Survey of Patients Who Underwent Orthopedic Trauma Surgery in a County Hospital Setting.

Patients with limited health literacy have difficulty understanding their injuries and postoperative treatment, which can negatively affect their outcomes. This cross-sectional questionnaire-based study of 103 adult patients sought to quantify patients' health literacy at a single county hospital's orthopedic trauma clinic and to examine their ability to understand injuries and treatment plans. Demographics, Newest Vital Sign (NVS) health literacy assessment, and knowledge scores were used to assess patients' comprehension of their injuries and treatment plan. Patients were grouped by NVS score (NVS <4: limited health literacy). Fisher's exact tests and t tests were used to compare demographic and comprehension scores. Multivariate logistic regression analysis was used to examine the association among low health literacy, sociodemographic variables, and knowledge scores. Of the 103 patients, 75% were determined to have limited health literacy. Patients younger than 30 years were more likely to have adequate literacy (50% vs 23%, P=.01). Patients who spoke Spanish as their primary language were 8.77 times more likely to have limited health literacy with respect to sociodemographic factors (odds ratio, 8.77; 95% CI, 1.03-76.92; P=.04). Low health literacy was 3.52 and 4.14 times more likely to predict discordance in answers to specific bone fractures and the narcotics prescribed (P=.04 and P=.02, respectively). Spanish-speaking patients have demonstrated limited health literacy and difficulty understanding their injuries and postoperative treatment plans compared with English-speaking patients. Patients with low health literacy are more likely to be unsure regarding which bone they fractured or their prescribed opiates. [Orthopedics. 2024;47(4):249-255.].

Wearable Sensors in Other Medical Domains with Application Potential for Orthopedic Trauma Surgery-A Narrative Review.

The use of wearable technology is steadily increasing. In orthopedic trauma surgery, where the musculoskeletal system is directly affected, focus has been directed towards assessing aspects of physical functioning, activity behavior, and mobility/disability. This includes sensors and algorithms to monitor real-world walking speed, daily step counts, ground reaction forces, or range of motion. Several specific reviews have focused on this domain. In other medical fields, wearable sensors and algorithms to monitor digital biometrics have been used with a focus on domain-specific health aspects such as heart rate, sleep, blood oxygen saturation, or fall risk. This review explores the most common clinical and research use cases of wearable sensors in other medical domains and, from it, derives suggestions for the meaningful transfer and application in an orthopedic trauma context.