Rate Of Hardware Removal Research Articles

Clinical and surgical factors influencing screw breakage during hardware removal following periacetabular osteotomy

Abstract Periacetabular osteotomy (PAO) is a procedure used to treat patients with hip dysplasia. Current literature reports symptomatic hardware removal (HWR) rates of 13.6% following PAO. No reports have examined the incidence of or factors relating to screw breakage during HWR. This study reports the incidence of screw breakage in patients undergoing HWR following PAO and examines the associated clinical and surgical factors. Patients who underwent PAO by a single surgeon from 2012 to 2022 were retrospectively reviewed. Demographic, surgical, and implant information was collected. Constructs were stratified by number (three-screw and four-screw) and type (3.5 mm only, 4.5 mm only, and mixed). Incidence rates of HWR and screw breakage were calculated. Three hundred and two hips from 254 patients undergoing PAO were included. Seventy-one hips from 58 patients underwent HWR (23.5%). Eighteen of 259 screws (6.9%) were broken upon removal in 10/71 hips (14.1%). Significantly more 3.5-mm screws were removed (24.7% vs 21.2%; P = .05) and broken than 4.5-mm screws (10.5% vs 3.8%; P = .04). Time to removal was significantly longer in broken screws (16.8 ± 12.7 months vs 33 ± 18.2 months, P < .001). The use of 3.5-mm screws and increased time from implantation to removal are associated with higher rates of screw breakage during HWR following PAO. The use of 4.5-mm screws and earlier time to removal (less than 12 months) both decrease the probability of breakage.

Computer-Aided Design and Manufacturing in Free Fibula Reconstruction of the Mandible: Comparison of Long-Term Outcomes with the Conventional Technique.

Pre-operative computer-aided design and manufacturing (CAD/CAM) revolutionized head and neck reconstruction after extirpative surgery. However, studies performing head-to-head comparison to the conventional technique have limited long-term follow-up. We aimed to compare short and long-term outcomes between conventional and CAD/CAM approaches for mandibular reconstruction with free fibula flaps. Patients undergoing free flap reconstruction from 2012 to 2021 were included. Data regarding patient demographics, past medical history, surgical details, complications, and reconstructive outcomes were collected. Patients who had CAD/CAM were compared with the patients who underwent reconstruction with the conventional technique. The cumulative incidence of hardware maintenance was displayed using the Kaplan-Meier method. A total of 215 patients (n=79 conventional, n=136 CAD/CAM) were included. Both cohorts had similar demographics except the CAD/CAM cohort was younger (p=0.043). The mean operative duration was 54 minutes shorter with the use of CAD/CAM (p=0.014). Total and partial flap loss rates were similar. Patients with CAD/CAM had significantly lower rates of early wound dehiscence (p=0.037). Median [interquartile range] follow-up duration was similar (931 [1854] days in conventional vs 728 [841] days in CAD/CAM, p=0.084). After excluding patients with major surgical complications in the first 30-days, CAD/CAM cohort had a lower hardware removal rate (28.8% vs 13.9%, p=0.011). The significance persisted after including only the patients with more than 2 years of follow-up. The use of preoperative CAD/CAM may reduce operative duration, while allowing for longer maintenance of hardware with reduced removal rates due to complications.

Comparative analysis of two double-plate fixation techniques for intercondylar fractures of the distal humerus

This study was aimed to compare the clinical and radiographic outcomes of patients with intercondylar fractures of the humerus treated with orthogonal and parallel plating methods via precontoured plates. This was a retrospective comparative study conducted on 50 adult patients with intercondylar humerus fractures that were surgically treated over an eleven-year period. The patients were divided into two groups: Group A underwent internal fixation via parallel plating, whereas Group B received orthogonal plating. Clinical outcomes were evaluated via the Mayo Elbow Performance Score (MEPS), and the radiographic assessments included time to consolidation, pseudoarthrosis, malunion and hardware removal. Both groups presented similar demographic and preoperative characteristics. The functional outcomes assessed by the MEPS were not significantly different between the groups. Radiographically, comparable healing times and rates of complications, including pseudoarthrosis, malunion and hardware removal, were observed. The study findings suggest that both orthogonal and parallel plating methods yield comparable clinical and radiographic outcomes in the treatment of intercondylar humerus fractures. These results underscore the effectiveness of both techniques and emphasize the importance of further research to elucidate the optimal plating method for specific fracture patterns.

Minimally Invasive vs Open First Ray Dorsiflexion Osteotomy: Radiographic Outcomes and Early Complications Report.

There is limited literature comparing open and minimally invasive surgical (MIS) techniques for first ray dorsiflexion osteotomy (DFO). This study is the first of its kind to report early healing and complication rates of patients undergoing MIS vs open first ray DFO. A retrospective cohort review of 28 patients who underwent a first ray DFO procedure at an academic medical center between 2015 and 2024 was conducted. Demographic factors and medical comorbidities were recorded. Radiologic parameters were measured along with healing. Postoperative healing and outcomes were identified through medical record review. Thirteen open and 15 MIS DFO procedures were performed. At follow-up, all osteotomies were healed with no wound or infection complications. There was no significant difference in hardware removal rates, 7.7% for open and 6.7% for MIS. The change in lateral Meary angle was 10.5 ± 3.9 and 9.7 ± 4.3 for the open and MIS groups, respectively (P = .61). The calculated dorsal closing wedge resection was 3.5 mm and 4.1 mm for open and MIS, respectively (P = .26). This study showed no significant differences in healing or complication rates in the short term between MIS and open surgery, with comparable magnitude of correction, suggesting similar ability for the MIS technique to correct first ray alignment. Further studies are needed to determine long-term outcomes.

A simple modified technique for screw fixation of displaced intra-articular calcaneus fracture through a sinus tarsi approach: a comparison with plate fixation

BackgroundPlates and screws are frequently used for the fixation of displaced intra-articular calcaneus fracture (DIACF). In this study, we compared the outcomes of a modified screw fixation technique with plate fixation via a sinus tarsi approach (STA).MethodsA series of 187 DIACF patients who were treated via an STA using a plate fixation (n = 81) or a screw fixation (n = 106) were included. Screw fixation was done with two 2.7 mm screws and two 6.5 mm cannulated screws. Outcomes were evaluated radiographically and clinically. Clinical evaluations included pain assessment by Visual Analogue Scale (VAS) and functional assessment by the American Orthopaedic Foot and Ankle Society (AOFAS) questionnaire and Foot Function Index (FFI).ResultsThe mean final VAS was smaller in the screw group (P = 0.01). The mean AOFAS and FFI scores were not significantly different between the two groups (P = 0.17 and P = 0. 19, respectively). The mean improvement of Bohler’s angle, but not the Gissane’s angle, was significantly greater in the screw group (P = 0.014 and P = 0.09, respectively). The mean improvement of calcaneal length and height were not significantly different between the two groups (P = 0.78 and P = 0.22, respectively). The hardware removal rate was 14.8% in the plate group and 3.8% in the screw group (P = 0.007).ConclusionThe modified screw fixation method provides lower pain, better radiographic outcome, and lower rate of hardware removal compared to plate fixation in the treatment of DIACF.

Complications of Hardware Removal in Pediatric Orthopaedic Surgery.

Hardware removal (HR) is one of the most common surgical procedures in pediatric orthopaedics. Surgeons advocate for HR for a variety of reasons, including to limit peri-implant fracture risk, restore native anatomy for adult reconstruction surgery, permit bone growth and development, and mitigate implant-related pain/irritation. To our knowledge, no recent study has investigated the characteristics and complications of HR in pediatric orthopaedics. The goal of this study is to report the prevalence and complications of hardware removals across all of pediatric orthopaedic surgery. A retrospective case series was conducted of all hardware removals from 2012 to 2023 performed at a single urban tertiary-care children's hospital. Cases were identified using CPT codes/billing records. Spinal hardware and cases for which hardware was either implanted or explanted at an outside hospital were excluded. Patient demographic and clinical data were recorded. For patients with multiple hardware removals, each case was recorded independently. A total of 2585 HR cases for 2176 children met study criteria (57.7% male; mean age 12.3±4.4y). The median postoperative follow-up time was 1.7 months (interquartile range: 0.6 to 6.9). The most common sites of hardware removal were the femur/knee (32.7%), tibia/fibula/ankle (19.3%), and pelvis/hip (18.5%). The most common complications included sustained, new-onset postoperative pain (2.6%), incomplete hardware removal (1.6%), and perioperative fracture (1.4%). The overall complication rate of hardware removal was 9.5%. Eighty-eight percent of patients who underwent hardware removal for pain experienced pain relief postoperatively. HR >18 months after insertion had a 1.2x higher odds of overall complication (P=0.002) and 3x higher odds of incomplete removal/breakage (P<0.001) than hardware removed 9 to 18 months after insertion. The overall complication rate of hardware removal across a large series in the pediatric population was 9.5%. Despite hardware removal being one of the most common and often routine procedures in pediatric orthopaedics, the complication rate is not benign. Surgeons should inform patients and families about the likelihood of success and the risks of incomplete removal during the informed consent process. IV.

Miniplates versus Headless Screws for Fixation of Displaced Radial Head Fractures: A Randomized Controlled Trial

BackgroundFixation of displaced radial head fractures using miniplates is technically challenging and has some drawbacks like hardware prominence and limitation of forearm rotation. Fixation by headless compression screws has emerged as a less invasive alternative to miniplates. This study compares the radiological and functional outcomes of both methods of fixation. MethodsThis single-center, prospective, randomized controlled trial was conducted at an academic level 1 trauma center. Sixty patients with displaced isolated radial head fractures were randomized to treatment using either headless compression screws or miniplates in 2 parallel groups. At the final follow-up of 18 months, patients were evaluated radiologically for union and clinically using the Mayo Elbow Performance Score (MEPS), elbow range of motion, grip strength, the visual analogue scale (VAS) for pain, and the Disabilities of the Shoulder, Arm, and Hand (DASH) score. ResultsUnion was achieved after 8±1.7 weeks in the screw group and after 8.5±2.7 weeks in the plate group. The MEPS was significantly better in the screw group (87.7±10.7) than in the plate group (80.5±13.9). However, this difference is below the minimum clinically important difference (MCID) for the MEPS and as such may not be clinically meaningful. No significant differences were observed between both groups regarding flexion, extension ranges, VAS, grip strength, or the DASH score. However, supination and pronation were significantly better in the screw group. The rate of complications was higher in the plate group (26.7%) than in the screw group (3.3%). ConclusionBoth techniques yielded comparable outcomes with better forearm rotation, a lower complication rate, and a lower hardware removal rate in the screw group.

Distal Positioning of the Ulnar Shortening Plate Increases Symptomatic Removal: A Comparative Analysis of Ulnar Shortening Osteotomy Plate Positioning and Symptomatic Hardware Removal

Abstract Background Ulnar shortening osteotomy (USO) is a common procedure to treat symptomatic ulnar-sided wrist symptoms in patients with positive ulnar variance who fail nonoperative management. Plate placement on the volar, dorsal, or subcutaneous border of the ulna has been described. There remains debate regarding the optimal plate placement to minimize soft tissue irritation and the need for plate removal. The goal of this study is to determine whether plate position along the volar cortex versus along the subcutaneous border, as well as the distance of the plate from the ulnar styloid, affects the risk of symptomatic hardware requiring removal. Methods In total, 112 USO procedures on 107 patients performed between 2017 and 2023 were retrospectively reviewed. The position of the plate on the ulna and the distance of the plate from the ulnar styloid were assessed radiographically. Demographic information, visual analog scale pain scores, disability of the arm, shoulder, and hand scores, and incidence of hardware removal were collected and compared between plate location groups. Results The overall symptomatic hardware removal rate was 79%. There was no difference in the rate of symptomatic hardware removal between volar (80%) and subcutaneous (77%) plate locations (p = 0.69) at a mean follow-up time of 26 months. The mean distance from the distal plate to the ulnar styloid was higher in cases in which hardware was retained (p = 0.03). Conclusion We found no difference in hardware removal rates based on volar versus subcutaneous plate placement after USO. Cases in which hardware was not removed had a higher mean distance from the distal plate to the ulnar styloid. Further prospective studies are warranted to determine optimal plate positioning to minimize hardware irritation after USO.

Low Rates of Hardware Removal and Tendon Rupture for the Acu-Loc 2 Volar Distal Radius Plate: A Minimum One-Year Follow-Up Study.

Volar locking plates designed for far distal radius fracture fixation can have a significant hardware removal rate and risk of tendon rupture.Plate design has a role in the rate of complications. This study assessed the hardware removal and tendon rupture rate of the Acu-Loc 2 volar distal radius (VDR) plate often used in the treatment of far distal radial fractures. We searched our electronic healthcare records system for all patients who had undergone fixation with an Acu-Loc 2 VDR plate (Acumed, Hillsboro, OR, USA) at a tertiary center between January 2017 and December 2021. Patients were excluded if their follow-up time was less than one year or if they could not be contacted by telephone follow-up. Pre-operative radiographs were examined for fracture classification. Follow-up time was defined as the last contact in the clinic or by telephone. A total of 92 patients underwent an open reduction and internal fixation (ORIF) with an Acu-Loc 2 VDR plate. A total of 85 patients met the inclusion criteria for this study. Our cohort included 33 males (38.8%) and 52 females (61.2%). The mean age was 50 years. Twenty-seven fractures (31.0%) were extra-articular, and 60 fractures (69.0%) were intra-articular. The mean follow-up time for the patients was 593.3 days (range 369 to 1185 days).Four patients (4.7%) had their hardware removed. Three (3.5%) patients underwent removal due to tendon irritation and one patient (1.2%) due to a peri-prosthetic fracture around the plate. There were no tendon ruptures recorded. The Acu-Loc 2 VDR plate had a low medium-term hardware removal rate and no tendon ruptures. These rates are lower than would be expected when compared with other far distal plate designs.

Acute anterior cruciate ligament rupture: can repair become an alternative to reconstruction: a meta-analysis of randomized controlled trials and cohort studies

PurposeTo perform a meta-analysis to compare clinical outcomes of anterior cruciate ligament (ACL) repair and ACL reconstruction for acute ACL rupture.MethodWe searched Pubmed, Embase, the Cochrane Library, and Web of Science databases to seek relevant studies. Clinical outcomes included failure rate, hardware removal rate, anteroposterior (AP) knee laxity, and patient-reported outcomes. In addition, subgroup analysis was carried out according to repair techniques, rupture locations, and study designs. Funnel plots were used to detect publication bias. All statistical analysis was performed using STATA (version 14.2, StataCorp).ResultsA total of 10 articles were included in this study, comprising 5 randomized controlled trials (RCTs) and 5 cohort studies, involving a total of 549 patients. We found no statistical differences between the ACL repair and ACL reconstruction in the following outcomes: failure rate, AP knee laxity, International Knee Documentation Committee (IKDC) score, Lysholm score, Knee Injury and Osteoarthritis Outcome (KOOS) Score, and Tegner score. However, the ACL repair group had a higher hardware removal rate. Except for AP knee laxity results on different repair techniques, there was no statistical difference in other subgroup analyses.ConclusionCompared with ACL reconstruction, ACL repair shows similar results in clinical outcomes, and it is promising to be an effective alternative treatment for acute ACL rupture. Larger samples and higher-quality studies are needed to support our results and further explore the advantages of ACL repair in other aspects.Level of evidenceLevel III.

Open Versus Percutaneous Stabilization of Thoracolumbar Fractures: A Large Retrospective Analysis of Safety and Reoperation Rates.

Thoracolumbar fractures (TLF) requiring surgical intervention can be treated with either open or percutaneous stabilization, each with some distinct risks and benefits.There is insufficient evidence available to support one approach as superior. Patients who underwent spinal fixation for TLF between 2008 and 2020 were reviewed.Patients with one or two levels of fracture treated with either open or percutaneous stabilization were included.Exclusion criteria were more than two levels of fracture, patients requiring corpectomy, stabilization constructs that crossed the cervicothoracic or lumbosacral junction, history of previous thoracolumbar fusion at the same level, spinal neoplasm, anterior or lateral fixation, and spinal infection.Demographic, operative, and clinical data were collected for all patients. 691 patients (377 open, 314 percutaneous) met the inclusion criteria.Patients in the percutaneous cohort sustained lower estimated blood loss (73 vs 334 ml; p< 0.001) and shorter length of surgery (114 vs. 151 minutes; p< 0.001).No differences were observed in the length of hospital stay or overall reoperation rates. Asymptomatic (7.0% vs 0.8%) and symptomatic (3.5% vs 0.5%) hardware removal was more common with the percutaneous cohort, while the incidence of revision surgery due to hardware failure requiring the extension of the construct (1.9% vs 5.8%) and infection (1.9% vs 6.4%) was greater in the open group. Percutaneous stabilization for TLF was associated with shorter operative time, less blood loss, lower infection rate, higher rates of elective hardware removal, and lower rates of hardware failure requiring extension of the construct compared to open stabilization.

Association of Smokeless Tobacco and Complications Following Ankle and Hindfoot Arthrodesis.

The purpose of this study was to (1) evaluate the rates of postoperative complications following ankle or hindfoot arthrodesis among current smokeless tobacco users and people who smoke compared to matched controls, and (2) compare rates of postoperative complications in current smokeless tobacco users vs people who smoke tobacco cigarettes. A retrospective cohort study was conducted using a large national database. For patients who underwent ankle or hindfoot arthrodesis, smokeless tobacco users (n = 131) and people who smoke (n = 1948) were matched 1:4 with controls, and smokeless tobacco users (n = 131) were matched 1:4 with people who smoke tobacco cigarettes (n = 524). Orthopaedic complications within 90 days, 1 year, and 2 years were compared using multivariable logistic regressions. Within 90 days of ankle or hindfoot arthrodesis, smokeless tobacco users demonstrated significantly higher rates of hardware removal (odds ratio [OR] 5.01, 95% CI 1.65-15.20), wound disruption or dehiscence (OR 3.00, 95% CI 1.21-7.44), and pooled complications (16.0% vs 5.9%, OR 2.84, 95% CI 1.50-5.38) compared with tobacco-naïve controls. The rates of hardware removal, wound disruption and dehiscence, and pooled complications remained significant in the smokeless tobacco cohort at 1 and 2 years. At 2 years following ankle or hindfoot arthrodesis, smokeless tobacco users additionally demonstrated significantly higher rates of infection (OR 6.08, 95% CI 1.15-32.05) and nonunion (OR 2.35, 95% CI 1.31-4.20) compared with tobacco-naïve controls. Within 90 days of ankle or hindfoot arthrodesis, smokeless tobacco users demonstrated significantly lower rates of malunion or nonunion than patients who smoke tobacco cigarettes (OR 0.34, 95% CI 0.12-0.97), whereas all other complications were not significantly different. Smokeless tobacco use is associated with higher rates of complications following ankle or hindfoot arthrodesis compared with tobacco-naïve controls, and physicians should screen for smokeless tobacco use specifically and encourage cessation before operating electively. Level III, retrospective cohort study.

The Continued Impact of Godina's Principles: Outcomes of Flap Coverage as a Function of Time After Definitive Fixation of Open Lower Extremity Fractures.

Early soft tissue coverage of open lower extremity fractures within 72 hours of injury leads to improved outcomes. Little is known about outcomes when definitive fixation is completed first. The purpose of this study is to quantify postoperative outcomes when soft tissue reconstruction is delayed until after definitive open reduction and internal fixation (ORIF) is completed. An insurance claims database was queried for all patients with open lower extremity fractures between 2010 and 2020 who underwent free or axial flap reconstruction after ORIF. This cohort was stratified into three groups: reconstruction performed 0 to 3, 3 to 7, and 7+ days after ORIF. The primary outcome was 90-day complication and reoperation rates. Bivariate and multivariable regression of all-cause complications and reoperations was evaluated for time to flap as a risk factor. A total of 863 patients with open lower extremity fractures underwent ORIF prior to flap soft tissue reconstruction. In total, 145 (16.8%), 162 (18.8%), and 556 (64.4%) patients underwent soft tissue reconstruction 0 to 3 days, 4 to 7 days, and 7+ days after ORIF, respectively. The 90-day complication rate of surgical site infections ( SSI; 16.6%, 16,7%, 28.8%; p = 0.001) and acute osteomyelitis (5.5%, 6.2%, 27.7%; p < 0.001) increased with delayed soft tissue reconstruction. Irrigation and debridement rates were directly related to time from ORIF to flap (33.8%, 51.9%, 61.9%; p < 0.001). Hardware removal rates were significantly higher with delayed treatment (10.3%, 9.3%, 39.3%; p < 0.001). The 0 to 3 day (odds ratio [OR] = 0.22; 95% confidence interval [CI]: 0.15, 0.32) and 4 to 7 day (OR = 0.26; 95% CI: 0.17, 0.40) groups showed protective factors against all-cause complications after bivariate and multivariate regression. Early soft tissue reconstruction of open lower extremity fractures performed within 7 days of ORIF reduces complication rates and reduces the variability of complication rates including SSIs, acute osteomyelitis, and hardware failure.

Four-Corner Fusion Versus Proximal Row Carpectomy for Scapholunate Advanced Collapse and Scaphoid Nonunion Advanced Collapse Wrist: A Systematic Review and Meta-Analysis

Although proximal row carpectomy (PRC) has increasingly been shown to have superior features to four-corner fusion (4CF), individual surgeons may remain convinced of the superiority of one procedure based on personal experience and individual biases. Hence, we sought to perform an updated meta-analysis with some of the largest studies to date to compare outcomes and complications between these procedures in the treatment of scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists. A systematic review and meta-analysis was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed/MEDLINE, Embase, Web of Science, and Cochrane were queried for articles on PRC and 4CF performed for scapholunate advanced collapse and scaphoid nonunion advanced collapse wrist. Primary outcomes included wrist range of motion; grip strength; outcome measures, including Disabilities of Arm, Shoulder, and Hand and Quick Disabilities of Arm, Shoulder, and Hand scores, Patient-Rated Wrist and Hand Evaluation, and visual analog scale pain scores; and surgical complications. Sixty-one studies reported on 3,174 wrists, of which 54% were treated with PRC and 46% were treated with 4CF. The weighted mean follow-up was 61 months (range, 12-216 months). Meta-analysis comparing PRC and 4CF demonstrated that PRC had significantly greater postoperative extension; ulnar deviation; postoperative improvement in extension, flexion, ulnar deviation; and visual analog scale score. No comparisons showed significant differences in grip strength. The percentage of wrists requiring arthrodesis was 5.2% for PRC and 11% for 4CF. There was an 8.9% (57/640 wrists) 4CF nonunion rate and 2.2% (17/789) hardware removal rate after 4CF. In the treatment of scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists, PRC results in better outcomes and a lower complication rate compared to 4CF. Therapeutic IV.

Comparison of Clinical Outcomes Between Modern Augmented ACL Repair and Autograft ACL Reconstruction: A Systematic Review and Meta-analysis of Studies With Minimum 2-Year Follow-up.

Anterior cruciate ligament (ACL) reconstruction has been the gold standard for primary ACL rupture since the 1990s. In the past decade, ACL repair has received renewed attention and increased research. To compare the clinical outcomes of modern augmented ACL repair versus autograft reconstruction for ACL ruptures. Systematic review; Level of evidence, 3. A search of the PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Library databases was conducted for prospective or retrospective comparative studies published between January 1, 2010, and January 3, 2023, with a minimum 2-year follow-up. Two independent reviewers performed data extraction and methodological quality assessment. Sensitivity analysis was performed to maintain the stability of results. Nine studies were included (minimum follow-up period, 24-60 months). The total sample size was 833 patients (augmented repair group: 358 patients; autograft ACL reconstruction group: 475 patients). There were 4 randomized controlled trials (level 1), 1 prospective comparative study (level 2), 2 retrospective comparative studies (level 3), and 2 case-control studies (level 3). The augmented ACL repair group attained significantly higher Lysholm score (weighted mean difference [WMD] = 1.57; 95% confidence interval [CI], 0.14-3.01; P = .03) and hamstring strength (WMD = 36.69; 95% CI, 29.07-44.31; P < .01) but had higher rates of hardware removal (odds ratio [OR] = 6.30; 95% CI, 2.44-16.23; P = .0001), reoperation (OR = 1.87; 95% CI, 1.33-2.62; P = .0003), and failure (OR = 1.58; 95% CI, 1.03-2.43; P = .0003) compared with the autograft ACL reconstruction group. No significant differences were observed between the repair and reconstruction groups regarding postoperative International Knee Documentation Committee scores, Tegner scores, knee laxity, satisfaction, ACL revisions, complications, and reoperation rather than revision. Augmented ACL repair was associated with higher rates of reoperation, hardware removal, and failure compared with autograft ACL reconstruction in studies with minimum 2-year follow-up data. However, augmented ACL repair had higher Lysholm scores and hamstring strength versus autograft ACL reconstruction.

Retrospective Review of Complications and Revision Rates Between Isolated Talonavicular vs Talonavicular and Subtalar (Double) Arthrodesis vs Triple Arthrodesis.

Hindfoot fusion procedures are common for the treatment of end-stage arthritis or deformity. Surgical treatments for these conditions include talonavicular joint (single) arthrodesis, talonavicular and subtalar (double) arthrodesis, or talonavicular, subtalar, and calcaneocuboid (triple) arthrodesis. This study evaluated the complication rate, revision surgery rate, and hardware removal rate for those treated with either single, double, or triple arthrodesis. A retrospective review was conducted for patients who underwent single (Current Procedural Terminology [CPT] code 28740), double (CPT 28725 and 28740), or triple (CPT 28715) arthrodesis to treat hindfoot arthritis/deformity (International Classification of Diseases, Ninth Revision [ICD-9] code: 734, International Classification of Diseases, Tenth Revision [ICD-10] codes: M76821, M76822, and M76829) from 2005 to 2022 using the South Carolina Revenue and Fiscal Affairs databank. Data collected included demographics, comorbidities, procedure data, and postoperative outcomes within 1 year of principal surgery. Student t test, chi-squared test, and multivariable logistic regression analysis were utilized during data analysis. A total of 433 patients were identified, with 248 undergoing single arthrodesis, 67 undergoing double arthrodesis, and 118 undergoing triple arthrodesis. There was no significant difference between single, double, and triple arthrodesis in the rate of complications, hardware removals, revision surgeries, or 30-day readmission when controlling for confounding variables. However, a decrease in Charlson Comorbidity Index (CCI) was found to be predictive of an increase in the revision surgery rate (OR = 0.46, 95% CI 0.22-0.85, P = .02). We found no difference in the rate of complications, hardware removals, or revision surgeries in those undergoing single, double, or triple arthrodesis. Surprisingly we found that a lower Charlson Comorbidity Index, indicating a healthier patient had a significant relationship with a higher rate of revision surgery. Further study including radiographic indications for surgery or the impact of overall health status on revision surgery rates may further elucidate the other components of this relationship. Level III, cohort study.

Increased Union Rates in Subtalar Joint Arthrodesis with Hybrid Nitinol Dynamic Compression Device

Category: Hindfoot Introduction/Purpose: Subtalar joint arthrodesis (STJA) is a well-established and widely accepted surgical procedure utilized for the treatment of numerous hindfoot conditions. Several fixation constructs in STJA have been described in the literature. With the current advancements in orthopedic technology, new devices utilizing nitinol elements have been developed in an effort to maintain sustained compression in the event of bony resorption which may occur during arthrodesis healing. The primary aim of our study is to introduce a hybrid nitinol dynamic compression (HNDC) device for STJA which provides dynamic compression without proximal locking fixation and compare union rates with a previous nitinol dynamic compression nail (NDCN) as well as a standard two-compression screw fixation construct. The secondary aim was to compare hardware removal rates amongst the three cohorts. Methods: From May 2019 through February 2022, 26 consecutive patients treated with a novel HNDC for STJA were compared to 15 patients treated with NDCN for STJA and 41 patients undergoing STJA using a two-compression screw fixation method. Patients were included in our study if they were greater than 18 years of age, underwent STJA with the use of one of the internal fixation constructs under investigation, and had a minimum 1-year follow-up with radiographs; there were no other exclusion criteria. Arthrodesis sites were augmented with autologous bone graft with or without bone graft substitute in all patients. Standard postoperative protocols were used amongst all three cohorts. Primary outcomes included subtalar joint union rates determined by radiographic and clinical assessment. The incidence of hardware removal was recorded and compared between groups. Patient-specific risk factors were studied to assess any potential negative effects on STJA union rates. Results: Union rates between the HNDC device and the NDCN group did not demonstrate a statistically significant difference at final follow-up. There was a statistically significant difference in union rates between subjects who underwent STJA with the HNDC device versus those who underwent STJA with a two-compression screw construct. Furthermore, there was a statistically significant increase in union rates in subjects who received nitinol dynamic compression fixation devices, HNDC or NDCN, versus standard compression screws. There was not a statistically significant difference in hardware removal rates among the 3 cohorts. No significant relationship was seen between smoking, diabetes, or alcohol consumption and union rates. Conclusion: Our data supports the HNDC device to have superior union rates to the two-screw fixation group. In addition, the HNDC device provides improved union rates, though not statistically significant, when compared to the NDCN. Furthermore, the HNDC device was found to have lower rates of hardware removal when compared to the two-screw fixation and the NDCN groups though this was not statistically significant. The early results of this HNDC device for STJA are encouraging and appear to offer a further improved alternative fixation construct with excellent union rates and minimal complications.

Lessons Learned – the Learning Curve of Percutaneous Hallux Valgus Correction Using 3rd Generation MICA in 106 Consecutive Cases

Category: Bunion; Other Introduction/Purpose: Minimally-invasive Chevron and Akin osteotomy (MICA) represents the third-generation percutaneous hallux valgus surgery which is characterized by an extra-articular osteotomy, stable internal fixation and a high potential for correction. Compared to other percutaneous techniques of the foot, MICA is generally regarded as an advanced and demanding surgical procedure with a prolonged learning curve. The aim of this study is to analyze a single-surgeons learning curve with his first 106 consecutive MICA procedures. Methods: Between May 2018 and November 2022, 106 consecutive MICA procedures performed by the author were prospectively analyzed focusing on surgery duration, number of fluoroscopies, radiological correction results and surgery- associated complications using a modified Clavien-Dindo classification. There were 95 female and 11 male patients with a mean age of 53y (range 16-78y). The mean preoperative intermetatarsal angle I/II (IMA) was 15,7°, the mean hallux valgus angle (HVA) 28,7°. Results: The average amount of radiological correction was 12,6° for IMA and 16,8° for HVA. Overall, the mean surgery duration was 41,6min. (range 27-90min.), the number of fluoroscopies (fs) was 110,8 (range 64-186 fs). Comparing the first 10 MICAS vs. the last 10 procedures, both surgery duration and the amount of fluoro shots decreased significantly (58,8min vs. 32,4min and 165,9 fs vs. 83,1fs). According to the modified Clavien-Dindo classification, there were three grade 1 complications (superficial cellulitis requiring oral antibiotics), four grade 2 complications (1 intraoperative conversion to open surgery, 1 delayed union, 2 symptomatic recurrences) and one grade 3 complication (delayed wound-healing requiring superifical wound revision). Overall screw removal rate was 18 /106 cases, all due to prominent hardware with square headless designed screws (non-beveled). Conclusion: This study represents the largest case series on the learning curve of MICA. Although the learning curve is prolonged requiring specific training and intensive practice, the rate of severe complications is not increased compared to open hallux valgus surgery. The use of bevel-headed screws is strongly advised to reduce the rate of secondary hardware removal. The learning curve manifests itself predominantly in a decreasing operation time and lower number of fluoroscopies. Adherence to the principles of MICA with stable fixation and meticulous intraoperative control of each surgical step helps to reduce complications and allows for adequate correction from the beginning.

Intramedullary vs Plate Fixation of Distal Fibular Fractures: Use Rates, Fracture Patterns, Patient Characteristics, and Complication Rates

Category: Trauma; Ankle Introduction/Purpose: The traditional surgical treatment for distal fibula fractures is open reduction and plate fixation (PF). However, intramedullary fixation (IMF) has been shown to provide advantages over plate fixation, particularly in patients and injuries with higher risks of soft tissue complications. Current evidence comparing the two fixation types remains scarce and is limited by modest sample sizes. Using a large national database, this retrospective cohort study aims to examine differences in use rates, associated fracture patterns, patient characteristics (e.g. age, gender, comorbidities, Elixhauser Comorbidity Index (ECI)), and complication rates between fibular IMF and PF within the United States. Methods: Patients (age≥18) with lower leg or ankle fractures treated with fibular IMF or PF between October 2015 and October 2021 were identified using a United States insurance claims database. The monthly ratio of IMF-treated patients to PF-treated patients was tracked over time to compare use rates. Fracture patterns were determined using fracture diagnoses within one month preceding surgery. Further analyses of patient characteristics and complication rates only included fibula fracture patients with 12 months of post-operative follow-up, and patients with concomitant upper tibia or tibia shaft fractures were excluded. To compare complication rates, a 1:4 (IMF:PF) matched comparison was performed, controlling for age, gender, high-energy (i.e. pilon, lower tibia, and trimalleolar) fractures, diabetes, tobacco use, obesity, and chronic kidney disease (CKD). Comparisons were conducted using chi-squared tests for categorical variables and t-tests for means. Ordinary least squares regression was used to visualize the trend in monthly relative use rates. Results: In total, 39329 patients (2294 IMF, 37035 PF) were identified. IMF use trended upwards relative to PF use over time (Figure 1). Tibia and fibula shaft fractures were the most common fractures in IMF patients versus trimalleolar and bimalleolar fractures in PF patients. A higher proportion of IMF patients had open fractures (p &lt; 0.01). 627 IMF and 29703 PF patients were included for further analysis of patient characteristics and complications. The IMF cohort was younger, with higher mean ECI, fewer females, and higher rates of CKD (ps &lt; 0.01). No significant differences in diabetes, tobacco use, or obesity rates were identified. Among 316 IMF and 1254 PF matched patients, no significant differences in infection, nonunion, malunion, revision, hardware removal, pulmonary embolism, and deep vein thrombosis rates were found. Conclusion: The upward trend in the ratio of IMF-treated to PF-treated patients suggests that the popularity of IMF is steadily rising. The higher rate of concomitant tibia shaft fractures and open fractures seen among IMF-treated patients in this study is consistent with the use of fibular IMF in cases involving higher-energy trauma and soft-tissue disruption. Higher ECI scores and rates of CKD in IMF patients also suggest that IMF is used more frequently in medically complex patients with impaired wound healing. Lastly, fibular IMF appears to be a viable alternative to PF when used in similar populations.

Is Age a Determining Factor When Considering Arthrodesis in LisFranc Injuries? A Retrospective Cohort Analysis with Patient Reported Outcomes

Category: Trauma; Midfoot/Forefoot Introduction/Purpose: The debate between primary arthrodesis and open reduction and internal fixation(ORIF) of LisFranc injuries continues. Most of the available literature focuses on radiographic and clinical outcomes and fails to add the patient perspective to the analysis. A small number of high-quality studies have suggested superiority of arthrodesis over ORIF in certain patient populations but, thus far, age has not been analyzed as an independent variable. Some studies mention an aversion to performing arthrodesis in young patients but no evidence is available to support this claim. In this study, we analyze the effects of age on patient reported, clinical, and radiographic outcomes in LisFranc injuries. Methods: In this IRB approved study, a retrospective analysis of prospectively collected data was conducted on 108 patients with a mean age of 44.6 +/- 16 years who underwent either arthrodesis or ORIF for a LisFranc injury. All patients who underwent surgery between January 2016 and January 2022 were included in the analysis. Patients were excluded if they were younger than 18, did not meet the minimum follow-up duration of 3 months, and did not have both preoperative and postoperative patient reported outcome scores. Two age categories were created based on the median age of the cohort (18-40 years old and then 40- 81 years old) and analysis was performed based these age categories. Adaptive PROMIS Depression, Physical Function, and Pain interference scores were collected. Clinical and radiographic analysis was performed using the electronic medical record and PACs system. All statistical analysis was performed by someone with an expertise in statistics. Results: 163 patients who underwent either procedure during the time period were identified but 55 patients were excluded due to incomplete data or being underage. 61 patients (average age 44.7 +/-13) underwent ORIF and 47 patients (46.1 +/-16) underwent arthrodesis for LisFranc injuries. Within the ORIF cohort 25 (41%) were 18-40 years old and within the arthrodesis cohort 19 (40%) we 18-40 years old. No differences were observed between the two groups with regard to quality of reduction, complications, or PROMIS data. Anatomic or acceptable reduction was achieved in 92% of the ORIF cohort and 96% of the arthrodesis cohort. There was an increased rate of hardware removal in the ORIF group. See the attached table for complete results. Conclusion: In this study, age was not a predictor of outcomes after Lisfranc surgery whether performing an ORIF or an arthrodesis. Outcomes, both clinical and patient reported, for young patients in this cohort did not differ statistically regardless of whether the patient underwent ORIF or arthrodesis. The results of this study suggest that younger age should not deter a surgeon from arthrodesis if this is the procedure felt to be most appropriate in a given injury. Anatomic reduction led to consistently good patient reported outcomes regardless of surgical technique used.