Comparative outcomes of operative treatment for two and three-part proximal humerus fractures with or without ipsilateral shaft fractures and head-split patterns: intramedullary nail versus open reduction internal fixation.

Purpose: To investigate whether the outcomes, including union rates, complications, reoperations, blood loss, operative time, and range of motion, differed following intramedullary nailing (IMN) or open reduction internal fixation (ORIF) of two- and three-part proximal humerus fractures with or without ipsilateral shaft fractures and head-split patterns.

Methods: This was a retrospective multicenter study at three community centers and one level 1 trauma center. Inclusion criteria were two- and three-part proximal humerus fracture treated with either IMN or ORIF from 2015 to 2022 with at least three months of postoperative follow-up.

Utility of CT Scans for Detecting Operative Malleolar Fractures Associated With Tibial Shaft Fractures.

Objectives: The purpose of this study was to define the utility of CT scans for detecting articular extension in tibial shaft fractures and determine whether radiographic parameters can predict the presence of operative distal tibial articular fractures (DTAFs).

Design: Retrospective cohort study.

Setting: Single level I trauma center.

Bone marrow aspirate and bone marrow aspirate concentrate: Does the literature support use in long-bone nonunion and provide new insights into mechanism of action?

Purpose: To assess the use of bone marrow aspirate (BM) and bone marrow aspirate concentrate (BMAC) in the treatment of long-bone nonunion and to understand mechanism of action.

Methods: A systematic review of PubMed and EBSCOHost was completed to identify studies that investigated the use of BM or BMAC for the diagnosis of delayed union and/or nonunion of long-bone fractures. Studies of isolated bone marrow-mesenchymal stem cells (BM-MSCs) and use in non-long-bone fractures were excluded.

Smoking Is Independently Associated with Increased Pain Severity and Interference in Patients with Traumatic Spinal Cord Injury.

Previous studies have shown a relationship between cigarette use and pain but never in the setting of traumatic spinal cord injury (TSCI). Therefore, the objectives of this study were to (1) determine whether smokers with TSCI experience increased pain compared with nonsmokers with TSCI and (2) determine whether smokers with TSCI experience worse functional outcomes than nonsmokers with TSCI. A retrospective analysis of the National Spinal Cord Injury Statistical Center database was performed.

Fractures in Patients With Diabetes Mellitus: Findings From a 20-year Registry at a Single Level 1 Trauma Center.

Introduction: Diabetes mellitus (DM) is a risk factor of infection. Although DM has been associated with worse functional outcomes after acetabular fracture, literature regarding the effect of DM on surgical site infection and other early complications is lacking.

Methods: A 20-year registry from a level 1 trauma center was queried to identify 134 patients with DM and 345 nondiabetic patients with acetabular fractures.

Prospective Multicenter Preliminary Validation of Limb Deformity-modified Scoliosis Instruments in Pediatric Patients With Limb Deformity.

Introduction: There are few disease-specific patient-reported outcome measures (PROMs) for use in pediatric limb deformity (LD), with authors instead relying on generic PROMs such as the Pediatric Outcomes Data Collection Instrument (PODCI) to assess treatment outcomes from the patient's perspective. The purpose of this study was to perform preliminary validation of 2 disease-specific PROMs in pediatric patients with LD.

Methods: LD modifications were created by substituting the word "limb" for "back" in the Early Onset Scoliosis Questionnaire (EOSQ, ages 10 and younger) and the Scoliosis Research Society (SRS, ages 11 to 18) survey, creating the LD-EOSQ and LD-SRS instruments.

Recovery Services for Interpersonal Violence Victims on Healthcare Use at a Trauma Center.

Introduction: Treatment of interpersonal violence (IPV) patients is often complicated by social and mental health comorbidities. New American College of Surgeons (ACS) requirements include provision of psychosocial support services for recovery after injury. We aim to describe utilization and patient outcomes after provision of Trauma Recovery Services (TRS) at our institution for the IPV population.

Community Readiness Assessment of the "Take TIME for Your Child's Health" Intervention.

Take TIME (Tobacco-free, Injury-free, Moving daily, Eating healthy) was an early intervention strategy targeting community readiness to support healthy lifestyles for young children in Uxbridge, Canada. This study aimed to assess the effectiveness of Take TIME using the Community Readiness Model adapted for childhood obesity prevention. Six interviews were completed in Uxbridge, before and after the intervention, with purposively selected community leaders in education, political, business, religious, not-for-profit, and healthcare fields.

What Are the Differences in Hospital Cost Associated With the Use of Cemented Versus Cementless Femoral Stems in Hemiarthroplasty and Total Hip Arthroplasty for the Treatment of Femoral Neck Fracture?

Background: The purpose of this study was to determine if there is a difference in hospital costs associated with the use of cemented versus cementless femoral stems in hemiarthroplasty (HA) and total hip arthroplasty (THA) for the treatment of femoral neck fracture (FNF).

Methods: This retrospective cohort study utilizes the 2019 Medicare Provider Analysis and Review Limited Data Set. Patients undergoing arthroplasty for the treatment of FNF were identified.

Maintenance of an Intraoperative External Fixator Is Associated With Decreased Postoperative Stiffness After Definitive Management of High-Energy Tibial Plateau Fractures.

Introduction Postoperative stiffness is a common complication after high-energy tibial plateau fractures. Investigation into reported surgical techniques for the prevention of postoperative stiffness is limited. The purpose of this study was to compare the rates of postoperative stiffness after second-stage definitive surgery for high-energy tibial plateau fractures between groups of patients who had the external fixator prepped into the surgical field and those who did not.

Perioperative allogenic blood transfusions are associated with increased fracture related infection rates, but not nonunion in operatively treated distal femur fractures.

Introduction: Distal femur fractures are common injuries that remain difficult for orthopedic surgeons to treat. High complication rates, including nonunion rates as high as 24% and infection rates of 8%, can lead to increased morbidity for these patients. Allogenic blood transfusions have previously been identified as risk factors for infection in total joint arthroplasty and spinal fusion surgeries.

Radiographic parameters associated with fracture-related infection in high energy bicondylar tibial plateau fractures managed with two-stage treatment: Identifying the bad actors.

Introduction: High energy tibial plateau fractures are fraught with complications, particularly fracture-related infection (FRI). Previous studies have evaluated patient demographics, fracture classification, and injury characteristics as risk factors for FRI in patients with these injuries. This study evaluated the relationship between radiographic parameters (fracture length relative to femoral condyle width (FLF ratio), initial femoral displacement (FD ratio), and tibial widening (TW ratio)) and fracture-related infection following internal fixation in high energy bicondylar tibial plateau fractures.

Emphysematous Osteomyelitis of the Pubis Associated With Necrotizing Soft Tissue Infection of the Thigh.

Emphysematous osteomyelitis (EO) is a rare condition identified through the presence of intraosseous gas. It is frequently fatal even with prompt recognition and management. We report a case of EO presenting with a necrotizing soft tissue infection of the thigh in the setting of prior pelvic radiation.

Mutations involving TGFB and MAPK may be associated with malignancy in granular cell tumors.

Granular cell tumors (GrCTs) are mesenchymal neoplasms of presumed schwannian differentiation that may present as solitary or multifocal lesions with excision usually being curative. A minority of cases, however, show histological features associated with an increased risk for metastasis and are highly aggressive leading to death in about a third of cases. While benign and malignant cases have been shown to harbor mutations in the H + ATPase genes, there is only limited data examining molecular aberrations associated with malignancy.

Molecular Characterization of Multifocal Granular Cell Tumors.

Granular cell tumors (GrCT) were recently found to be driven by inactivating mutations in vacuolar H + -ATPase (V-ATPase) genes, most frequently ATP6AP1 and ATP6AP2 . Multifocal presentation is present in ~10% of cases; however, the relationship between multifocal tumors in a given patient has not been elucidated. We hypothesized that benign-appearing multifocal GrCT are molecularly distinct whereas paired primary and metastatic malignant GrCT share identical mutations.

Social Determinants of Health and Patients With Traumatic Injuries: Is There a Relationship Between Social Health and Orthopaedic Trauma?

Background: Although economic stability, social context, and healthcare access are well-known social determinants of health associated with more challenging recovery after traumatic injury, little is known about how these factors differ by mechanism of injury. Our team sought to use the results of social determinants of health screenings to better understand the population that engaged with psychosocial support services after traumatic musculoskeletal injury and fill a gap in our understanding of patient-reported social health needs.

Question/purpose: What is the relationship between social determinants of health and traumatic musculoskeletal injury?

Methods: Trauma recovery services is a psychosocial support program at our institution that offers patients and their family members resources such as professional coaching, peer mentorship, post-traumatic stress disorder screening and treatment, educational resources, and more.

High-volume Arthroplasty Centers Are Associated With Lower Hospital Costs When Performing Primary THA and TKA: A Database Study of 288,909 Medicare Claims for Procedures Performed in 2019.

Background: With bundled payments and alternative reimbursement models expanding in scope and scale, reimbursements to hospitals are declining in value. As a result, cost reduction at the hospital level is paramount for the sustainability of profitable inpatient arthroplasty practices. Although multiple prior studies have investigated cost variation in arthroplasty surgery, it is unknown whether contemporary inpatient arthroplasty practices benefit from economies of scale after accounting for hospital characteristics and patient selection factors.

Patients who have undergone total shoulder arthroplasty prefer greater surgeon involvement in shared decision making.

Background: There has been a shift in medical decision making from a paternalist model to a shared decision-making (SDM) approach, described as a patient-physician relationship where both parties collaborate to arrive on an evidence-based treatment regimen that best suits the patient's needs and values. However, there is a scarcity in evidence regarding SDM in shoulder arthroplasty. The purpose of this study was to evaluate overall patient preference for SDM and determine demographic and socioeconomic factors related to SDM preference in those undergoing shoulder arthroplasty.

Comparison of outcomes and operative course between septic and aseptic nonunion in long bones.

Purpose: The treatment of nonunion of long bones is difficult particularly in the presence of infection, which often involves staged surgical management. There is limited literature to compare the post operative course and outcomes of patients treated for septic versus aseptic nonunion. Thus, the purpose of this study was to determine if a difference exists between the number of surgical procedures, time to union, and rate of successful union for these two groups.

Do number and location of plates impact infection rates after definitive fixation of high energy tibial plateau fractures?

Purpose: Surgical trauma may confer additional infectious risk after operative fixation for high energy tibial plateau fractures. This study aims to determine the impact of plate number and location on infection rates after these injuries.

Methods: This retrospective cohort study completed at two level one trauma centers included patients who underwent staged fixation for a tibial plateau fracture between 2015 and 2019.

External fixator pin placement during initial management of tibial plateau fractures: are there parameters to minimize pin-plate overlap?

Purpose: External fixator pin site overlap with definitive fixation implants (pin-plate overlap) has been identified as a risk factor for surgical site infection in tibial plateau fractures. Despite this, pin-plate overlap occurs in 24-38% of patients. This study sought to identify radiographic characteristics associated with pin-plate overlap to help minimize occurrences.

Do Patients With Chronic Diabetes Have Worse Motor Outcomes After Cervical ASIA C Traumatic Spinal Cord Injury?

Study Design: This was a level IV retrospective prognostic study.

Objective: The objective of this study was to determine if patients with chronic diabetes have worse functional outcomes and motor recovery after cervical traumatic spinal cord injury (TSCI).

Summary Of Background Data: Diabetes mellitus has multiple deleterious neurological effects and has been shown to worsen elective cervical spine surgery outcomes.

Are Infection Rates Increased After Sterilization of the External Fixator During Staged Internal Fixation of High-Energy Tibial Plateau Fractures?

Objectives: To compare infection rates after second-stage definitive surgery for high-energy tibial plateau fractures between groups of patients who had the external fixator prepped into the surgical field and those who did not.

Design: Retrospective cohort study.

Setting: Two academic Level 1 trauma centers.