Hatchteague9953

To examine the efficacy and safety of radiotherapy for the prevention of heterotopic ossification (HO) about the elbow.

Retrospective chart review.

Level 1 Trauma Center.

Two hundred and twenty-nine patients who received prophylactic radiotherapy (XRT) over a 15 year period were identified. Patients were included if they received XRT to the elbow joint and had at least 12 weeks of follow up after XRT. Fifty-four patients were ultimately included.

All patients were treated with a single dose of 7 Gy. 98% of patients received XRT within 24 hours after surgery, and all patients received XRT within 72 hours after surgery.

The primary study measures evaluated were the presence or absence of clinically symptomatic HO and the presence of radiographic HO after XRT to the elbow joint.

Eighteen patients were treated with XRT after a traumatic injury requiring surgery (primary prophylaxis), and 36 were treated with XRT after excision surgery to remove HO which had already formed (secondary prophylaxis). In the primary cohort, 16.7% developed symptomatic HO after XRT, and 11.1% required surgery to resect heterotopic bone. In the secondary cohort, 11.1% developed symptomatic HO after surgery and XRT, and 5.5% required resection surgery. No secondary malignancies were identified.

Our findings suggest that XRT for elbow HO may be safe and effective for both primary and secondary HO. XRT for HO was not shown to be associated with radiation-induced sarcoma in this series, at least in the short term. Further study in a large patient population with extended follow up is required to better characterize populations at high risk for development of HO and secondary malignancy. [ZERO WIDTH SPACE].

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.Objectives to quantify radiographic outcomes and identify predictors of late displacement in the nonoperative treatment of LC-2 pelvic ring injuries.

Retrospective review.

Two level 1 trauma centers.

Thirty eight patients ≥18 years old with LC-2 pelvic ring injuries.

Nonoperative treatment.

Crescent fracture displacement measured on initial axial Computed Tomography. Change in pelvic ring alignment measured by the Deformity Index, Simple Ratio, Inlet and Outlet Ratios on successive plain radiographs.

Patients in this study had minimally displaced LC-2 pelvic ring injuries, with median initial crescent fracture displacement of 2mm and median initial Deformity Index of 2%. No patient had a ≥10 percentage point change in Deformity Index over the treatment period, but small amounts of displacement were seen on the other ratios. No patients initially selected for nonoperative treatment converted to operative treatment. No radiographic predictors of late displacement were identified. Bilateral pubic rami fractures and the presence of a complete sacral fracture ipsilateral to the crescent fracture were not associated with late displacement.

A spectrum of injury severity and stability exists in the LC-2 pattern. Nonoperative treatment of LC-2 injuries with low initial deformity and crescent fracture displacement results in minimal subsequent displacement.

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Hospital and surgeon volume are known to affect the outcomes of orthopaedic surgeries. The current study evaluates the relationship between hospital and surgeon volume of peritrochanteric hip fracture fixation and complication rates.

Adults (≥60 years old) who underwent surgical fixation for closed peritrochanteric fractures from 2009-2015 were identified using ICD-9/10 Clinical Modification and Procedural codes in the New York Statewide Planning and Research Cooperative System (SPARCS) database. Readmission, reoperations, in-hospital mortality, and other adverse events were compared across surgeon and facility volumes. Statistical significance was set at P<0.05.

29,656 patients were included. Low-volume (LV) facilities had higher rates of readmission (Hazard ratio (HR) 1.07, 95% Confidence Interval (CI) 1.05-1.17), pneumonia (HR 1.36, 95% CI 1.22-1.51), wound complications (HR 1.24, 95% CI 1.03-1.49) and mortality (HR 1.15, 95% CI 1.04-1.27), but lower rates of acute renal failure (HR 0.90, 95% CI 0n mortality and readmissions, but not all complications. There was no significant decrease in complications if fixation was performed by HV surgeons relative to LV surgeons.

To evaluate the outcomes of patients with pelvic ring injuries managed with resuscitative endovascular balloon occlusion of the aorta (REBOA).

Retrospective case series.

Academic, level-1 trauma center in North America.

Twenty-five patients with disruption of the pelvic ring and hemodynamic instability.

Placement of a REBOA as an adjuvant treatment to trauma resuscitation.

Death and ischemic related complications.

Average age of patients was 43 years (range 17-85). Patients presented with a median lactate of 6.3 mmol/L, systolic blood pressure of 116mmHg, heart rate of 121, and injury severity score of 34. The median units of pack red blood cells received via transfusion in the first 24 hours was 13 (IQR 8-28). Young-Burgess injury patterns included 5 LC-1, 1 LC-2, 8 LC-3, 4 APC-2, and 7 APC-3 fractures. Angiography and embolization was performed in 24 (96%) patients. Selective embolization occurred in 18 (72%) patients with non-selective angiography of the iliac system occurring in 7 (24%) patients. There were 12 (48%) deaths, 7 (28%) patients requiring lower extremity fasciotomy, 5 (20%) lower extremity amputations, and 1 (4%) thrombectomy.

REBOA use in pelvic ring injuries is rare and most frequently utilized in critically ill poly-trauma patients. Successful pelvic embolization can occur in concert with REBOA use, however the severity of injury is associated with a high complication profile. In this series of 25 patients in-hospital mortality was 48%. For those patients that survived 54% experienced a major complication (fasciotomy, amputation, deep infection). Further investigation is required to evaluate the role REBOA may play in managing these patients.

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

To compare deep infection rate and causative organisms in open fractures of the lower extremity from agricultural trauma to similar injuries in non-agricultural trauma.

Retrospective.

Two tertiary-care institutions.

Open lower extremity fractures sustained between 2003-2018 by agriculture-related trauma in adult patients were reviewed. A non-agriculture open fracture control group was identified for comparison. Patient demographics and injury characteristics were assessed. Outcomes included occurrence of deep infection and causative organism.

178 patients were identified in the agriculture(AG) (n=89) and control(NAG) (n=89) groups. Among agricultural-injury patients, farm machinery was the most common mechanism in 69 (77.5%) patients. Open injuries of the foot (38.2%) were most common in the AG-group and tibial shaft (25.8%) in the NAG-group.Deep infection was seen in 21% of the AG-group compared to 10% in the NAG-group(p<0.05). see more AG-group anaerobic infection occurred in 44% of patients with deep infection versus 9.1% in NAG-group(p<0.05). Most common anaerobic organisms included Enterococcus, Pseudomonas aeruginosa, and Clostridium perfringens.

This study supports that open fractures due to agricultural trauma have a high infection rate, with anaerobic infection occurring at higher rates than in non-agricultural trauma. Prophylactic treatment with antibiotics directed against anaerobes is indicated in these injuries.

Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

To delineate if there were differences in outcomes between definitive fixation strategies in open tibial shaft fractures.

MEDLINE, EMBASE, CENTRAL, OpenGrey.

Randomized and Quasi-randomized studies analyzing adult patients (>18 years) with open tibial shaft fractures (AO-42), undergoing definitive fixation treatment of any type.

Data regarding patient demographics, definitive bony/soft-tissue management, irrigation, type of antibiotics and follow up. Definitive intervention choices included unreamed intramedullary nailing (UN), reamed intramedullary nailing (RN), plate fixation, multiplanar, and uniplanar external fixation (EF). The primary outcome was unplanned reoperation rate. Cochrane risk of bias tool and GRADE systems were used for quality analysis.

A random-effects meta-analysis of head-to-head evidence, followed by a network analysis that modelled direct and indirect data was conducted to provide precise estimates (relative risks (RR) and associated 95% confidence intervals (95% CI)).

In open tibial shaft fractures, direct comparison UN showed a lower risk of unplanned reoperation versus EF (RR 0.67, 95% CI 0.43 - 1.05, p=0.08, moderate confidence). In Gustilo type III open fractures, the risk reduction with nailing compared to EF was larger (RR 0.61, 95% CI 0.37 - 1.01, p=0.05, moderate confidence). UN had a lower reoperation risk compared to RN (RR 0.91, 95% CI 0.58 - 1.4, p=0.68, low confidence), however this was not significant and did not demonstrate a clear advantage.

Intramedullary nailing reduces the risk of unplanned reoperation by a third compared to EF, with a slightly larger reduction in type III open fractures. Future trials should focus on major complication rates and health-related quality of life in high-grade tibial shaft fractures.

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

To compare the results and complications of a large consecutive series of total hip arthroplasty (THA) performed for acute femoral neck (FN) fracture by Adult Reconstructive (AR) and Trauma (T) surgeons to determine if there is a difference in outcomes.

Retrospective chart review.

Level one trauma center.

149 consecutive patients who presented to our institution with displaced FN fractures treated by THA were included in this study.

All patients were treated with THA.

Implant survival, 90-day complications, 90-day readmission, 1-year complications.

For the group as a whole, the major surgical complication rate (defined as dislocation, deep infection, loosening, fracture) was significantly higher for T surgeons (20%) than for AR surgeons (7%), (p=0.021). AR surgeons had significantly less radiographic component malpositioning 12% Vs 3% (p=0.024). Mortality and readmission rates were similar between the two cohorts at all time points. Implant survivorship was significantly higher at one year for AR surgeons (p=0.