Intradepartmental orthopaedic fragility fracture liaison improves osteoporosis follow-up and treatment.

OBJECTIVE: Over 2 million people in the United States sustain fractures related to osteoporosis annually, but only 20% of these patients receive treatment for their osteoporosis. The purpose of this study was to evaluate the effects of a fragility fracture liaison within the orthopedic department on treatment and follow up for osteoporosis. DESIGN: Retrospective cohort study SETTING: University Level I Trauma center PARTICIPANTS: 112 patients treated under the aegis of an interdepartmental fracture liaison and 208 patients treated following the introduction of an orthopedic fragility fracture liaison at a single institution. INTERVENTION: Transition from referral to interdepartmental fracture liaison to intradepartmental orthopedic fragility fracture liaison for fragility fractures. MAIN OUTCOME MEASURES: Outcomes evaluated included demographics, fracture type, DEXA scan results, follow up and treatment plan, and subsequent fracture. RESULTS: The mean age at time of fracture was 75 years, and the mean BMI was 27. The most common fracture types were femoral neck fractures (29%), pertrochanteric fractures (30%) and femur fractures (8%). There was a statistically significant increase in adherence to follow up and treatment after the introduction of an orthopaedic fragility fracture liaison. CONCLUSIONS: The introduction of an intradepartmental fragility fracture liaison significantly increases osteoporosis follow-up and introduces the ability to combine both osteoporosis treatment and postoperative orthopaedic care. The results of this study highlight the utility of incorporating a fragility fracture liaison within the orthopaedic department given the economic burden of fragility fractures and the morbidity associated with these fractures. LEVEL OF EVIDENCE: III cohort study.

The Use of Carbon Fiber Implants for Impending or Existing Pathologic Fractures.

OBJECTIVES: To evaluate the utility and complications of using carbon fiber implants (CFIs) compared with standard titanium alloy (TI) intramedullary implants for stabilization of impending or existing pathologic fractures. DESIGN: Retrospective comparison. PATIENTS/PARTICIPANTS: Ninety-four patients undergoing intramedullary fixation of 100 impending or existing pathologic fractures between 2014-2019 were identified for inclusion. MAIN OUTCOME MEASUREMENTS: The primary outcome was postoperative complications. Other outcomes included implant type, pathology, indication, and adjuvant therapy. RESULTS: Fifty-three percent of cases used a CFI, whereas 47% of cases used a TI. There were no differences between groups with regard to anatomic location (P = 0.218), indication for surgery (P = 0.066), histology (P = 0.306), or postoperative adjuvant therapy (P = 0.308). Nineteen percent of cases incurred a postoperative complication in each group (P = 0.530), and no differences were noted with regard to complication type including implant failure (P = 0.442) and wound complications (P = 0.322). There was a cost saving of $400 with TI implants compared with CFI. CONCLUSIONS: This is a high-risk population for postoperative complications after stabilization of pathologic fractures. Although there were no statistical differences in complications between CFI and TI, implant choice depends on patient characteristics and surgeon preference. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Bilateral Atypical Femur Fractures Complicated by Carbon Fiber Cephalomedullary Nail Fracture: A Case Report.

CASE: A 69-year-old woman with a history of breast cancer, on long-term antiresorptive medications, was treated with carbon fiber cephalomedullary nails for bilateral atypical femur fractures. Her thigh pain was presumed to be from metastatic lesions and was treated with radiation without standard imaging. The index procedure was complicated by a left nail fracture. The patient underwent exchange cephalomedullary nail fixation with plate augmentation. At 1 year, the patient was asymptomatic with radiographs demonstrating healing. CONCLUSION: This case highlights the importance of appropriate imaging in all patients with thigh pain on antiresorptive therapy and features an uncommon complication of carbon fiber cephalomedullary nail fixation.

Elevated BMI is associated with intra-articular comminution, prolonged operative time, and postoperative complications in distal radius fractures.

INTRODUCTION: Obesity continues to be a problem in the United States with greater than 35% of the adult population affected. Obesity influences fracture care as it affects impact forces, alters cellular pathways of healing, and is often associated with higher complication rates. Distal radius fractures are among the most common fracture patterns in the adult population. The purpose of this study was to evaluate the effect of BMI on the degree of intra-articular fracture comminution, operative time, and return to the OR in obese patients who underwent operation for distal radius fractures. METHODS: A retrospective analysis of the American College of Surgeons National Surgical Improvement Program's (ACS-NSQIP) database was performed and logistic regressions were used to assess the relationship between BMI and open treatment of distal radius fractures. Three separate CPT codes were used to distinguish between extra-articular fractures, intra-articular split fracture, and intra-articular fracture with comminution. Percutaneous or closed treatment of distal radius fractures were excluded. RESULTS: A total of 11,228 patients (mean age 65.1 years) with open reduction and internal fixation of distal radius fractures were identified. For every increase in BMI point, there was an increased risk of intra-articular split fracture by 1.7% (OR 1.017, 95% CI 1.010-1.023, p < 0.01) and increased risk of intra-articular comminution by 3.1% (OR 3.1, 95% CI 1.025-1.037, p < 0.01). Additionally, for every increase in BMI point, the risk of a surgical complication increased by 2.3% DISCUSSION: This nationally representative, population-based study demonstrates that elevated BMI is associated with increased risk for intra-articular involvement and higher risk for post-operative complications. Our results can be useful to patients and orthopedic surgeons as prognostic information for counseling patients on expectations following open reduction and surgical fixation of distal radius fractures. LEVEL OF EVIDENCE: Case-control study. Level III.

Ten-Year Trends and Independent Risk Factors for Unplanned Readmission Following Elective Total Joint Arthroplasty at a Large Urban Academic Hospital.

BACKGROUND: Total joint arthroplasty procedures continue to provide consistent, long-term success and high patient satisfaction scores. However, early unplanned readmission to the hospital imparts significant financial risks to individual institutions as we shift away from the traditional fee-for-service payment model. METHODS: Using a combination of our hospital's administrative database and retrospective chart reviews, we report the 30-day and 90-day readmission rates and all causes of readmission following all unilateral, primary elective total hip and knee arthroplasty procedures at a large, urban, academic hospital from 2004 to 2013. RESULTS: In total, 1165 primary total hip (511) and knee (654) arthroplasty procedures were identified, and the 30-day and 90-day unplanned readmission rates were 4.6% and 7.3%, respectively. A multivariate regression model controlled for a variety of potential clinical and surgical confounders. Increasing body mass index levels, an American Society of Anesthesiologists score of ≥3, and discharge to an inpatient rehab facility each independently correlated with risk of both 30-day and 90-day unplanned readmission to our institution. Additionally, use of general anesthesia during the procedure independently correlated with risk of readmission at 30 days only, while congestive heart failure independently correlated with risk of 90-day unplanned readmission. Readmissions related directly to the surgical site accounted for 47% of the cases, and collectively totaled more than any single medical or clinical complication leading to unplanned readmission within the 90-day period. CONCLUSION: Increasing body mass index values, general anesthesia, an American Society of Anesthesiologists score of ≥3, and discharge to an inpatient rehab facility each were independent risk factors for early unplanned readmission.