Nonunion Fractures: Trends in Epidemiology and Treatment of Femur Fractures, 2017-2022.

BACKGROUND: The incidence of femur fractures has increased in recent years, along with the rate of surgery and subsequent nonunion following these fractures. Nonunion is a significant concern due to the burden it places on both patients and the healthcare system. This study aims to investigate the demographic factors associated with femoral shaft fracture nonunion by comparing two surgical management approaches: open reduction internal fixation (ORIF) with plating versus closed reduction and fixation using intramedullary nailing (IMN). METHODS: The TriNetX database was queried using current procedural terminology (CPT) codes for surgical repair of femoral shaft fractures (FSFs), including IMN surgery (CPT: 27506) and femur ORIF (CPT: 27507). The subsequent chronological nonunion cases were identified using the 10th revision of the International Classification of Diseases (ICD-10) codes for femoral nonunion (S72.301K, S72.302K). Results were analyzed both descriptively and comparatively to assess differences among patients. Factors considered included age, sex, ethnicity, race, smoking status, and the type of surgical management (ORIF versus nailing) across the six-year study period. RESULTS: From 2017 to 2022, the prevalence of femoral shaft fracture surgeries increased for both IMN and ORIF. The rate of nonunion was 2.1% following IMN and 1.7% following ORIF. The mean age for nonunion was 54 years (SD: 20) following IMN and 63 years (SD: 18) following ORIF. Patients with a positive smoking history had higher rates of nonunion compared to those without. CONCLUSION: Our study revealed a relatively consistent rate of FSFs and nonunion over the six-year period. However, with a growing population, the absolute number of cases is steadily increasing, underscoring the burden on the healthcare system. This study contributes to the growing body of literature focused on improving patient outcomes and promoting health equity in fracture management practices.

Total knee arthroplasty combined with simultaneous open reduction and internal fixation in the treatment of knee osteoarthritis with patellar fracture: a case report and review of the literature.

BACKGROUND: Patients with severe knee osteoarthritis combined with patellar fracture are rare, and it is unclear whether single-stage surgery affects the enhanced recovery after surgery. CASE PRESENTATION: This case report describes two patients of Han nationality. A 69-year-old male patient was previously diagnosed with severe knee osteoarthritis of the left knee joint and was treated conservatively with long-term oral nonsteroidal antiinflammatory drugs and intraarticular injection of sodium hyaluronate. He was hospitalized for acute left knee injury owing to a fall from a height. He was diagnosed with knee osteoarthritis of the left knee joint and patellar fracture. Another 74-year-old female patient was previously diagnosed with severe knee osteoarthritis, long-term oral nonsteroidal antiinflammatory drugs and topical Chinese medicine to relieve the pain. A month ago, she fell down the stairs and fractured the patella in her left knee, she was diagnosed with severe left knee osteoarthritis combined with an old left patella fracture. Both patients were successfully treated by single-stage primary total knee arthroplasty and fixation of the patellar fracture. They both carried out early functional exercise normally and successfully achieved enhanced recovery. CONCLUSION: Successful single stage total knee replacement with patella management can not only reduce the number of operations, but also enable patients to achieve rapid postoperative recovery. However, single stage may increase the risk of local surgical complications. Therefore, for most patients, especially those with low risk of anesthesia related complications, standard of treatment remains first fixing the patellar fracture and when the fracture is healed proceed with the total knee arthroplasty.

Primary Arthrodesis or Open Reduction and Internal Fixation for Lisfranc Injuries: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Background: Lisfranc injuries are often managed surgically with primary arthrodesis (PA) or open reduction and internal fixation (ORIF); however, neither approach has been shown to be superior. This systematic review and meta-analysis assessed randomized controlled trials (RCTs) to compare the functional and surgical outcomes of PA and ORIF in the treatment of Lisfranc injuries. Methods: This study was performed as per the PRISMA protocol. Database searches were conducted on Cochrane, Embase, and PubMed libraries. Five RCTs were identified for inclusion involving 241 patients, of which 121 underwent PA and 120 underwent ORIF. Results: Statistically significant differences in visual analog scale pain score at 2 years (mean difference 0.89, 95% CI 0.18-1.59), patient satisfaction (OR 10.04, 95% CI 1.78-56.76), and all-cause return to surgery (OR 27.31, 95% CI 12.72-58.63) were observed, all favoring PA. There were no statistically significant differences between PA and ORIF with regard to American Orthopaedic Foot & Ankle Society midfoot scores at 2 years, 36-Item Short Form Health Survey (SF-36) scores, and unplanned return to surgery. Conclusion: This study showed significant improvement in pain at 2 years, patient satisfaction, and all-cause return to surgery favoring PA in all instances. Given ORIF often necessitates a second operation for hardware removal, it is to be expected that all-cause return to surgery is higher in ORIF groups. Overall, these results do not have the power to confer an advantage to a particular approach because of significant heterogeneity. Further studies should focus on larger patient cohorts and longer follow-up, or analysis stratified by patient demographics and injury presentation. In the absence of clinically significant differences, cost-benefit analyses should be considered to answer the question of whether to "fix or fuse" for Lisfranc injuries.

Single-Incision Direct Lateral Approach Versus Dual-Incision Approach for Distal Tibial and Fibular Fractures.

INTRODUCTION: Distal tibial and fibular fractures are typically the result of high-energy trauma. Open reduction and internal fixation (ORIF) are often used to reconstruct and reduce displaced fractures, especially intra-articular ones. These fractures can be addressed either by a dual-incision approach (medial approach for the distal tibia and lateral approach for the fibula) or by a single-incision direct lateral approach to fix both the tibia and fibula. The direct lateral approach avoids injury to the medial soft tissues. This study was conducted to compare the postoperative clinico-radiological and functional outcomes of the single-incision direct lateral approach and the dual-incision approach for distal tibial and fibular fractures. MATERIALS AND METHODS: A prospective comparative cohort study of 40 patients was conducted. The patients were classified into two cohorts of 20 each based on the surgical approach: those who underwent a single-incision direct lateral approach and those who underwent a dual-incision approach for distal tibial and fibular fractures (procedure: ORIF with plating). The study was conducted from September 2022 to March 2024. A follow-up period of at least 12 months was carried out, comparing operative time, discharge time, and postoperative outcomes using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, ankle range of motion (ROM), Southampton wound score for wound healing, visual analog scale (VAS) pain score, and periodic radiographs at each follow-up. Complications were also studied. RESULTS: The mean operative time was 95.06 ± 7.04 minutes for the single-incision approach and 109.89 ± 7.88 minutes for the dual-incision approach. The average blood loss was 202.41 ± 32.76 mL for the single-incision approach and 248.39 ± 28.18 mL for the dual-incision approach. The hospital stay was shorter in the direct lateral approach group, and the AOFAS score at 12 months was better in the direct lateral approach group (91.47 ± 2.55 for the single-incision approach vs. 83.33 ± 8.71 for the dual-incision approach). Postoperative wound healing was observed, and the Southampton wound score was compared. Overall, soft tissue complications were fewer in the direct lateral approach group. The postoperative VAS pain score was consistently lower in the single-incision direct lateral approach group, which also demonstrated better ankle ROM. The p-value was significant (<0.05) for these parameters. At the six-month follow-up, all patients exhibited clinical and radiographic healing and bone union, except for one case in the dual-incision group. A medial compound wound, treated by plastic surgery with flap cover intervention, was identified as one of the definitive indications for single-incision plating. CONCLUSION: The single-incision approach was associated with better soft tissue healing, fewer wound complications, and superior ankle functional outcomes compared to the dual-incision approach.

Surgical stabilization of rib fractures (SSRF): the WSES and CWIS position paper.

BACKGROUND: Rib fractures are one of the most common traumatic injuries and may result in significant morbidity and mortality. Despite growing evidence, technological advances and increasing acceptance, surgical stabilization of rib fractures (SSRF) remains not uniformly considered in trauma centers. Indications, contraindications, appropriate timing, surgical approaches and utilized implants are part of an ongoing debate. The present position paper, which is endorsed by the World Society of Emergency Surgery (WSES), and supported by the Chest Wall Injury Society, aims to provide a review of the literature investigating the use of SSRF in rib fracture management to develop graded position statements, providing an updated guide and reference for SSRF. METHODS: This position paper was developed according to the WSES methodology. A steering committee performed the literature review and drafted the position paper. An international panel of experts then critically revised the manuscript and discussed it in detail, to develop a consensus on the position statements. RESULTS: A total of 287 studies (systematic reviews, randomized clinical trial, prospective and retrospective comparative studies, case series, original articles) have been selected from an initial pool of 9928 studies. Thirty-nine graded position statements were put forward to address eight crucial aspects of SSRF: surgical indications, contraindications, optimal timing of surgery, preoperative imaging evaluation, rib fracture sites for surgical fixation, management of concurrent thoracic injuries, surgical approach, stabilization methods and material selection. CONCLUSION: This consensus document addresses the key focus questions on surgical treatment of rib fractures. The expert recommendations clarify current evidences on SSRF indications, timing, operative planning, approaches and techniques, with the aim to guide clinicians in optimizing the management of rib fractures, to improve patient outcomes and direct future research.

Can early treatment of lisfranc injuries without planned re-intervention be safely performed.

The Lisfranc complex is a unique combination of ligamentous and osseous relationships between the medial cuneiform and second metatarsal base that is often injured by high energy mechanisms. Fixation for these injuries is often operative; however, the optimal timing of surgical treatment has been debated. All patients who underwent operative fixation of a Lisfranc injury at a single urban tertiary care center were reviewed. Patient were split into two groups based on timing to fixation with one group being less than 24 h from presentation and a second group being greater than 24 h. There were 58 patients who underwent what was planned as final operative stabilization of their Lisfranc injury in less than 24 h and 41 patients who underwent fixation after more than 24 h. The early treatment of Lisfranc injuries did not lead to significant increases in follow up time, infections, time to weight bearing, union rates, or time to union compared patients treated with delayed fixation. There was a higher rate of superficial infection in the early intervention group, but it did not reach statistical significance. We believe our findings demonstrate that delayed fixation is not superior to early treatment of Lisfranc injuries. LEVEL OF EVIDENCE: Level 3 Therapeutic retrospective comparative study.

Proximal Humeral Fractures in Finland - Regional Differences in Incidence and Methods of Treatment.

BACKGROUND: Proximal humeral fractures (PHF) are one of the most common fragility fractures and there is accumulating evidence that even displaced PHFs should be treated conservatively. The treatment should be as effective and standardized as possible regardless of the hospital district of the patient. The aim of this study was to describe possible regional variation in incidence and treatment methods of PHFs in Finland. METHODS: The study included all Finnish inhabitants aged 16 years and older with PHF diagnosis between 1997 and 2019. All records are based on data from two national registers. The fractures and operations were organized according to hospital district of the patient and annual incidences of PHFs, and different treatment methods were calculated for each hospital district. RESULTS: Between 1997 and 2019, 79,053 PHFs were identified. 64,117 of PHFs were treated conservatively and 14,936 operatively. The incidence of conservative treatment corresponded closely to the fracture incidence per hospital district. Internal fixation (IF) incidence generally increased towards the end of the first half of the study period and declined thereafter, and hemiarthroplasty (HA) was replaced by total shoulder arthroplasty (TSA) as the most common type of arthroplasty by the end of the period. We found regional variation in the incidence of PHFs, with a low of 61.4 per 105 in Åland, and a high of 97.7 per 105 in East-Savo. CONCLUSIONS: In Finland, the treatment of PHFs did not differ fundamentally between hospital districts and a general evidence-based shift in treatment practice was shown. We found regional variation in the incidence of PHFs, and it seems that the higher incidence of PHFs is concentrated in the Eastern Finland.

Surgical Treatment of Periarticular Distal Radius Fracture in Elderly: A Systematic Review.

Background/Objectives: The treatment of periarticular distal radius fractures remains challenging. Different surgical treatment options have been proposed as alternatives to conservative treatment. This systematic review aims to compare the functional outcomes, radiological outcomes, and complications among volar locking plates (VLPs), Kirschner-wire fixations, and external fixations (EFs) for distal radius fractures in patients aged 60 years and older. Methods: We conducted a comprehensive search of PubMed, Cochrane, and Science Direct databases assessing the effects of VLP, EF, and K-wire treatments for distal radius fractures in patients aged 60 years and over. The primary outcome was the evaluation of the range of motion (ROM) degrees after three surgical procedures, trying to assess the best treatment option. The secondary outcome included evaluation of the Disabilities of the Arm, Shoulder, and Hand (DASH) score, quick-DASH score, Patient-Rated Wrist Evaluation (PRWE) score, Visual Analog Scale (VAS) score, grip strength, radiographic assessment, and complications comparing VLPs, EFs and K-wires. Results: A total of 23 studies were included, comparing VLP, EF, and K-wire fixation. The overall population comprised 5618 patients, with 4690 females and 1015 males, of which 4468 patients were treated with VLP, 503 with EF, and 647 with K-wire. The most common complications among the VLP group were complex regional pain syndrome (7.5%) and carpal tunnel syndrome (6.8%); for the EF group, infections (9.8%) and carpal tunnel syndrome (6.8%); and for the K-wire group, carpal tunnel syndrome (7.5%) and infections (6.9%). Conclusions: VLP showed better clinical outcomes in the first few months after treatment. However, these differences decreased over time and became similar after one year. EF and K-wire fixations remain easier to manage during surgery.

Unusual Morphology of a Distal Femur Fracture.

Fractures of the distal femur are rare but serious injuries that often follow a distinct pattern, occurring more frequently in both younger and older populations. In younger individuals, these fractures usually result from high-energy trauma, while in the elderly, they are often caused by domestic accidents. A 65-year-old female with a history of type 2 diabetes, hypertension, anxiety, and dyslipidemia fell on the stairs, impacting her right knee. She experienced intense pain and was unable to walk. Examination showed a swollen right knee without abrasions, tenderness, or neurovascular compromise. X-rays revealed a displaced fracture of the medial femoral condyle, with a fracture line extending to the diaphysis, and a non-displaced lateral femoral condyle fracture. The case underscores a significant distal femur fracture in an elderly patient following a low-energy impact. Early diagnosis and surgical stabilization are vital for good outcomes in femoral condylar fractures. Goals include anatomical reduction and restoring limb alignment while preserving vascularity. The choice of surgical methods depends on fracture configuration and surgeon preference. Surgery is the gold standard for displaced fractures.

Superior locking plate with braided PDS coracoclavicular fixation for the unstable distal clavicle fracture: a technical trick and case series.

The ideal method of operative fixation for unstable distal clavicle fractures remains controversial, with particular emphasis on the need to restore the normal coracoclavicular distance. Our preferred method of fixation includes open reduction and internal fixation with a distal clavicle locking plate in combination with a polydioxanone suture wrapped around the plate and coracoid to restore the coracoclavicular distance and offload the bony repair. The purpose of this study is to report clinical, radiographic, and functional outcomes in patients with unstable distal clavicle fractures treated with this method of fixation.

Outcomes of Intramedullary Nailing Versus Plate Fixation in the Management of Humeral Shaft Fractures: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis aimed to compare the outcomes of intramedullary nailing (IMN) and open reduction with internal fixation (ORIF) in treating traumatic humeral shaft fractures in adults (18 years and above). A comprehensive literature search was conducted in databases including PubMed, Google Scholar, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL). The primary outcome was time to union, while secondary outcomes included non-union rates, incidences of iatrogenic radial nerve palsy, surgical site infections, and intra-operative comminution. Twenty-six studies, encompassing 1,674 patients (867 IMN, 807 ORIF), were included. IMN demonstrated a shorter time to union compared to ORIF (mean difference -1.06 (95% CI, -1.88 to -0.23)), with significant statistical heterogeneity (I² = 70%), and a mean difference of -2.14 (95% CI, -3.16 to -1.12) in the randomized controlled trial (RCT) subgroup analysis, which had no significant statistical heterogeneity. Both techniques had comparable non-union rates (risk ratio 0.34 (95% CI, 0.94 to 1.93)). IMN was associated with lower incidences of iatrogenic radial nerve palsy (risk ratio 0.48 (95% CI, 0.27 to 0.87)) and surgical site infections (risk ratio 0.44 (95% CI, 0.25 to 0.76)), but had a higher risk of intra-operative comminution (risk ratio 3.04 (95% CI, 1.24 to 7.44)). The studies exhibited significant heterogeneity and varying outcome measures, highlighting the need for cautious interpretation. IMN offers rapid fracture stabilization and minimal additional physiological insult, while ORIF remains preferable for achieving precise anatomical reduction. These findings highlight the importance of considering patient-specific factors and surgical expertise in selecting the appropriate fixation technique.

Locked Posterior Shoulder Dislocation with Accompanying Fracture: A Debilitating Rare Injury for Athletes?

Shoulder dislocation is undoubtedly one of the most common injuries in traumatology. Posterior dislocation of the shoulder is regarded as comparatively rare compared to anterior dislocation, whilst it is strikingly extraordinary for this type of injury to be accompanied by a concomitant fracture. Accurate diagnosis and appropriate treatment can be considerably demanding, while being vitally important in this exceedingly rare condition. These injuries are broadly considered to be under-reported in the existing literature, especially among high-demand athletes. We present a rare case of a high-demand athlete sustaining a traumatic locked posterior shoulder dislocation with an accompanying fracture treated in our Institution. A detailed clinical examination and plain radiography revealed the peculiar condition, and a CT scan was subsequently performed for more thorough evaluation of the injury. The patient underwent surgery on the day following admission for repair of the extensive shoulder damage, and a deltopectoral approach was utilized. Reduction of the metaphyseal fracture and the dislocation was accomplished with gentle manipulations, and stabilization was obtained with an anatomic plate. A modified McLaughlin procedure was carried out to address the reverse Hill-Sachs lesion. The postoperative period was uneventful, followed by a painstaking physical rehabilitation program, and the patient returned successfully to his sporting activities 6 months postoperatively. By presenting this thought-provoking case, we stress the challenging nature of these immensely infrequent injuries while also highlighting the requirement for more sensitive factor-specific studies regarding their optimal treatment.

The efficacy of arthroscopy-assisted versus stand-alone open reduction and internal fixation for treating tibial plateau fracture: a systematic review and meta-analysis.

BACKGROUND: The optimal surgical technique for treating tibial plateau fractures remains controversial. This study aimed to compare the outcomes of arthroscopy-assisted reduction and internal fixation (ARIF) to those of open reduction and internal fixation (ORIF) in treating tibial plateau fractures. METHODS: This systematic review and meta-analysis were conducted to compare surgical outcomes between ARIF versus ORIF for patients with tibial plateau fractures. Relevant studies, comprising randomized controlled trials (RCTs) and non-RCTs, were identified through searches in Cochrane CENTRAL, PubMed, and Embase databases. Risk of bias assessments were conducted using the revised Cochrane risk-of-bias tool for RCTs (RoB 2.0), Newcastle Ottawa scales for non-RCTs, and Joanna Briggs Institute Critical Appraisal Checklist for case series studies. Data synthesis utilized a random-effects model meta-analysis. The primary outcome assessed was functional outcomes, with complications considered as secondary outcomes. RESULTS: There were fifteen studies (one RCT and fourteen non-RCTs) included in this study, comprising a total of 969 participants (548 in the ARIF group and 421 in the ORIF group). Although patients in the ARIF group showed a trend towards better functional outcomes compared to the ORIF group, the difference was not statistically significant (Hospital for special surgery score, mean difference (MD) = 5.13, 95% confidence interval (CI)=-1.67 to 11.92, I²=83%; Knee society score, MD = 5.84, 95% CI=-1.18 to 12.86, I²=74%). No significant differences were noted in infection, stiffness, DVT, and overall complications between two groups. The ARIF group included ten case series studies with a total of 302 patients. The pooled mean Rasmussen Radiological Score was 16.59 (95% CI, 15.72 to 17.50), and the pooled mean Rasmussen Clinical Score was 27.38 (95% CI, 26.45 to 28.33). CONCLUSION: The findings of this study reveal no significant difference in clinical outcomes and complication rates between ARIF and ORIF. Additionally, this study found that the complication rate for patients undergoing ARIF falls within previously reported ranges. This suggests that ARIF is a reliable and effective surgical option for treating tibial plateau fractures, even in cases involving high-energy trauma.

Complications and morbidity of the extended delto-pectoral approach in treating complex humeral shaft fractures with proximal metaphyseal extension using a long locking plate for internal fixation.

BACKGROUND: Humeral shaft fractures account for up to 3% of all fractures, but complex forms of those fractures (type AO/OTA B or higher) are rare. Plate and screw fixation of the fracture are rated as consolidated from 80 to 97%. Reported complications include non-union, secondary radial nerve palsy and infection. Minimally invasive plate osteosynthesis (MIPO) should provide the same union rate as open reduction and internal fixation (ORIF) but potentially with fewer complications. The aim of our study was to review patients treated for complex humeral fractures with ORIF through an extended delto-pectoral approach using a long pre-contoured locking plate. The morbidity of the open approach, complication rates, union rate and clinical outcomes were assessed. METHODS: We performed a retrospective analysis of 26 consecutive complex humeral shaft fractures (7 males, mean age 59 years; 19 females, mean age 67 years) treated in our institution with a long pre-contoured locking plate between June/2011 and December/2017. Fracture healing was evaluated with standard radiographs. Eventual complications and the morbidity of the approach were assessed through chart review. The final clinical outcome and quality of life were assessed via telephone interview with DASH score and EQ-5D-3 L in 25 of the 26 patients included. RESULTS: There were no complications related to the open approach with uneventful wound healing in all cases without any infections. Mechanical complications occurred in 3 cases (11%): one tuberosity dislocation (revised) and two plate failures (one revised). Postoperative radial nerve palsy was observed in two patients (7%), of which one was transient, the other was persistent. The plate was removed in 4 cases (15%). The average radiological and clinical follow-up was 21 months (range: 12-56). At 12 months follow-up complete fracture healing was confirmed in 22 out of 26 cases and in three more patients after 18 months. After an average of 44 months, the mean DASH score was 35 (SD ± 15.83) points; the EQ-5D-3 L score 0.7 (SD ± 0.31). CONCLUSION: ORIF with a long locking plate though an extended delto-pectoral approach is certainly still a viable option to treat complex humeral shaft fractures with good soft tissue and bone healing as well as good functional recovery. No increased morbidity was attributed to the open surgical approach. In our series, radial nerve palsy could not be completely avoided, accentuating the potential risk of this specific fracture in close proximity to the radial nerve. TRIAL REGISTRATION: Ethics Committee: Ethikkommission Ostschweiz (EKOS), Project ID: 2019-00323.

Reverse total shoulder arthroplasty policy in Germany - an analysis of the health care reality from 2010 to 2022.

BACKGROUND: The last few years have been characterized by increasing numbers of reverse shoulder arthroplasties. In addition to the classic indication of cuff tear arthropathy, the use for complex proximal humeral fractures (PHFs) and rotator cuff tear (RCT) in very old patients have been established. The objective of this study is to clarify and substantiate the above statements specifically for Germany (based on official data from 2010 to 2022). Since substantial changes in the structure of the population are expected over time, all data must be adjusted for these changes. The hypotheses are (1) the German population is ageing with a shift to more elderly patients over time, and (2) the general use of shoulder arthroplasty (total anatomic - shoulder arthroplasty (aTSA) and reverse - rTSA) has increased during the time period, but the effect is beyond the shift of age stratification but attributable to a change of hospital admissions and surgical therapy for PHF and RCT. METHODS: In this retrospective study, data were collected from the National Bureau of Statistics in Germany for the period of 2010 to 2022. Three different data sources were combined for the analysis: a database regarding the structure of the population in age groups for every year, a database reporting relevant operation codes, and the data on hospital admissions based on ICD-10 codes. The relevant data were extracted and combined using Excel spread sheets (Microsoft Corporation, version 2019). Absolute numbers are reported and adjusted for 100.000 inhabitants in each age group in order to calculate the incidence. RESULTS: Only slight change in absolute numbers of the population (n = 81751602 to 84358845, +3%) was observed, but a substantial shift toward the group of elderly people: the peak age group has shifted from 40-50 to 55-65. The number of TSA has significantly increased (n = 15000 to n = 28117, +187%; incidence 18.35 to 28.53, +155%). The number of rTSA has largely increased (n = 5326 to n = 24067, +452%; incidence 6.51 to 28.53, +438%), whereas the number of aTSA steadily decreased (n = 9674 to n = 4050, -42%; incidence 11.83 to 4.80, -41%). The number of revision arthroplasties has increased 1.8-fold (n = 2179 to n = 3893; incidence 1.7-fold). The peak revision rate shifted from the age group 70-75 toward 90- 95; 76% of all revision cases were performed in patients 65 years and older in 2010 increasing to 87% in 2022. Hospital admissions for PHF have increased 7.8-fold (n = 110091 to n = 810907). The peak in the age groups has shifted by a decade from 70-74 to 80-84. The absolute number of surgical therapy for PHF has decreased (n = 12816 to n = 9562, 75%; incidence 72%). The number of hospital admissions for RCT increased by 2.6-fold (n = 47004 to n = 124096; incidence + 255%). The number of surgical interventions for RCT increased by 3.7% (n = 51350 to n = 53294; incidence 62.8 to 63.2). Combined numbers for the operative therapy of PHF, RCT, and rTSA show an increase of +124% (n = 69491 to n = 86715) with a peak shift on one decade toward the age group 60-94 with 79% of the patients in 2022. The increased use of rTSA, as expressed by incidence, is strongly correlated with the increasing proportion of people aged 65 and over. CONCLUSION: The data show a substantial increase in the use of shoulder arthroplasty procedures in Germany in the observed time period, with the main driving factor being the increase of rTSA, whereas aTSA numbers decreased. The combined analysis of the hospital admissions and operative procedures performed to treat PHF and RCT indicated a shift of treatment numbers from open reduction and internal fixation and rotator cuff repair in the elderly toward the alternative use of rTSA in this age group. The observed shift of the stratification of age groups gives a further explanation for the increase in rTSA use: the number of patients in the age groups with the typical and alternative indications for rTSA substantially increased with a shift of the peak age group towards the elderly of one decade. Healthcare officials should be aware of these fundamental changes in the population, which create further demands on the health care system. The expected continuation of rising numbers of rTSA needs to be addressed by providing adequate resources such as reimbursement, surgical and rehabilitation facilities, and staff.

Facial Nerve Paresis After Combined Intraoral and Preauricular Approach to High Condylar Fractures: A Case Report.

Condylar fractures are the most common mandibular fractures, and a variety of open and closed approaches are used for repair, each with its own inherent risks and benefits. A 27-year-old man had a severely displaced and angulated high subcondylar fracture with anterior open bite deformity. The patient underwent open reduction and internal fixation of the condyle via a combined preauricular and intraoral approach as well as maxillomandibular fixation to repair his fracture. This combined approach allows the surgeon to maximize exposure while limiting risks of permanent injury from surgery.

Readmission within 30-days of open reduction and internal fixation for ankle fractures: NSQIP analysis of 29,905 patients.

BACKGROUND: Historically, ankle fractures have been treated with open reduction and internal fixation (ORIF) procedures, which are considered safe and effective. Patient characteristics may contribute to postoperative difficulties thereby increasing risk of hospital readmission. The objective of this study was to determine the frequency of and reasons for 30-day readmission and postoperative complications following ORIF for ankle fractures. METHODS: A retrospective review of the National Surgical Quality Improvement Program (NSQIP) database from 2015 to 2021 identified patients undergoing ORIF for ankle fractures. Patient demographics, complication incidence, and reasons for unplanned hospital readmission were collected. Multivariable analyses identified patient risk factors for any adverse event (AAE) and readmission within 30-days of surgery. RESULTS: The 29,905 patients queried who underwent ORIF procedures for ankle fractures between 2015 and 2021 were 49.6 ± 18.40 years of age, 30.9 ± 7.10 kg/m2, and 40.81% male. Of this cohort, 981 (3.30%) experienced 30-day postoperative adverse events, with surgical site infections (SSI; 1.25%) the most common. Unplanned readmission was observed in 2.08% of patients after a mean of 14.64 days. Surgical site related readmissions were 20.55% (n = 128) of reported readmissions with the most common being superficial incisional SSI. Notable risk factors for adverse events included ASA class (OR = 1.579, P < .001), COPD (OR = 1.522, P < .001), bleeding disorders (OR = 1.489, P = .001), diabetes (OR = 1.254, P = .008), and current smoking status (OR = 1.295, P = .002). Risk factors for readmission were ASA class (OR = 1.762, P < .001), COPD (OR = 1.599, P < .001), bleeding disorder (OR = 1.711, P < .001), diabetes (OR = 1.494, P < .001), end stage renal disease (OR = 3.304, P < .001), steroid use (OR = 2.144, P < .001), and current smoking status (OR = 1.667, P < .001). CONCLUSION: Despite a low adverse event rate, 2% of patients required unplanned readmission after ORIF for ankle fractures. Surgical site complications account for almost half of reported readmissions. ASA class and various medical comorbidities were found to significantly increase the risk of postoperative adverse events and hospital readmission.

A Systematic Review of the Optimal Management of Pediatric Distal Radius Displacement Fractures: Open Reduction and Internal Fixation Versus Cast Placement.

Distal radius fractures are among the most common pediatric injuries, affecting thousands of children each year. These fractures often require clinical intervention to reduce displacement and ensure the proper healing of the growth plate and wrist bone. The primary objective of this comprehensive analysis is to compare the effectiveness of open reduction and internal fixation (ORIF) versus cast placement in the treatment of pediatric distal radius fractures, with the aim of identifying the optimal treatment approach. Therefore, a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted on pediatric distal radius displacement fractures using extensive database searches from 2000 to 2024 for specific keywords, ensuring transparency and reproducibility. Our findings indicate that higher displacement necessitates ORIF to minimize long-term complications and ensure better functional outcomes for pediatric patients. Rare studies comparing ORIF and cast placement are analyzed, emphasizing the advantages and limitations of each approach. The document concludes that the choice between ORIF and casting depends on factors such as fracture severity, patient's age, and specific characteristics of the injury to ensure optimal outcomes in pediatric distal radius fracture management. In conclusion, our data suggests that ORIF and cast placement each have pros and cons for pediatric distal radius fractures, with the best treatment depending on fracture specifics and patient factors, but neither method is clearly superior for long-term outcomes.

Posterior Cruciate Ligament Avulsion Fracture of Tibia: Fixation with Screw and Augmentation Using Ethibond Suture for Improved Clinical Outcomes.

Introduction: The posterior cruciate ligament (PCL) is a vital structure in knee biomechanics, and its avulsion fractures present a unique challenge. This prospective cohort study was conducted at Grant Government Medical College and JJ Hospital, Mumbai, aimed to assess the clinical outcomes of open reduction and internal fixation (ORIF) utilizing cancellous screws and ethibond suture augmentation for PCL avulsion fractures. PCL avulsion fractures often result from traumatic incidents, such as road traffic accidents, and are associated with complications if left untreated. Materials and Methods: Patients aged 20-45 years with isolated PCL avulsion fractures, confirmed by clinical and radiological assessments, were included. Seven eligible patients underwent ORIF, and outcomes were evaluated through clinical assessments, radiological imaging, and the Lysholm knee scoring system. Follow-ups were conducted for a mean time of 13.2 months, assessing stability, range of motion, and complications. Results: The study demonstrated a mean post-operative Lysholm score of 93.8, significantly improved from the pre-operative score of 49.6. Post-operative knee flexion averaged 125.2°. Fracture healing was observed in all cases, and complications were minimal. The study provides evidence of the effectiveness of ORIF with ethibond suture augmentation for PCL avulsion fractures. Conclusion: The study concludes that the proposed surgical technique yields positive outcomes, including enhanced knee functionality, successful fracture healing, and minimal complications. This approach, combining cancellous screws and ethibond suture augmentation, presents a promising option for the management of PCL avulsion fractures, contributing to the diverse landscape of effective treatment modalities.

Minimum 10-year Follow-up after Open Reduction and Internal Fixation of Radial Head Fractures Mason Type II and III.

INTRODUCTION: The treatment of complex radial head fractures remains controversial with open reduction and internal fixation (ORIF), radial head arthroplasty, and radial head excision being the most common treatment options. While ORIF is the preferred treatment strategy for Mason type II fractures, the optimal treatment of Mason type III fractures is debated. PURPOSE: To report minimum 10-year outcomes after ORIF of Mason type II and type III radial head fractures. We hypothesized that both Mason Type II and Type III fracture patients would demonstrate satisfactory clinical outcomes at minimum 10-year follow-up. METHODS: All patients with Mason type II or III radial head fractures who were treated with ORIF by a single surgeon between 2005 and 2010 were included. Fractures with significant bone defects were treated with bone grafts and elbow ligament injuries were treated with either primary ligament repair or reconstruction. Patient reported outcome (PRO) questionnaires were administered at the time of last clinical follow-up and at a minimum of 10 years postoperatively. RESULTS: Twenty-four patients, including 13 male and 11 female patients with an average age of 39 (range 19-60) at the time of surgery met inclusion criteria. Thirteen patients suffered from Mason type II and 11 patients from Mason type III fractures. At initial follow-up, 21 out of 24 fractures (88%) demonstrated radiographic union. Three non-unions, 2 of which were Mason type III fractures, were treated with revision ORIF and iliac crest bone grafting. 11 patients developed postoperative elbow stiffness and required capsular release surgery. At last clinical follow-up, average flexion was 139 degrees, average extension was 4 degrees, average supination was 77 degrees, and average pronation was 81 degrees. The median DASH score was 7 (ranging from 0 - 32). Minimum 10-year follow-up (mean: 14.6 years) was collected on 18 of 24 (75%) of the patients. At a minimum of 10 years postoperatively, the median QuickDASH score was 4.5 (range: 0 to 25) and the median SANE score was 96.5 (range: 75-100). Median satisfaction with the surgical outcome was 10/10 (range: 3-10). CONCLUSION: ORIF of Mason type II and III radial head fractures results in high union rates with good functional outcomes at a mean of 14.6 years postoperatively. The study results suggest that ORIF of Mason type II and III radial head fractures leads to long-term positive functional outcomes.