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BACKGROUND: Given the rare nature of tibial tubercle fractures, previous studies are mostly limited to small, single-center series. This results in practice variation. Previous research has shown poor surgeon agreement on utilization of advanced imaging, but improved evidence-based indications may help balance clinical utility with resource utilization. The purpose of this study is to quantify diagnostic practices for tibial tubercle fractures in a large, multicenter cohort, with attention to the usage and impact of advanced imaging. METHODS: This is a retrospective series of pediatric tibial tubercle fractures from 7 centers between 2007 and 2022. Exclusion criteria were age above 18 years, missing demographic and pretreatment data, closed proximal tibial physis and tubercle apophysis, or a proximal tibia fracture not involving the tubercle. Demographic and injury data were collected. Fracture classifications were derived from radiographic evaluation. The utilization of advanced imaging was recorded as well as the presence of findings not identified on radiographs. Standard descriptive statistics were reported, and χ2 tests were performed (means reported±SD). RESULTS: A total of 598 patients satisfied the inclusion criteria, of which 88.6% (530/598) were male with a mean age of 13.8±1.9 years. Internal oblique x-rays were obtained in 267 patients (44.6%), computed tomography (CT) in 158 (26.4%), and magnetic resonance imaging (MRI) in 64 (10.7%). There were significant differences in the frequency at which CT (7.2% to 79.4%, P<0.001) and MRI were obtained (1.5% to 54.8%, P<0.001). CT was obtained most frequently for Ogden type IV fractures (50/99, 50.5%), and resulted in novel findings that were not visualized on radiographs in a total of 37/158 patients (23.4%). The most common finding on CT was intra-articular fracture extension (25/37). MRI was obtained most frequently for Ogden type V fractures (13/35, 37.1%), and resulted in novel findings in a total of 31/64 patients (48.4%). The most common finding was patellar tendon injury (11/64), but only 3 of these patients required tendon repair. CONCLUSIONS: Substantial variation exists in the diagnostic evaluation of tibial tubercle fractures. CT was most helpful in clarifying intra-articular involvement, while MRI can identify patellar tendon injury, periosteal sleeve avulsion, or a nondisplaced fracture. This study quantifies variation in diagnostic practices for tibial tubercle fractures, highlighting the need for evidence-based indications for advanced imaging. LEVEL OF EVIDENCE: Level III.
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PURPOSE: To assess the efficacy and safety of intrawound antibiotics in posterior fusions for adolescent idiopathic scoliosis (AIS). METHODS: The NSQIP-Pediatric databases 2016-2018 were utilized. Patients 10 years of age or older with AIS who underwent posterior fusion were selected and divided into two cohorts based on the receipt of intrawound antibiotics. Patient characteristics and complications were compared. Multivariate analyses were performed to determine the efficacy and safety of intrawound antibiotics. RESULTS: A total of 4203 patients received intrawound antibiotics while 879 patients did not. The intrawound antibiotic group had longer constructs, higher blood loss, and longer operative times, factors historically associated with higher infection rates. Those that received intrawound antibiotics had SSI rate of 0.69%, while its counterpart had 0.57% (p = 0.689). The reoperation rates were 1.12% and 1.25% (p = 0.735), for those with and without intrawound antibiotics, respectively. In multivariate analyses, intrawound antibiotics use was not found to be a significant predictor for SSI, any complications, reoperation and readmission. CONCLUSION: The current study represents the largest AIS surgery cohort studied to evaluate the efficacy of intrawound antibiotics. Our analysis failed to demonstrate association between the use of intrawound antibiotics and reduction in SSI. While other studies have reported seroma, wound dehiscence and renal failure with the practice, we did not observe an increased rate of such complications. This study highlights the difficulty of understanding the role for individual infection prevention measures in current surgical settings, where the SSI rate for the control group was substantially lower than 1%.
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Cifosis , Escoliosis , Fusión Vertebral , Humanos , Adolescente , Niño , Antibacterianos/efectos adversos , Escoliosis/complicaciones , Fusión Vertebral/efectos adversos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Cifosis/complicacionesRESUMEN
INTRODUCTION: Quantification of a researcher's productivity relies on objective bibliometric measurements, such as the Hirsch index (h-index). However, h-index is not field and time-normalized and possesses bias against newer researchers. Our study is the first to compare the relative citation ratio (RCR), a new article-level metric developed by the National Institutes of Health, with h-index in academic orthopaedics. METHODS: Academic orthopaedic programs in the United States were identified using the 2022 Fellowship and Residency Electronic Interactive Database. Available demographic and training data for surgeons were collected. RCR was calculated using the National Institutes of Health iCite tool, and h-index was calculated using Scopus. RESULTS: Two thousand eight hundred twelve academic orthopaedic surgeons were identified from 131 residency programs. H-index, weighted RCR (w-RCR), and mean RCR (m-RCR) all significantly differed by faculty rank and career duration. However, while h-index and w-RCR varied between sexes (P < 0.001), m-RCR did not (P = 0.066), despite men having a longer career duration (P < 0.001). DISCUSSION: We propose that m-RCR be used in conjunction with w-RCR or h-index to promote a fairer, comprehensive depiction of an orthopaedic surgeon's academic effect and productivity. Use of m-RCR may reduce the historic bias against women and younger surgeons in orthopaedics, which has implications in employment, promotion, and tenure.
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Cirujanos Ortopédicos , Ortopedia , Masculino , Humanos , Femenino , Estados Unidos , Eficiencia , Docentes , BibliometríaRESUMEN
The purpose of this study was to determine the variability in clinical management of tibial tubercle fractures among a group of pediatric orthopedic surgeons. Nine fellowship-trained academic pediatric orthopedic surgeons reviewed 51 anteroposterior and lateral knee radiographs with associated case age. Respondents were asked to describe each fracture using the Ogden classification (type 1-5 with A/B modifiers), desired radiographic workup, operative vs. nonoperative treatment strategy and plans for post-treatment follow-up. Fair agreement was reached when classifying the fracture type using the Ogden classification (k = 0.39; P < 0.001). Overall, surgeons had a moderate agreement on whether to treat the fractures operatively vs. nonoperatively (k = 0.51; P < 0.001). Nonoperative management was selected for 80.4% (45/56) of type 1A fractures. Respondents selected operative treatment for 75% (30/40) of type 1B, 58.3% (14/24) of type 2A, 97.4% (74/76) of type 2B, 90.7% (39/43) of type 3A, 96.3% (79/82) of type 3B, 71.9% (87/121) of type 4 and 94.1% (16/17) of type 5 fractures. Regarding operative treatment, fair/slight agreement was reached when selecting the specifics of operative treatment including surgical fixation technique (k = 0.25; P < 0.001), screw type (k = 0.26; P < 0.001), screw size (k = 0.08; P < 0.001), use of washers (k = 0.21; P < 0.001) and performing a prophylactic anterior compartment fasciotomy (k = 0.20; P < 0.001). Furthermore, surgeons had fair/moderate agreement regarding the specifics of nonoperative treatment including degree of knee extension during immobilization (k = 0.46; P < 0.001), length of immobilization (k = 0.34; P < 0.001), post-treatment weight bearing status (k = 0.30; P < 0.001) and post-treatment rehabilitation (k = 0.34; P < 0.001). Significant variability exists between surgeons when evaluating and treating pediatric tibial tubercle fractures.