Seasonal variation and preoperative risk factors for polymicrobial infection following open fracture.

Introduction: Despite modern approaches to open fracture management, fracture-related infection (FRI) rates remain high. Recent studies demonstrated the seasonal and regional variation of causative organisms in FRI. This study aims to better understand the causative organisms and identify preoperative risk factors for the primary outcome of FRIs at a Level I trauma center. Materials and methods: This retrospective cohort study examined all patients that underwent irrigation and debridement of an open fracture at a single Level I trauma center between 2007 and 2019. Exclusion criteria included gunshot wounds, hand injuries, and follow-up less than 3 months. Patients that developed FRI were compared by season, injury characteristics, patient demographics, initial management, and causative organisms. Results: Among 695 patients with open fractures, 78 patients (11.2 %) developed infection, of which eight were Gustilo-Anderson (GA) Type I, 16 were GA Type II, 25 were GA Type IIIA, 26 were GA Type IIIB, and three were GA Type IIIC. Gram-positive FRIs were most common (81.1 %), followed by 56.8 % polymicrobial, 54.1 % gram-negative, and 10.1 % culture-negative infections. More than half (55.1 %) of the infections were from open tibial fractures and occurred after a motorcycle (32.1 %) or motor vehicle collision (23.1 %). Patients were more likely to have high FRI rates in the summer (12.8 %, n = 29) and fall (15.8 %, n = 32) in comparison of spring (4.7 %, n = 7) and winter (8.5 %, n = 10) (p < 0.01). Staphylococcus infections were more common in fall and winter (73.8 %, n = 31) versus spring and summer (44.4 %, n = 16) (p = 0.01). Patients that were transferred from outside hospitals had significantly higher rates of polymicrobial infection when compared to those who arrived from the field (63.6 % vs 41.2 %, p = 0.03). No differences were observed in infection causative organisms based on GA type. Conclusions: Two preoperative risk factors for polymicrobial infection following open fracture include inter-hospital transfers and warm/humid weather. Broadening antibiotic prophylaxis during spring/summer months or for transferred patients may enhance antibiotic coverage and reduce infections.

Safety and Efficacy of Tranexamic Acid in Total Ankle Arthroplasty.

Tranexamic acid has been shown to significantly reduce blood loss in patients undergoing total knee arthroplasty and total hip arthroplasty. However, there is a paucity of data regarding its safety and efficacy in total ankle arthroplasty. The purpose of this study was to determine whether tranexamic acid use in patients with total ankle arthroplasty affects blood loss or overall complication rate. A retrospective chart review was conducted for 64 patients who underwent total ankle arthroplasty with (n = 32) and without (n = 32) intraoperative tranexamic acid from 2014 to 2023 at a single academic medical center. Recorded blood loss, pre-to-postoperative hemoglobin changes, hidden blood loss, and complication rates were recorded and compared. There was no statistically significant difference in recorded blood loss, total calculated blood loss, pre-to-postoperative hemoglobin difference, hidden blood loss, or overall complications between the groups (all, P > .05). A lower rate of wound complications was observed in the tranexamic acid group, but the difference between each group was not statistically significant (P > .05). Tranexamic acid did not decrease blood loss during total ankle arthroplasty, as measured in our study. Tranexamic acid was not associated with any increase in overall complications. Based on our findings, tranexamic acid may be a safe intervention in total ankle arthroplasty, but further studies are needed to better elucidate its clinical impact.Level of Evidence: Level 3.

Nonhardware Subchondral Transosseous Cerclage for Displaced Comminuted Patella Fracture Repair: A Case Report.

CASE: We report a case of a 62-year-old woman who presented to our clinic with a displaced transverse comminuted patella fracture. The fracture was repaired using a subchondral transosseous suture cerclage technique which uses the dense subchondral bone to obtain an initial anatomic reduction of the articular surface, contain the comminution, and achieve union while avoiding complications associated with traditional hardware. CONCLUSION: This case illustrates the potential for the broader implementation of subchondral transosseous cerclage suture fixation techniques for patellar fractures.

Exploring Alternative Sites for Glenoid Component Fixation Through Three-Dimensional Digitization of the Glenoid Vault: An Anatomic Analysis.

INTRODUCTION: Glenoid component loosening has remained one of the most common complications for total shoulder arthroplasty. Three-dimensional modeling of the glenoid may reveal novel information regarding glenoid vault morphology, providing a foundation for implant designs that possess the potential to extend the survivorship of the prosthesis. METHODS: A three-dimensional digitizer was used to digitize the glenoids of 70 cadaveric scapulae. We identified ideal position, fit, and maximum diameter for cylinders of 5, 10, and 15 mm depths. Maximum diameter and volume were also measured at the glenoid center, and the data were compared. RESULTS: The vault region that accommodates the greatest diameter and volume for 5, 10, and 15 mm depth cylinders were identified in the postero-inferior glenoid. Across all specimens, this region accommodated a cylinder diameter that was 24.82%, 40.45%, and 50.34% greater than that achieved at the glenoid center for 5, 10, and 15 mm depth cylinders, respectively (all, P < 0.0001). The location of this site remains reliable for each cylinder depth, regardless of sex. DISCUSSION: This study presents novel findings pertaining to glenoid morphology through the analysis of a newly characterized glenoid vault region. This region has not been identified or described previously and has potential to serve as an alternative to the glenoid center for peg or baseplate fixation. Our method of vault analysis and findings may be used to guide further research regarding pathologic glenoid anatomy, providing a foundation for alternative approaches to glenoid prosthesis fixation in total shoulder arthroplasty and related procedures.