Indirect Coronal Reduction Technique Using a Volar Locking Plate in Distal Radius Fractures: A Case Series.

This is a retrospective case series of patients with distal radius fractures treated with an indirect coronal reduction technique previously described by the senior author using volar locking plates. Seventeen distal radius fractures underwent treatment at a Level I Trauma Center and were retrospectively reviewed for anatomic alignment, surgical complications, and wrist range of motion in the global period. Near-anatomic restoration was achieved with the average radial inclination, radial height, and volar tilt measured as 23.2 ± 3.9 degrees, 11.8 ± 2.1 degrees, and 8.5 ± 5.4 degrees, respectively. Average coronal translation was 2.8 ± 2.7 mm. Postoperative wrist motion on average was within the normal ranges for pronation, supination, wrist flexion, and wrist extension at an average of 36 weeks follow-up. There were no complications related to surgical technique or implant. This case series demonstrates the reliability for coronal reduction with a volar locking plate technique without complications. (Journal of Surgical Orthopaedic Advances 33(1):037-040, 2024).

Sex-Based Reporting of Common Musculoskeletal Conditions.

Introduction: Sex- and gender-based differences affect all aspects of health and disease, including musculoskeletal conditions. However, it is unknown how often authors publish outcomes of common conditions based on sex. We reviewed the frequency with which articles in orthopedic journals published sex-specific outcomes with regard to a condition with known sex-based differences and one in which differences are less known. Materials and Methods: Articles that reported original clinical studies from four high-impact orthopedic journals were reviewed: Journal of Bone and Joint Surgery (JBJS), Clinical Orthopedics and Related Research (CORR), American Journal of Sports Medicine (AJSM), and Journal of Arthroplasty (JOA). JBJS and CORR were reviewed as journals intended for a general audience, while AJSM and JOA were included as subspecialty journals. Analysis of data based on sex beyond the statement of how many men and women were included was designated as successfully reporting sex-specific outcomes. The gender of authors was assessed for impact on reporting. Results: Sex-specific outcomes were reported in 24%-29% of articles regarding rotator cuff pathology and in 32%-40% of publications concerning knee osteoarthritis. There was a trend toward more publications with sex-specific outcomes in knee osteoarthritis (p = 0.0562). No significant changes in rates of reporting were noted over time. Articles listing a woman as the first or last author were significantly more likely to report results based on sex. Conclusions: While there was a trend for sex-specific outcomes to be reported more often in knee osteoarthritis, the level of reporting was still low. Reporting based on sex was higher if a woman was the first or last author. To improve care for all patients, sex-specific outcomes should be reported across all orthopedic conditions by all researchers.

The Impact of the Tertiary Survey in an Established Trauma Program.

INTRODUCTION: The trauma tertiary survey (TTS) was first described in 1990 and is recognized as an essential practice in trauma care. The TTS remains effective in detecting secondary injuries in the modern era. METHODS: Trauma patients discharged between August 1, 2016, and December 31, 2016, were identified in our trauma registry. Collected data include TTS completion rates, detection of injuries, type of provider, and timing. TTS documentation was qualitatively evaluated. RESULTS: Out of 407 patients, 264 patients (65%) received a TTS. Injury detection rate was 1.1.%. Average time to TTS was 41 hours. TTS were completed by resident physicians (46%) and advanced practice providers (APPs; 46%). TTS documentation was more complete for APPs than for resident physicians. CONCLUSION: TTS remains an integral component of modern trauma care. Ongoing education on the significance of TTS and the importance of thorough documentation is essential. Provision of real-time feedback to providers is also critical for improving current practices.

Primary Arthrodesis for Diabetic Ankle Fractures.

BACKGROUND: Treatment of ankle fractures in patients with diabetes is associated with increased complication rates. Ankle arthrodesis is considered a salvage procedure after failed ankle fracture fixation, yet primary ankle arthrodesis has been proposed as a treatment option for patients with significant diabetes-related complications. To date, the characteristics of patients who undergo primary ankle arthrodesis and the associated outcomes have not been described. METHODS: A retrospective review was performed of 13 patients with diabetes who underwent primary arthrodesis for traumatic ankle fracture. Patient demographics were characterized in addition to their diabetes complications, Adelaide Fracture in the Diabetic Ankle (AFDA) score, and fracture type. Outcomes assessed included reoperation rates, infection rates, wound complications, nonunion/malunion, amputation, and development of Charcot arthropathy postoperatively. RESULTS: Patients who underwent primary arthrodesis had high rates of diabetes complications, average AFDA scores of 6.4, and high rates of severe injuries, including 38.5% open fractures and 69.2% fracture dislocations. The overall complication rate for primary arthrodesis of ankle fractures in diabetes patients was more than 75% in this cohort. Complications included a 38.5% reoperation rate, 38.5% infection rate, 53.8% wound complication rate, and 23.1% amputation rate. Despite a high nonunion rate at the attempted fusion sites, 89.9% of fractures healed and patients had a stable extremity. CONCLUSION: This review is the first to characterize the epidemiology and complications of diabetes patients undergoing primary ankle arthrodesis for ankle fractures. In this cohort, patients with multiple diabetic complications and severe injuries underwent primary arthrodesis, which led to an overall high complication rate. Further research is needed to determine the appropriate treatment option for these high-risk patients, and tibiotalocalcaneal stabilization without arthrodesis may be beneficial. LEVEL OF EVIDENCE: Level IV, retrospective case series.

SPECC1L deficiency results in increased adherens junction stability and reduced cranial neural crest cell delamination.

Cranial neural crest cells (CNCCs) delaminate from embryonic neural folds and migrate to pharyngeal arches, which give rise to most mid-facial structures. CNCC dysfunction plays a prominent role in the etiology of orofacial clefts, a frequent birth malformation. Heterozygous mutations in SPECC1L have been identified in patients with atypical and syndromic clefts. Here, we report that in SPECC1L-knockdown cultured cells, staining of canonical adherens junction (AJ) components, ß-catenin and E-cadherin, was increased, and electron micrographs revealed an apico-basal diffusion of AJs. To understand the role of SPECC1L in craniofacial morphogenesis, we generated a mouse model of Specc1l deficiency. Homozygous mutants were embryonic lethal and showed impaired neural tube closure and CNCC delamination. Staining of AJ proteins was increased in the mutant neural folds. This AJ defect is consistent with impaired CNCC delamination, which requires AJ dissolution. Further, PI3K-AKT signaling was reduced and apoptosis was increased in Specc1l mutants. In vitro, moderate inhibition of PI3K-AKT signaling in wildtype cells was sufficient to cause AJ alterations. Importantly, AJ changes induced by SPECC1L-knockdown were rescued by activating the PI3K-AKT pathway. Together, these data indicate SPECC1L as a novel modulator of PI3K-AKT signaling and AJ biology, required for neural tube closure and CNCC delamination.

Sall1-dependent signals affect Wnt signaling and ureter tip fate to initiate kidney development.

Development of the metanephric kidney depends on precise control of branching of the ureteric bud. Branching events represent terminal bifurcations that are thought to depend on unique patterns of gene expression in the tip compared with the stalk and are influenced by mesenchymal signals. The metanephric mesenchyme-derived signals that control gene expression at the ureteric bud tip are not well understood. In mouse Sall1 mutants, the ureteric bud grows out and invades the metanephric mesenchyme, but it fails to initiate branching despite tip-specific expression of Ret and Wnt11. The stalk-specific marker Wnt9b and the beta-catenin downstream target Axin2 are ectopically expressed in the mutant ureteric bud tips, suggesting that upregulated canonical Wnt signaling disrupts ureter branching in this mutant. In support of this hypothesis, ureter arrest is rescued by lowering beta-catenin levels in the Sall1 mutant and is phenocopied by ectopic expression of a stabilized beta-catenin in the ureteric bud. Furthermore, transgenic overexpression of Wnt9b in the ureteric bud causes reduced branching in multiple founder lines. These studies indicate that Sall1-dependent signals from the metanephric mesenchyme are required to modulate ureteric bud tip Wnt patterning in order to initiate branching.