Outcomes of operatively managed periprosthetic distal femur fractures compared to fractures in patients with native knees.

Introduction: With the increasing incidence of total knee arthroplasty (TKA), there is an expected rise in rate of periprosthetic fractures in the coming years. It is unclear how the outcomes of patients with distal femur fractures (DFF) and a total knee arthroplasty compare to patients of the same age group with native knees (NK). Materials and methods: A retrospective review was completed for distal femur fractures treated with surgical fixation from January 2019-March 2021. We excluded patients <50 years old, non-ambulatory patients, revision surgeries, and patients with less than 90 days of follow-up. A chart review was performed to collect age, gender, BMI, smoking status, American Society of Anesthesiology (ASA) classification, fracture type, fixation method, time to full weight bearing, and complications. Comparisons between the TKA vs native knee groups were performed using t-test, chi-square, and Fisher's exact test where appropriate. Results: 138 patients were included in our study with a mean age of 74 years. 69 DFF ipsilateral to a TKA were included in the study group and 71 DFF were included in the native knee group. Age, sex, BMI, smoking status, and ASA class were similar between the groups. All patients with periprosthetic femur fractures had 33A AO/OTA fracture classification. Patients with native knees were more likely to receive dual implant fixation, 15.5% compared to 4.3% (p = 0.02). Full weight bearing was achieved at 8.5 vs 8.6 weeks between the NK and TKA groups (p = 0.64). The complication rate was 16.9% in the NK group vs. 7.2% in the TKA group (p = 0.21). Conclusion: Patients with periprosthetic femur fractures have similar time to weight bearing and complications rate with patients with distal femur fracture in native knees. We found a higher utilization rate of dual implant fixation in the native knee group.

Return to Sport after Arthroscopic Rotator Cuff Repair of Full-Thickness Rotator Cuff Tears: A Systematic Review.

OBJECTIVE: Perform a systematic literature review regarding return to sport (RTS) outcomes after arthroscopic rotator cuff repair (aRCR) for full-thickness rotator cuff tears (FTRCTs). DATA SOURCES: Systematic review of all articles in PubMed, Medline, and Excerpta Medica Database (EMBASE) was conducted in April 2022 using a combination of keywords: "rotator cuff repair," "RCR," "complete," "full-thickness," "tear," "RCT," "injury," "shoulder," "arthroscopic," "return to sport," "RTS," "sport," "return to play," and "athlete." Cohorts were included from all articles reporting RTS after aRCR for FTRCTs. Studies that were non-English, failed to distinguish between partial and FTRCT outcomes, or treated FTRCTs by open RCR, mini-open RCR, debridement, or nonsurgical management were excluded. Abstracted data included study design, surgical techniques, concomitant procedures, demographics, FTRCT type and size, patient-reported outcomes, type of sport, competition level, time to return, and reasons for failing to RTS. MAIN RESULTS: 11 studies were reviewed, with inclusion of 463 patients (385 athletes; mean age 47.9). RTS varied considerably in rate and timing, with 50.0% to 100% of patients returning on average between 4.8 to 14 months. In addition, 31 patients returned to a higher level of sport, 107 returned to or near preinjury level, and 36 returned to a lower level of competition or failed to RTS entirely. CONCLUSIONS: The ability for athletes to RTS after aRCR for FTRCTs is likely multifactorial, demonstrating high variability in return rates and time to RTS. Given the paucity of available literature, future studies are warranted to provide a more definitive consensus.

Association of Preoperative Opioid Use With Postoperative Opioid Use and Patient-Reported Outcomes in Ankle Fracture Fixation Patients.

Background: Ankle fracture surgery is a common procedure with many patients receiving opioid medications for postoperative pain control. Whether there are factors associated with higher medication quantities or patient-reported outcomes, however, remains largely unknown. Methods: Patients with isolated, rotational ankle fractures who underwent surgical fixation between January 2018 and March 2020 were retrospectively reviewed. Patient demographics, injury characteristics, and preoperative and postoperative opioid prescription information were recorded. Clinical follow-up and Foot and Ankle Ability Measure (FAAM) questionnaires were collected at 6 weeks and 3 months postoperatively. Multiple linear regression was used to examine the influences of age, sex, body mass index (BMI), fracture characteristics, medical comorbidities, and preoperative opioid use (OU) on postoperative opioid morphine milligram equivalent (MME) amount and FAAM scores. Results: A total of 294 patients were included with an average age of 52.11 ± 17.13 years (range, 18-97). Fracture types were proportional to one another. Chronic pain (mean = 145.89, 95% CI = 36.72, 255.05, P = .0009), preoperative OU (mean = 178.22, 95% CI = 47.46, 308.99, P = .0077), psychiatric diagnoses (mean = 143.81, 95% CI = 58.37, 229.26, P = .001), tobacco use (mean = 137.37, 95% CI = 33.35, 229.26, P = .0098), and trimalleolar fractures (mean = 184.83, 95% CI = 86.82, 282.84, P = .0002) were associated with higher postoperative opioid MME amounts. Older age (mean = ‒0.05, 95% CI = ‒0.08, -0.02, P = .0014) and higher BMI (mean = ‒0.06, 95% CI = ‒0.12, 0.00, P = .048) were both independently associated with lower FAAM scores at 6 weeks. At 3 months, higher BMI (mean = ‒0.09, 95% CI = ‒0.13, -0.04, P = .0002), bimalleolar fractures (mean = ‒1.17, 95% CI = ‒2.17, -0.18, P = .021), and higher postoperative MME amounts (mean = ‒0.10, 95% CI = ‒0.19, -0.01, P = .0256) were each independently associated with lower FAAM scores. Conclusion: In this study, we found that patients with chronic pain, preoperative OU, psychiatric diagnoses, tobacco use, and trimalleolar fractures were more likely to have higher amounts of opioid prescribed following ankle fracture surgery. However, only age, BMI, bimalleolar fractures, and postoperative MME amount were associated with lower FAAM scores postoperatively. Level of Evidence: Level III, retrospective cohort study.