bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early Outcomes of Proximal Humerus Fractures in Adults Treated With Locked Plate Fixation Compared with Nonoperative Treatment: An Age-, Comorbidity-, and Fracture Morphology-Matched Analysis
Authors: Samborski S. Andrew , Haws Brittany E. , Karnyski Steven , Soles Gillian , Gorczyca John T. , Nicandri Gregg , Voloshin Ilya , Ketz John P. 
Published: February 2023

Objectives:
To compare patient-reported outcomes (PROs), range of motion (ROM), and complication rates for proximal humerus fractures managed nonoperatively or with open reduction internal fixation (ORIF).

Design:
Retrospective cohort.

Setting:
Academic level 1 trauma center.

Patients/Participants:
Four hundred thirty-one patients older than 55 years were identified retrospectively. 122 patients were excluded. 309 patients with proximal humerus fractures met inclusion criteria (234 nonoperative and 75 ORIF). After matching, 192 patients (121 nonoperative and 71 ORIF) were included in the analysis.

Intervention:
Nonoperative versus ORIF (locked plate) treatment of proximal humerus fracture.

Main Outcome Measurements:
Early Visual Analog Score (VAS), ROM, PROs, complications, and reoperation rates between groups.

Results:
At 2 weeks, ORIF showed lower VAS scores, better passive ROM, and patient-reported outcomes measurement information system (PROMIS) scores (P < 0.05) compared with nonoperative treatment. At 6 weeks, open reduction internal fixation (ORIF) had lower VAS scores, better passive ROM, and PROMIS scores (P < 0.05) compared with nonoperative treatment. At 3 months, ORIF showed similar PROMIS scores (P > 0.05) but lower VAS scores and better passive ROM (P < 0.05) compared with nonoperative treatment. At 6 months, ORIF showed similar VAS scores, ROM, and PROMIS scores (P > 0.05) compared with nonoperative treatment. There was no difference in secondary operation rates between groups (P > 0.05). ORIF patients trended toward a higher secondary reoperation rate (15.5% vs. 5.0%) than nonoperative patients (P = 0.053).

Conclusions:
In an age-, comorbidity-, and fracture morphology-matched analysis of proximal humerus fractures, ORIF led to decreased pain and improved passive ROM early in recovery curve compared with nonoperative treatment that normalized after 6 months between groups.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
An Evaluation of Treatment Patterns for Osteoporosis and Outcomes After a Fragility Fracture in a Real-World Setting
Authors: Singer Andrea J. , Williams Setareh A. , Pearman Leny , Wang Yamei , Pyrih Nick , Jeray Kyle 
Published: February 2023

Objectives:
Treatment initiation and persistence after a fragility fracture are critical to reduce the risk of subsequent fractures. The authors evaluated osteoporosis management and outcomes after index fracture.

Methods:
This retrospective cohort study used real-world data for patients (≥50 years), including pharmacy claims linked to commercial and Medicare medical claims from Symphony Health Patient Source. Osteoporosis management was evaluated for at least 12 months after the first case-qualifying fracture during the identification period and continued until a second fracture or March 31, 2020 (depending on data availability). Secondary fracture incidence was evaluated overall and for subgroups at very high risk.

Results:
Of 755,312 eligible patients, the proportion with a claim for bone mineral density testing at 12 months after index fracture was low [64,932 (8.6%)], and 75.3% of those tested were ≥65 years of age. Most patients (88.6%) remained untreated at any time after fracture. Among those treated, most (64.9%) were initially treated with bisphosphonates (oral, 93.7%; IV, 6.3%). Treatment duration and persistence were low for all treatments ranging from 6.5 months with 19.6% persistent for abaloparatide to 11.3 months with 45.0% persistent for denosumab. During follow-up, 13.6% of patients had a secondary fracture at any site, with higher incidence in subgroups considered to be at high risk for fracture than in the overall population.

Conclusions:
Low rates of osteoporosis testing and treatment initiation and high secondary fracture rates (particularly among patients at very high risk) highlight the need for better management of patients after a fracture.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Geriatric Distal Femur Fractures: Equivalent Long-Term Reoperation Rates Between Fixation and Primary Arthroplasty
Authors: Shi Brendan Y. , Upfill-Brown Alexander , Brodke Dane J. , Stavrakis Alexandra I. , Lee Christopher , SooHoo Nelson F. 
Published: February 2023

Objective:
Our primary objectives were to (1) determine the rate of requiring conversion to arthroplasty after open reduction internal fixation (ORIF) of geriatric distal femur fractures and (2) compare 10-year reoperation rates after ORIF versus primary arthroplasty for geriatric distal femur fractures.

Design:
Propensity-matched retrospective cohort study.

Setting:
All centers participating in the California Office of Statewide Health Planning and Development (OSHPD) database.

Patients/Participants:
All patients 65 years of age or older who underwent operative management of a distal femur fracture between 2000 and 2017.

Intervention:
ORIF, total knee arthroplasty (TKA), or distal femur replacement (DFR).

Main outcome measurements:
Reoperation.

Results:
A total of 16,784 patients with geriatric distal femur fracture were identified, of which 16,343 (97.4%) underwent ORIF. The cumulative incidence of conversion to arthroplasty within 10 years of ORIF was found to be 3.5%, with young age and female sex identified as risk factors for conversion. There was no significant difference in 10-year reoperation-free survival rate between propensity-matched patients undergoing ORIF versus primary arthroplasty (94.5% vs. 96.2%, P = 0.659). There were no differences in short-term complication or readmission rates between matched treatment cohorts, but arthroplasty was associated with a higher rate of wound infection within 90 days (2.0% vs. 0.2%, P = 0.011).

Conclusions:
The 10-year cumulative incidence of conversion to arthroplasty after ORIF was found to be low. There was no significant difference in long-term reoperation-free survival rates between patients undergoing ORIF versus primary arthroplasty. Primary arthroplasty was associated with significantly higher rates of acute wound or joint infection.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Locked Plating versus Nailing for Proximal Tibia Fractures: A Multicenter RCT
Authors: Dunbar Robert P. , Egol Kenneth A. , Jones Clifford B. , Ostrum Robert F. , Humphrey Catherine A. , Ricci William M. , Phieffer Laura S. , Teague David C. , Sagi H. Claude , Pollak Andrew N. , Schmidt Andrew H. , Sems Andrew , Pape Hans-Christoph , Morshed Saam , Perez Edward A. , Tornetta Paul 
Published: February 2023

Objectives:
The main 2 forms of treatment for extraarticular proximal tibial fractures are intramedullary nailing (IMN) and locked lateral plating (LLP). The goal of this multicenter, randomized controlled trial was to determine whether there are significant differences in outcomes between these forms of treatment.

Design:
Multicenter, randomized controlled trial.

Setting:
16 academic trauma centers.

Patients/Participants:
108 patients were enrolled. 99 patients were followed for 12 months. 52 patients were randomized to IMN, and 47 patients were randomized to LLP.

Intervention:
IMN or lateral locked plating.

Main Outcome Measurements:
Functional scoring including Short Musculoskeletal Functional Assessment, Bother Index, EQ-5Dindex and EQ-5DVAS. Secondary measures included alignment, operative time, range of motion, union rate, pain, walking ability, ability to manage stairs, need for ambulatory aid and number, and complications.

Results:
Functional testing demonstrated no difference between the groups, but both groups were still significantly affected 12 months postinjury. Similarly, there was no difference in time of surgery, alignment, nonunion, pain, walking ability, ability to manage stairs, need for ambulatory support, or complications.

Conclusions:
Both IMN and LLP provide for similar outcomes after these fractures. Patients continue to improve over the course of the year after injury but remain impaired even 1 year later.

Level of Evidence:
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Mapping of Pelvic Ring Injuries From High-Energy Trauma Using Unfolded CT Image Technology
Authors: Mills Andrew T. , LaRoque Michael C. , Thomas Claire N. , George Albert V. , Albright Patrick A. , Cole Peter A. 
Published: February 2023

Objectives:
High-energy pelvic ring injuries are associated with significant morbidity and mortality, elevating the importance of injury pattern identification. The purpose of this study was to use a novel 3D computed tomography (CT) unfolding process to both evaluate high-energy pelvic ring injures and to produce injury frequency maps based on injury patterns.

Methods:
Patients 18–65 years of age presenting to a level 1 trauma center with pelvic ring injuries between 2016 and 2020 were identified. Of the 482 patients reviewed, 355 were excluded primarily due to having a low energy mechanism, inadequate radiographs, or an isolated fracture. Unfolded pelvic CT images were created using syngo.via CT Bone Reading software. Pelvic ring injury frequency maps were created using the unfolded pelvic CT images and a previously described mapping technique.

Results:
One hundred twenty-seven patients analyzed had a mean age of 32.7 years. The most common mechanisms of injury (MOI) were motor vehicle collision (30.7%) and fall from height (23.6%). The breakdown of pelvic ring injuries included LC1 = 44.1%, LC2 = 7.1%, LC3 = 14.2%, APC1 = 2.4%, APC2 = 15.0%, APC3 = 5.5%, and VS = 11.8%, with OTA/AO-61B = 74.0% and OTA/AO-61C = 26.0%. Pelvic ring mapping revealed that articular and bony injuries varied markedly between the different types of pelvic ring disruptions, both in type and location.

Conclusions:
Pelvic ring injury frequency maps created from unfolded CT images reflect consistent injury patterns providing distinctive information based on force vector mechanisms. Unfolded CT images allow for a novel way to visualize pelvic ring injuries which yield greater comprehension of failure patterns with implications for treatment.
Anterior Hook Plating of Patella Fractures: A Biomechanical Analysis and Clinical Series
Authors: Alley Maxwell C. , Kain Michael , Mitchell Sean , Walker Brock J. , Jones Clifford B. , Tornetta Paul 
Published: February 2023

Objectives:
To compare anterior hook plating with established fixation constructs biomechanically and report outcomes and complications in a cohort of patella fractures treated with the technique.

Design:
Laboratory-based biomechanical study and clinical multicenter retrospective cohort study.

Setting:
2 US Level 1 trauma centers.

Patients/Participants:
51 patients (28 M and 23 F) with 30 simple transverse and 21 comminuted patella fractures. Thirty-six cadaveric patellae were used for the biomechanical study.

Intervention:
Biomechanical—dorsal plating was compared with cerclage wiring and modified tension band cable fixation in a comminuted patella fracture model in 36 cadaveric patellae. Constructs were tested at 0° and 45 degrees of flexion. Clinical—we reviewed a consecutive series of patella fractures in 2 centers for outcome and complications.

Main Outcome Measurements:
Biomechanical—construct stiffness. Clinical—reduction, union, complications, and range of motion.

Results:
Stiffness was greatest in dorsal plating at both 0° and 45 degrees. Dorsal plating (976 N, 1643 N) > modified tension band (317 N, 297 N) > cerclage (89.8 N, 150.3 N) at 0 and 45 degrees, respectively. 51 patients with patella fractures had them fixed with dorsal 2.7-mm mini fragment plates including a distal to proximal lag screw through the plate from the nose of the patella. 9 cases were small distal fragments not easily managed with screws and cables. All patients were followed up to union. There were 2 infections (1 superficial and 1 deep with nonunion), and 5 had implant removal (9.8%).

Conclusions:
Dorsal plating is biomechanically and clinically superior to modified tension band and cerclage techniques in comminuted patella fractures. This method allows for fixation of small distal pole fractures.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Diagnosis of Occult Infection Using Fracture-Related Infection Criteria at the Time of Nonunion Repair
Authors: Shah Nihar S. , Simpson Nana A. , Frederickson Matthew , Dowell Evan , Doyle Matt , Sabbagh Ramsey S. , Sagi H. Claude 
Published: February 2023

Objectives:
To apply the recently developed fracture-related infection criteria to patients presenting for repair of fracture nonunion and determine the incidence and associated organisms of occult infection in these patients.

Design:
Retrospective study.

Setting:
Tertiary referral trauma center.

Patients and Participants:
Patients presenting with fracture nonunion after operative intervention.

Main Outcome Measurements:
Demographic variables, injury characteristics, culture results, and physical examination and laboratory values at the time of presentation.

Results:
A total of 270 nonunion patients were identified. Sixty-eight percent (n = 184) had no clinical or laboratory signs of infection at presentation before nonunion repair. After operative intervention, 7% of these clinically negative patients (n = 12/184) had positive intraoperative cultures indicating occult infection. The most common organisms causing occult infection were low-virulence coagulase-negative Staphylococcus (83%) and Cutibacterium acnes (17%). Thirty-two percent of patients (n = 86/270) presented with clinical and/or laboratory signs of infection at presentation before nonunion repair, with 19% of these patients (n = 16/86) having negative cultures. The most common organisms in this group of patients with positive clinical signs and intraoperative cultures were methicillin-resistant Staphylococcus Aureus (21%) and gram-negative rods (29%). Patients with nonunion of the tibia were significantly more likely to have high-virulence organism culture results (P < 0.001).

Conclusions:
Based on this analysis, occult infection occurs in 7% of patients presenting with nonunion and no clinical or laboratory signs of infection. We recommend that all patients should be carefully evaluated for infection with intraoperative cultures regardless of presentation. Organisms associated with occult infection at the time of nonunion repair were almost exclusively of low virulence (CoNS and C. Acnes) and were more likely to present in the upper extremity. Patients with nonunion of the tibia were more likely to have infection secondary to high-virulence organisms and demonstrate clinical or laboratory signs of infection at the time of presentation.

Level of Evidence:
Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Outcomes After Acute Versus Staged Fixation of Complete Articular Tibial Plafond Fractures
Authors: Flanagan Christopher D. , Lufrano Reuben C. , Mesa Lazaro , Watson David , Shah Anjan R. , Maxson Benjamin J. , Infante Anthony , Donohue David , Downes Katheryne , Sanders Roy W. , Mir Hassan R. 
Published: February 2023

Objective:
To determine the outcomes after acute versus staged fixation of complete articular tibial plafond fractures.

Design:
Retrospective cohort study.

Setting:
Single Level 1 Trauma center.

Participants:
98 skeletally mature patients with OTA/AO 43C type fractures who underwent definitive fixation with plate and screw constructs and had a minimum 6 months of follow-up.

Intervention:
Acute open reduction internal fixation (aORIF) versus staged (sORIF) definitive fixation.

Main Outcome Measurement:
Rates of wound dehiscence/necrosis and deep infection.

Results:
Acute (N = 40) versus staged (N = 58) ORIF groups had comparable rates of vascular disease, renal disease, and substance/nicotine use, but aORIF patients had higher rates of diabetes mellitus (10% vs. 0%, P < 0.001), which correlated with higher American Society of Anaesthesiologist scores (>American Society of Anaesthesiologist 3: 37.5% vs. 13.8%, P = 0.02). Both groups achieved anatomic/good reductions, as determined by postoperative CT scans, at rates greater than 90%; however, the sORIF group required modestly longer operative times to achieve this outcome (aORIF vs. sORIF: 121 vs. 146 minutes, P = 0.02). Postoperatively, both groups had similar rates of wound dehiscence (2.5% vs. 6.9%, P = 0.65), superficial infections (10% vs. 17.2%, P = 0.39), and deep infections (10% vs. 8.6%, P = 0.99). While the injury pattern itself required free flap coverage in 1 patient in each group, unplanned free flap coverage occurred in 10.0% and 10.3% of aORIF and sORIF groups, respectively. Overall, rates of unplanned reoperations, excluding ankle arthrodesis, did not differ between groups (aORIF vs. sORIF:12.5% vs. 25.9%, P = 0.13).

Conclusions:
In select patients managed by fellowship-trained orthopaedic traumatologists, acute definitive pilon fixation can produce acceptable outcomes.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
A Comparison Between 3 Functional Hip Scores for Evaluation of the Pediatric Hip
Authors: Huebschmann Nathan A. , Masrouha Karim Z. , Dib Aseel , Moscona Leon , Castañeda Pablo 
Published: February 2023

Background:
This investigation aimed to determine the degree of correlation among 3 functional scales for evaluating the hip in pediatric patients and determine the correlation between measures of global function and outcome.

Methods:
We performed a prospective study of 173 consecutive patients (Mage = 13 ± 3 y) being followed for developmental dysplasia of the hip (n = 122, 71%), slipped capital femoral epiphysis (n = 31, 18%), or Legg-Calve-Perthes disease (n = 20, 12%). We evaluated patients clinically, and we compiled scores for the Iowa Hip Score (IHS), Harris Hip Score (HHS), and Children’s Hospital Oakland Hip Evaluation Scale (CHOHES). Patients concomitantly completed the Pediatric Outcomes Data Collection Instrument (PODCI) at the same clinic visit. We assessed Global Functioning Scale the and the Sports and Physical Functioning Core Scale of the PODCI. We determined the degree of correlation between the functional hip scales and between each scale and the PODCI scales using Spearman rank correlation coefficients.

Results:
The correlations between the IHS, HHS, and CHOHES scores were robust (IHS and HHS ρ = 0.991; IHS and CHOHES ρ = 0.933; HHS and CHOHES ρ = 0.938; all P < 0.001). The correlation between the Global Functioning Scale of the PODCI and the 3 hip scores was ρ = 0.343 for the IHS, ρ = 0.341 for the HHS, and ρ = 0.352 for the CHOHES (all P < 0.001). The correlation between the sports and physical functioning core scale of the PODCI and the 3 hip scores was ρ = 0.324 for the IHS, ρ = 0.329 for the HHS, and ρ = 0.346 for the CHOHES (all P < 0.001).

Conclusions:
In a pediatric population with diverse hip pathology, there was a very strong correlation between scores on the IHS, HHS, and CHOHES. However, none of these 3 most commonly used hip scores correlated strongly with the global functioning scale or sports and physical functioning core scale of the PODCI. The most frequently used scores to determine the outcome of pediatric patients with hip pathology correlate strongly with each other but do not necessarily relate to global functional results.

Level of Evidence:
Level IV.
Facet Distraction and Dysphagia: A Prospective Evaluation of This Common Postoperative Issue Following Anterior Cervical Spine Surgery
Authors: Kanhere Arun P. , Paziuk Taylor , Lambrechts Mark J. , Issa Tariq Z. , Karamian Brian A. , Mazmudar Aditya , Tran Khoa S. , Purtill Caroline , Mangan John J. , Vaccaro Alexander R. , Kepler Christopher K. , Schroder Gregory D. , Hilibrand Alan S. , Rihn Jeffrey A. 
Published: February 2023

Study Design.
Prospective cohort study.

Objective.
Our primary study was to investigate whether the degree of postoperative facet and disk space distraction following anterior cervical discectomy and fusion (ACDF) affects the rate of postoperative dysphagia.

Summary of Background Data.
Although ACDF is safe and well tolerated, postoperative dysphagia remains a common complication. Intervertebral disk space distraction is necessary in ACDF to visualize the operative field, prepare the endplates for fusion, and facilitate graft insertion. However, the degree of distraction tolerated, before onset of dysphagia, is not well characterized ACDF.

Materials and Methods.
A prospective cohort study was conducted of 70 patients who underwent ACDF between June 2018 and January 2019. Two independent reviewers measured all preoperative and postoperative radiographs measured for interfacet distraction distance and intervertebral distraction distance, with intrareviewer reproducibility measurements after one month. For multilevel surgery, the level with the greatest distraction was measured. Primary outcomes were numerical dysphagia (0–10), Eating Assessment Tool 10, and Dysphagia Symptom Questionnaire score collected at initial visit and two, six, 12, and 24 weeks postoperatively.

Results.
A total of 70 patients were prospectively enrolled, 59 of whom had adequate radiographs. An average of 1.71 (SD: 0.70) levels were included in the ACDF construct. Preoperatively, 13.4% of patients reported symptoms of dysphagia, which subsequently increased in the postoperative period at through 12 weeks postoperatively, before returning to baseline at 24 weeks. Intrareviewer and interreviewer reliability analysis demonstrated strong agreement. There was no relationship between interfacet distraction distance/intervertebral distraction distance and dysphagia prevalence, numerical rating, Eating Assessment Tool 10, or Dysphagia Symptom Questionnaire.

Conclusions.
Patients who had an ACDF have an increased risk of dysphagia in the short term, however, this resolved without intervention by six months. Our data suggests increased facet and intervertebral disk distraction does not influence postoperative dysphagia rates.

Level of Evidence:
3.