What’s New in Orthopaedic Trauma: Level I and II Studies

Every month, JBJS publishes a Specialty Update—a review of the most pertinent and impactful studies published in the orthopaedic literature during the previous year in 13 subspecialties. Here is a summary of selected findings from Level I and II studies cited in the July 15, 2015 Specialty Update on orthopaedic trauma:

Clavicular Fractures

–Among 46 patients with acute clavicular fractures, upright radiographs were better than supine radiographs at demonstrating clavicular displacement.

Proximal Humeral Fractures

–A prospective randomized study of 120 patients undergoing open reduction and internal fixation (ORIF) of proximal humeral fractures showed that the deltoid-split and deltopectoral approaches resulted in similar patient outcomes.

Femoral Shaft Fractures

–Multiple studies investigating femoral rotation after treatment with intramedullary rods found that, other than increasing comminution, no patient, injury, or surgical variables increased the risk for malrotation.

–Use of electromagnetic targeting for placing femoral-rod locking bolts decreased radiation exposure and may decrease surgical time when using retrograde rods.

Distal Femoral Fractures

–Proximal fixation with far cortical locking screws to dynamize bridge-plate fixation was safe and produced better healing than did standard locking implants investigated in previous studies.

Tibial Plateau Fractures

–Ten years after surgery for displaced tibial plateau fractures, 7.3% of 8426 patients needed a total knee arthroplasty, a 5.3-fold increase relative to the general population’s need for knee arthroplasty.

–Among 40 patients with surgically treated intra-articular tibial plateau fractures, the use of continuous passive motion immediately after surgery did not provide lasting range-of-motion or other clinical benefits.

Distal Tibial Fractures

–A prospective randomized trial of 142 patients found that the use of angular stable locking screws with intramedullary nailing did not improve short-term outcomes relative to the use of conventional locking screws.

Calcaneal Fractures

–A post hoc analysis of 8- to 12-year results from a randomized trial of 56 patients demonstrated better long-term outcomes among those who were treated operatively versus nonoperatively.

–Among 31 patients randomized to undergo either ORIF or ORIF with primary subtalar fusion, researchers found no functional differences, although ORIF with primary fusion may provide quicker healing and prevents the need for late secondary fusion.

Mental Health Issues

–Among a prospective cohort of 152 patients treated operatively for one or more fractures, psychological challenges were highly prevalent, with catastrophic thinking associated with worse mid-term outcomes.

–In a prospective cohort study of 110 patients admitted with orthopaedic injuries, researchers found persistent depression to be associated with higher depression-screening scores and prior psychiatric history.

Infection Management

–In a prospective cohort study of 737 open fractures, injury severity—not time to surgery—was associated with deep infection.

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