Recent findings on fracture management and other trauma-related news are presented in the JBJS Guest Editorial “What’s New in Orthopaedic Trauma.” Here, we spotlight the 5 most compelling investigations as selected by co-author Yelena Bogdan, MD.
– Researchers conducted a secondary analysis of the FISH (Finnish Shaft of the Humerus) randomized trial¹. The study included 82 adult patients treated for closed humeral shaft fractures. At 2 years, patients who underwent surgery for nonunion after initial nonoperative treatment had inferior DASH scores compared with patients whose fractures had healed successfully whether through initial surgery or bracing.
Distal Radial Fractures
– A multicenter RCT evaluated the treatment of extra-articular distal radial fractures². Patients 18 to 70 years of age underwent either external fixation (EF) or volar locking plate fixation (VLP). The VLP group had earlier recovery of function, but at 1 year, no significant difference in function was found. Full recovery was noted for 81% of the VLP group and 79% of the EF group. The VLP group had less pain during activity and better wrist motion at 1 year. The EF group had a higher rate of chronic pain syndrome.
– The WRIST randomized trial evaluated the surgical treatment of distal radial fractures in patients ≥60 years of age³. Patients treated with volar locking plate fixation, external fixation, or closed reduction and percutaneous pinning were compared with patients treated with casting. At 2 years, no differences in scores of the Michigan Hand Questionnaire were found. Although malunion was highest in the casting group, it was not associated with less employment, worse quality of life, or worse outcome scores.
– Researchers investigated the question: does size matter for cephalomedullary nails in geriatric intertrochanteric fractures?4. Specifically, they looked at the need for reoperation for fractures treated with 10-mm nails versus those treated with nails >10 mm. No significant differences in reoperation rates were found.
– Studies involving long bone, foot, and carpal open fractures were included in the GOLIATH meta-analysis5. The investigators sought to determine whether there was an association between the timing of initial debridement and infection. The unstratified analysis of all fractures showed a greater risk of infection with delay. When stratified by treatment within 6, 12, and 24 hours, Gustilo type IIIB fractures demonstrated increasing infection risk.
“What’s New in Orthopaedic Trauma” is freely available at JBJS.org.
What’s New by Subspecialty
Each month, JBJS publishes a review of the most pertinent studies from the orthopaedic literature in a select subspecialty. To read the reports, visit the “What’s New by Subspecialty” collection at JBJS.org.
- Rämö L, Paavola M, Sumrein BO, Lepola V, Lähdeoja T, Ranstam J, Järvinen TLN, Taimela S; FISH Investigators. Outcomes with surgery vs functional bracing for patients with closed, displaced humeral shaft fractures and the need for secondary surgery: a prespecified secondary analysis of the FISH randomized clinical trial. JAMA Surg. 2021 Apr 14;156(6):526-34.
- Ludvigsen T, Matre K, Gudmundsdottir RS, Krukhaug Y, Dybvik EH, Fevang JM. Surgical treatment of distal radial fractures with external fixation versus volar locking plate: a multicenter randomized controlled trial. J Bone Joint Surg Am. 2021 Mar 3;103(5):405-14.
- Chung KC, Kim HM, Malay S, Shauver MJ; WRIST Group. Comparison of 24-month outcomes after treatment for distal radius fracture: the WRIST randomized clinical trial. JAMA Netw Open. 2021 Jun 1;4(6):e2112710.
- Rinehart DB, O’Neill DE, Liu JW, Sanders DT. Does size matter for cephalomedullary nails in geriatric intertrochanteric fractures? J Orthop Trauma. 2021 Jun 1;35(6):329-32.
- Foote CJ, Tornetta P 3rd, Reito A, Al-Hourani K, Schenker M, Bosse M, Coles CP, Bozzo A, Furey A, Leighton R; GOLIATH Investigators. A reevaluation of the risk of infection based on time to debridement in open fractures: results of the GOLIATH meta-analysis of observational studies and limited trial data. J Bone Joint Surg Am. 2021 Feb 3;103(3):265-73.