What’s New in Orthopaedic Trauma 2023

Recent findings on fracture management and other trauma-related topics are presented in the new JBJS Guest Editorial “What’s New in Orthopaedic Trauma.” Here, we highlight 5 of the >30 studies featured, as selected by co-authors Christopher D. Flanagan, MD and Heather A. Vallier, MD. 

Distal Radius and Wrist

Researchers performed a secondary analysis of a randomized controlled trial (RCT) evaluating closed reduction and casting compared with volar locking plating in patients ≥60 years of age with a distal radial fracture¹. Outcomes at 24 months were assessed; 90% of the original cohort had follow-up data. No clinically important differences in Patient-Rated Wrist Evaluation (PRWE) scores or complication rates were found. However, only 44.6% in the closed-reduction group reported their treatment as “very successful” compared with 75% in the volar plating group. “The reasons remain unclear but may include preexisting perceptions with regard to the benefits of a surgical procedure,” say the JBJS Guest Editorial authors. 

Hip

Investigators examined the cost-effectiveness of cemented hemiarthroplasty versus hydroxyapatite-coated uncemented hemiarthroplasty for the treatment of displaced intracapsular hip fractures in older adults². This was a within-trial economic evaluation of the World Hip Trauma Evaluation 5 (WHiTE 5) RCT performed in the U.K. The analysis suggested a 95% to 97% probability of cemented implants being cost-effective. 

Tibia

In an RCT published in JBJS, the Major Extremity Trauma Research Consortium (METRC) assessed the 1-year probability of a major limb complication in patients treated with modern external ring fixation compared with internal fixation for severe open tibial shaft fractures³. A total of 254 of the 260 randomized patients were included in the final analysis. External fixation had a higher probability of at least 1 major complication and loss of fixation. The risks of deep infection, amputation, nonunion, malunion, and soft-tissue complications did not differ between the 2 treatment groups. 

Tranexamic Acid Administration

An RCT involving 9,535 patients assessed the efficacy and safety of tranexamic acid (TXA) in non-cardiac surgery⁴. Patients were randomized to TXA or placebo at the beginning and end of surgery. A composite bleeding outcome (life-threatening bleeding, major bleeding, or bleeding into a critical organ) at 30 days was the primary efficacy outcome, and a composite cardiovascular outcome (myocardial injury, non-hemorrhagic stroke, peripheral arterial thrombosis, or symptomatic proximal venous thromboembolism) at 30 days was the primary safety outcome. The incidence of the composite bleeding outcome was significantly lower for TXA than for placebo, with no differences between TXA and placebo in cardiovascular safety. 

Mental and Social Health

A recent study evaluated the potential association between patient-reported fear of death at the time of injury and the development of posttraumatic stress disorder (PTSD)⁵. Of the 250 patients who were screened, 43 (17%) responded “yes” when asked if they had a fear of death at the time they were injured. On multivariable regression analysis, these patients had a >13 times higher odds of developing PTSD. Say the authors of the JBJS Guest Editorial, “The adoption of this simple question may identify more patients who could benefit from psychiatric support.” 

“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. 

Recent OrthoBuzz posts include: “What’s New in Spine Surgery,” “What’s New in Foot and Ankle Surgery,” and “What’s New in Sports Medicine.” 

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References 

1. Lawson A, Naylor J, Buchbinder R, Ivers R, Balogh ZJ, Smith P, Xuan W, Howard K, Vafa A, Perriman D, Mittal R, Yates P, Rieger B, Smith G, Adie S, Elkinson I, Kim W, Sungaran J, Latendresse K, Wong J, Viswanathan S, Landale K, Drobetz H, Tran P, Page R, Beattie S, Mulford J, Incoll I, Kale M, Schick B, Li T, Higgs A, Oppy A, Harris IA; Combined Randomised and Observational Study of Surgery for Fractures in the Distal Radius in the Elderly (CROSSFIRE) Study Group. Plating vs closed reduction for fractures in the distal radius in older patients: a secondary analysis of a randomized clinical trial. JAMA Surg. 2022 Jul 1;157(7):563-71. 
2. Png ME, Petrou S, Fernandez MA, Achten J, Parsons N, McGibbon A, Gould J, Griffin XL, Costa ML; WHiTE 5 trial collaborators. Cost-utility analysis of cemented hemiarthroplasty versus hydroxyapatite-coated uncemented hemiarthroplasty for the treatment of displaced intracapsular hip fractures: the World Hip Trauma Evaluation 5 (WHiTE 5) trial. Bone Joint J. 2022 Aug;104-B(8):922-8. 
3. Major Extremity Trauma Research Consortium (METRC). Modern external ring fixation versus internal fixation for treatment of severe open tibial fractures: a randomized clinical trial (FIXIT Study). J Bone Joint Surg Am. 2022 Jun 15;104(12):1061-7. 
4. Devereaux PJ, Marcucci M, Painter TW, Conen D, Lomivorotov V, Sessler DI, Chan MTV, Borges FK, Martínez-Zapata MJ, Wang CY, Xavier D, Ofori SN, Wang MK, Efremov S, Landoni G, Kleinlugtenbelt YV, Szczeklik W, Schmartz D, Garg AX, Short TG, Wittmann M, Meyhoff CS, Amir M, Torres D, Patel A, Duceppe E, Ruetzler K, Parlow JL, Tandon V, Fleischmann E, Polanczyk CA, Lamy A, Astrakov SV, Rao M, Wu WKK, Bhatt K, de Nadal M, Likhvantsev VV, Paniagua P, Aguado HJ, Whitlock RP, McGillion MH, Prystajecky M, Vincent J, Eikelboom J, Copland I, Balasubramanian K, Turan A, Bangdiwala SI, Stillo D, Gross PL, Cafaro T, Alfonsi P, Roshanov PS, Belley-Côté EP, Spence J, Richards T, VanHelder T, McIntyre W, Guyatt G, Yusuf S, Leslie K; POISE-3 Investigators. Tranexamic acid in patients undergoing noncardiac surgery. N Engl J Med. 2022 May 26;386(21):1986-97. 
5. Simske NM, Joseph NM, Rascoe A, Kalina M Jr, Simpson M, Hendrickson SB, Vallier HA. “Did you think you would die?”: Fear of death and its relationship to the development of posttraumatic stress disorder after traumatic injury. J Am Acad Orthop Surg. 2022 Jan 15;30(2):e272-8.