Topics of interest in orthopaedic trauma, including fracture fixation, pain management, and more, are highlighted in the new JBJS Guest Editorial What’s New in Orthopaedic Trauma. Here, we summarize the 5 most impactful studies, as selected by co-author Andrew T. Chen, MD.
Proximal Femur
A randomized controlled trial (RCT) compared the rates of deep surgical site infection following hemiarthroplasty for hip fracture between older adults who received a high-dose dual-antibiotic-loaded cement (2,453 patients) and those who received a low-dose single-antibiotic-loaded cement (2,483 patients). No significant difference was found between the groups with respect to the rate of deep surgical site infection at the 90-day follow-up (1.2% and 1.7%, respectively; p = 0.16)1.
A meta-analysis of 3 RCTs evaluated internal fixation vs. hemiarthroplasty for treating nondisplaced femoral neck fracture in older adults. Hemiarthroplasty was associated with better Harris hip scores at 6 months and better quality of life at 1 year, although the treatments were comparable with respect to Harris hip scores at 1 and 2 years and quality of life at 2 years. In terms of the secondary outcomes, internal fixation had higher complication and reoperation rates but less blood loss and operative time2.
The effect of preoperative skeletal traction on pain in older adults with a stable intertrochanteric femoral fracture was evaluated in an RCT that included 154 patients. Skin traction was not associated with a difference in Visual Analogue Scale for pain scores or morphine usage at 2 hours preoperatively or 24 hours postoperatively. The study authors concluded that their data “does not support the routine application of pre-operative skin traction in patients with intertrochanteric fractures”3.
Proximal Tibia
The outcomes of extra-articular proximal tibial fractures treated with intramedullary nailing (52 patients) vs. locked lateral plating (47 patients) were compared in a multicenter RCT. Functional scores at 12 months did not differ between the groups, with both groups demonstrating high residual disability. No differences were found regarding complications or malalignment, which were secondary outcomes4.
Thromboprophylaxis
A multicenter RCT by the Major Extremity Trauma Research Consortium investigated the efficacy and safety of aspirin (81 mg twice daily) vs. low-molecular-weight heparin (30 mg twice daily) in 12,211 adult patients with an operatively treated extremity fracture or a nonoperatively treated pelvic or acetabular fracture. Ninety-day mortality did not differ between the groups. Thromboprophylaxis with aspirin was concluded to be noninferior to low-molecular-weight heparin in preventing death5.
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.
References
- Agni NR, Costa ML, Achten J, Peckham N, Dutton SJ, Png ME, Reed MR; WHiTE 8 Investigators. High-dose dual-antibiotic loaded cement for hip hemiarthroplasty in the UK (WHiTE 8): a randomised controlled trial. Lancet. 2023 Jul 15;402(10397):196-202.
- Sattari SA, Guilbault R, MacMahon A, Salem HS, Khanuja HS. Internal fixation versus hemiarthroplasty for nondisplaced femoral neck fractures: a systematic review and meta-analysis. J Orthop Trauma. 2023 May 1;37(5):e219-26.
- Kheiri S, Akbari Aghdam H, Motififard M, Gharib Gashteh Shahi N, Saleki Mehrjardi M, Rezaei T. The effect of skin traction on pain relief in patients with isolated intertrochanteric fractures, a randomized clinical trial. BMC Musculoskelet Disord. 2023 Jan 12;24(1):25.
- Dunbar RP, Egol KA, Jones CB, Ostrum RF, Mullis BH, Humphrey CA, Ricci WM, Phieffer LS, Teague DC, Sagi HC, Pollak AN, Schmidt AH, Sems A, Pape HC, Morshed S, Perez EA, Tornetta P 3rd. Locked plating versus nailing for proximal tibia fractures: a multicenter RCT. J Orthop Trauma. 2023 Apr 1;37(4):155-60.
- Major Extremity Trauma Research Consortium (METRC); O’Toole RV, Stein DM, O’Hara NN, Frey KP, Taylor TJ, Scharfstein DO, Carlini AR, Sudini K, Degani Y, Slobogean GP, Haut ER, Obremskey W, Firoozabadi R, Bosse MJ, Goldhaber SZ, Marvel D, Castillo RC. Aspirin or low-molecular-weight heparin for thromboprophylaxis after a fracture. N Engl J Med. 2023 Jan 19;388(3):203-13.