The Journal Of The American Academy Of Orthopaedic Surgeons[JOURNAL]
Sun
200 papers
Surgical Fixation Versus Cast Immobilization for Adults With Bicortical Scaphoid Fractures: A Target Trial Emulation of the SWIFFT Trial.
Zhang W, Yi C, Wu P … +3 more , Hu G, Shen Y, Lu S
J Am Acad Orthop Surg · 2026 Jul · PMID 42384474 · Publisher ↗
AIMS: The Scaphoid Waist Internal Fixation for Fractures Trial (SWIFFT) reported no notable difference in functional outcomes between surgical fixation and cast immobilization for minimally displaced scaphoid waist fract...
AIMS: The Scaphoid Waist Internal Fixation for Fractures Trial (SWIFFT) reported no notable difference in functional outcomes between surgical fixation and cast immobilization for minimally displaced scaphoid waist fractures in UK settings. We aimed to emulate SWIFFT using Chinese hospital electronic health record (EHR) data to evaluate whether similar treatment effects are observed in a population with different risk profiles and to identify subgroups that may benefit differentially from surgery. METHODS: This target trial emulation used a clone-censor-weight design with inverse probability of treatment and censoring weighting. Deidentified EHR data were extracted from three Tertiary A teaching hospitals in China (July 2018 to August 2024). Adults aged 16 years or older with a bicortical scaphoid waist fracture (displacement ≤2 mm) presenting within 14 days of injury were eligible. Patients received either headless compression screw fixation (n = 2,544) or below-elbow cast immobilization (n = 4,225). The primary outcome was the Disabilities of the Arm, Shoulder, and Hand (DASH) score at 52 weeks. RESULTS: Among 6,769 patients (mean age 32.1 years; 81.6% male; 42.4% current smokers), surgery produced statistically significant DASH improvements at all time points. At 52 weeks, the adjusted mean difference was -4.2 (95% CI, -4.9 to -3.5; P < 0.001), below commonly cited MCID estimates (10 to 15 points) but approaching lower proposed thresholds (7 to 10 points). Surgery halved nonunion risk (8.4% vs 17.5%; RR 0.48, 95% CI, 0.41 to 0.55) but increased complications sevenfold (14.1% vs 2.0%), predominantly screw-related. Subgroup analyses showed larger surgical benefits among patients with displaced fractures (-8.5) and current smokers (-6.7). Nearly one in five cast-treated patients (18.1%) ultimately required surgery for nonunion. CONCLUSION: Surgery was associated with statistically significant but modest DASH improvements, halved nonunion risk, and a sevenfold increase in complications. Cast immobilization remains a reasonable initial strategy for undisplaced fractures, while surgery offers measurable advantages for displaced fractures or smokers.
Dementia as a Marker of Poor Outcome After Hip Hemiarthroplasty.
Vu NH, Olson D, Hammond B … +3 more , Egol KA, Konda SR, Ganta A
J Am Acad Orthop Surg · 2026 Jun · PMID 42377450 · Publisher ↗
PURPOSE: To evaluate the effect of baseline dementia on postoperative outcomes in hip fracture patients undergoing hemiarthroplasty. METHODS: A retrospective review was conducted of patients aged 55 years or older who un...
PURPOSE: To evaluate the effect of baseline dementia on postoperative outcomes in hip fracture patients undergoing hemiarthroplasty. METHODS: A retrospective review was conducted of patients aged 55 years or older who underwent hemiarthroplasty for displaced femoral neck fracture (AO/OTA 31B) between 2012 and 2024 at a large urban academic institution. Dementia was identified by ICD-10 codes and confirmed by chart review. A 3:1 propensity score matched cohort was created using the Score for Trauma Triage in Geriatric and Middle-aged (STTGMA). Demographics and baseline characteristics were compared to ensure similarity. Outcomes included total complications, major and minor complications, periprosthetic dislocation, length of stay, ICU admission, discharge location, 30- and 90-day readmission, revision surgery, inpatient, and 30-day and 1-year mortality. RESULTS: A total of 1,030 patients were included, with 241 patients with dementia and 839 controls. After 3:1 STTGMA propensity matching, baseline characteristics were comparable (mean age 82.75 vs. 83.0 years, P = 0.065; Charlson Comorbidity Index 1.96 vs. 1.92, P = 0.42; STTGMA 0.022 vs. 0.020, P = 0.50). Patients with dementia had increased major complications (17.92% vs. 10.93%, P = 0.013), including sepsis (5.00% vs. 2.21%, P = 0.027), urinary tract infections (13.33% vs. 6.78%, P = 0.002), and hip hemiarthroplasty dislocations (6.25% vs. 2.21%, P = 0.002). Patients with dementia also had longer length of stay (7.84 ± 5.83 vs. 6.80 ± 2.24 days, P = 0.030), increased 30-day readmissions (15.83% vs. 8.85%, P < 0.001), increased 90-day readmission (20.00% vs. 11.76%, P < 0.001), and higher 1-year mortality (16.25% vs. 8.02%, P < 0.001). No differences were observed in pneumonia, stroke, myocardial infarction, cardiac arrest, venothromboembolism, acute kidney injury, anemia, and revision surgery. CONCLUSION: Dementia was associated with increased major complications, hip hemiarthroplasty dislocations, higher readmission, and mortality after hemiarthroplasty. These findings highlight the need for targeted perioperative planning and multidisciplinary care pathways in cognitively impaired patients.
Fix or Replace: Evidence for Treatment Options in the Management of Femoral Neck Fractures.
Nauth A, Schemitsch G, Schmidt A … +1 more , Schemitsch E
J Am Acad Orthop Surg · 2026 Jun · PMID 42357876 · Publisher ↗
Femoral neck fractures are highly morbid injuries in elderly populations and can be challenging to treat. Surgical management can consist of internal fixation or arthroplasty after careful consideration of injury and pat...
Femoral neck fractures are highly morbid injuries in elderly populations and can be challenging to treat. Surgical management can consist of internal fixation or arthroplasty after careful consideration of injury and patient factors. There has been a trend toward increased usage of acute arthroplasty in the management of femoral neck fractures. The present review aims to evaluate treatment indications, technical considerations, and treatment outcomes in the management of hip trauma with both internal fixation and arthroplasty.
Epidemiology, Treatment Patterns, and Comorbidities of Trigger Finger: A Contemporary Population-Based Analysis.
Sun C, Campbell H, Demetriou Z … +3 more , Castro A, Jones CM, Ilyas AM
J Am Acad Orthop Surg · 2026 Apr · PMID 42357875 · Publisher ↗
HYPOTHESIS: The aim of this study was to evaluate the contemporary prevalence, demographics, treatment trends, and common comorbidities associated with trigger finger (TF). METHODS: The TriNetX Research Network was queri...
HYPOTHESIS: The aim of this study was to evaluate the contemporary prevalence, demographics, treatment trends, and common comorbidities associated with trigger finger (TF). METHODS: The TriNetX Research Network was queried for patients diagnosed with TF from January 1, 2015, to January 1, 2023, resulting in 465,763 patients. TF prevalence was assessed in the general population and in a cohort with diabetes mellitus. Demographics, comorbidities, and TF treatments were recorded. A secondary analysis examined rates of repeat injection and surgery after initial steroid injection. Comparative analyses were conducted using TriNetX's platform tools. RESULTS: The data demonstrated a TF prevalence of 2.0% in the general population and 5.8% in the diabetic population. Those with TF were older (60.6 vs. 39.5 years) and more likely female (63.0% vs. 54.3%) compared with those without TF. The most affected digits were the thumb (35.2%), middle finger (34.1%), and ring finger (26.0%). Approximately 13.5% and 16.6% of patients with TF underwent surgical release within 1 and 3 years, respectively. Among patients who received an initial injection, 25.9% and 36.0% received an additional injection and 13.4% and 20.1% required surgery within 1 and 3 years, respectively. After adjusting for demographic confounders, the TF cohort had nearly four times higher prevalence of carpal tunnel syndrome. CONCLUSION: TF affects 2% of the general population and nearly 6% of diabetic patients. The thumb, middle, and ring fingers are the most commonly affected, with an overall rate of surgery of 16.6% within 3 years. These data can help inform treatment decisions and guide future research.
Posterior Approaches to Pilon Fractures: Considerations, Indications, and Outcomes.
Tiee MS, Stewart CC, Usmani K
J Am Acad Orthop Surg · 2026 Jul · PMID 42357867 · Publisher ↗
Intra-articular fractures of the distal tibia, termed pilon fractures, represent challenging injuries due to poor soft-tissue envelope, articular and metaphyseal comminution, difficult visualization, and reduction techni...
Intra-articular fractures of the distal tibia, termed pilon fractures, represent challenging injuries due to poor soft-tissue envelope, articular and metaphyseal comminution, difficult visualization, and reduction techniques, as well as high rates of complications. Choice of surgical approach has been dictated by location of articular injury, positioning of appropriate fixation and soft-tissue considerations. Posterior column shortening, malalignment or posterior articular comminution/impaction have all warranted consideration for the utilization of a posterior approach. A variety of posterior approaches have been described in the literature, yet limited data exist to guide the decision regarding selection of posterior approaches. This review will detail posterior approaches to tibial pilon fractures, with a focus on described techniques, indications, and comparison between the different posterior approaches and respective outcomes.
Effect of Season on Patient-reported Outcomes and Discharge Disposition in Total Hip and Knee Arthroplasty.
Travers HI, Kuznetsov M, Calkins T … +1 more , Smith EL
J Am Acad Orthop Surg · 2025 Dec · PMID 42357866 · Publisher ↗
INTRODUCTION: Total joint arthroplasty (TJA) is the benchmark for the surgical treatment of osteoarthritis. As TJA is elective, timing can be influenced by patient-specific and environmental factors. Although previous st...
INTRODUCTION: Total joint arthroplasty (TJA) is the benchmark for the surgical treatment of osteoarthritis. As TJA is elective, timing can be influenced by patient-specific and environmental factors. Although previous studies focused on complications and readmissions, few have looked at patient-reported outcome measures (PROMs). In the Northeast, cold weather and higher rates of seasonal affective disorder may influence patient satisfaction postoperatively. Given the link between depression and poorer TJA outcomes, this study explores whether season of surgery affects outcomes while accounting for mental health diagnoses. METHODS: A retrospective single-center review of patients who underwent primary total hip or knee arthroplasty (THA/TKA) between January 2019 and May 2024 (10,989 THA, 12,399 TKA) was done. Seasons were defined meteorologically. Patient demographics, comorbidities, surgical characteristics, discharge disposition, length of stay (LOS), and PROMs (baseline, 3, 6, 12, and 24 months) were analyzed. Multinomial regression and multivariable linear regression assessed the effect of season on discharge and LOS. A fixed-effects model analyzed changes in PROMs over time. RESULTS: Fall surgeries had the shortest LOS (THA: 0.85 days, TKA: 1.05 days; P < 0.001). Longer LOS was linked to spring/summer surgeries and depression. Fall also had the lowest inpatient rehabilitation discharges (THA: 7.3%, TKA: 8.6%), and season was a predictor of discharge disposition in TKA but not THA (P < 0.001). Baseline PROMs were highest in fall, with lower baseline pain scores and higher baseline function scores. THA patients had greater improvements in HOOS JR and VAS24 scores after spring/summer surgeries (P = 0.01). CONCLUSION: Seasonality affects LOS and discharge disposition, especially in TKA. Although baseline PROMs varied by season, postoperative improvements were minimally affected. Seasonal factors seem to influence short-term outcomes but have limited long-term effects on patient recovery.
Impact of Intraoperative Neuromonitoring Alert Resolution on Motor Deficits and Short-Term Outcomes After Spine Fusion.
Olson J, Dalton JF, Martinazzi B … +27 more , Giakas A, Lee Y, Mathew J, Narayanan R, Tarawneh O, Oris RJ, Herczeg C, Baidya J, Huang R, Ng M, Baek G, Green WA, Eichbaum Y, Hitchner M, Witt L, Hammelef E, Middleton CJ, Patel K, Uvarov E, McCurdy M, Kaye ID, Cha TD, Canseco JA, Hilibrand AS, Vaccaro AR, Schroeder GD, Kepler CK
J Am Acad Orthop Surg · 2025 Dec · PMID 42357864 · Publisher ↗
INTRODUCTION: Intraoperative neurophysiologic monitoring (IONM) is commonly used during spinal surgery to track nerve function, with alerts indicating reduced nerve output and input. While IONM allows for surgical adjust...
INTRODUCTION: Intraoperative neurophysiologic monitoring (IONM) is commonly used during spinal surgery to track nerve function, with alerts indicating reduced nerve output and input. While IONM allows for surgical adjustments to mitigate nerve damage, its precise indications, effectiveness, and interpretation of alerts remain debated. Therefore, this study investigated the effect of IONM alert resolution on postoperative outcomes. METHODS: All adult patients who underwent spinal fusion with IONM and experienced an alert in 2017 at a single tertiary center were included. Patients who experienced mortality or had incomplete physical examination documentation were excluded. Postoperative weakness/deficit was defined as a decrease of ≥1 point on a five-point motor strength scale at either immediate postoperative or 2-week follow-up compared with preoperative strength. Deficits were categorized as immediate only, persistent, or de novo (appearing at 2 weeks). IONM alert resolution was graded as full (return to baseline), partial (improvement but no return to baseline), or no resolution. Statistical analysis used Kruskal-Wallis tests (alpha = 0.05). RESULTS: Our study included 115 patients, categorized by alert resolution: no resolution (n = 20), partial resolution (n = 22), and full resolution (n = 73). The partial and full resolution groups had higher cervical region involvement (86.4% and 67.1% vs. 25.0%, P < 0.001) compared with the no-resolution group. Otherwise, demographic characteristics were similar across groups. Notably, the degree of alert resolution was not associated with the rate, timing, or eventual resolution of postoperative motor deficits. Complications, length of stay, discharge disposition, and 90-day emergency department visits and readmissions were similar across groups. CONCLUSION: Despite its frequent use in spine surgery, our findings suggest that the resolution of an IONM alert may not reliably predict the presence, timing, or reversibility of postoperative motor deficits. This suggests that neurologic injury, once indicated, may be more persistent than intraoperative monitoring alone can convey.
Orthoplastic Surgery: A Practical Approach to Limb Salvage.
Barrera J, Levine J, Levin LS … +1 more , Hacquebord J
J Am Acad Orthop Surg · 2026 Jun · PMID 42335408 · Publisher ↗
Complex extremity wounds, if not addressed properly, are a leading cause of major limb amputation. Chronic wounds in salvaged extremities contribute to long-term morbidity in the extremity. Orthoplastic surgery treats li...
Complex extremity wounds, if not addressed properly, are a leading cause of major limb amputation. Chronic wounds in salvaged extremities contribute to long-term morbidity in the extremity. Orthoplastic surgery treats limb-threatening conditions through the combined application of orthopaedic and plastic surgical principles, applied to clinical problems simultaneously. Key components include early stakeholder evaluation of the limb and patient and open collaborative communication between orthopaedic and plastic surgeons. Meticulous débridement at the time of presentation and careful selection of fixation informed by the overall reconstructive plan should be executed when the patient presents to the emergency department. Implementation of Orthoplastic protocols results in quicker time to skeletal stabilization and soft tissue coverage, reduced risk of infection, improved functional outcomes, and less cost for care. This review presents a protocol-driven guide for establishing an Orthoplastic program and optimizing limb salvage outcomes across diverse practice settings.
Frailty is a Vital Tool for Predicting Outcomes Following Prophylactic Femur Fixation.
Sbaih O, Koltenyuk V, Gupta N … +5 more , Dixon L, Gill V, Ogburn M, Williamson TK, Alderete J
J Am Acad Orthop Surg · 2026 Jun · PMID 42328829 · Publisher ↗
BACKGROUND: Frailty measures have become increasingly common in the literature as proposed mechanisms for identifying patients at risk of adverse postoperative outcomes. Prophylactic femur fixation in patients with metas...
BACKGROUND: Frailty measures have become increasingly common in the literature as proposed mechanisms for identifying patients at risk of adverse postoperative outcomes. Prophylactic femur fixation in patients with metastatic disease can prevent future fracture and improve quality of life; however, these patients are inherently high-risk surgical candidates. The role of this study is to characterize the relationship between frailty and postoperative outcomes in patients undergoing prophylactic femoral fixation (ProphFF) and compare the predictive ability of different frailty measures for adverse outcomes in this population. METHODS: Data from the 2015 to 2020 American College of Surgeons National Surgical Quality Improvement Program database was used. The study focused on patients aged ≥18 years undergoing ProphFF and those undergoing PathFF. Frailty was measured using both the revised Risk Analysis Index (RAI-rev) and the five-factor modified Frailty Index (mFI-5). Primary outcomes included 30-day mortality, major complications, unplanned readmission, and unplanned revision surgery, nonhome discharge, and extended length of stay. Propensity score matching was employed to adjust for baseline differences of age, body mass index, sex, functional status, and ASA between ProphFF and PathFF groups. Statistical methods included multivariable logistic regression and receiver operating characteristic curve analysis to evaluate the relationships between frailty measures and postoperative outcomes. RESULTS: A total of 921 patients (57.7% female, median age 65 years [IQR, 56 to 72 years]) undergoing ProphFF or PathFF were included. Multivariable analysis demonstrated that increasing frailty increased odds of 30-day mortality, with each 1-point increase in RAI-rev and mFI-5 associated with a 5% (OR: 1.05, 95% CI, 1.01 to 1.08; P < 0.01) and 31% (OR: 1.31, 95% CI, 1.01 to 1.71; P < 0.05) higher mortality risk, respectively. Propensity score matching resulted in 842 patients (421 prophylactic and 421 pathologic). Patients undergoing PathFF had higher likelihood of mortality compared with patients undergoing ProphFF (OR: 2.79, 95% CI, 1.61 to 4.82; P < 0.01). RAI-rev (C-statistic 0.73 [95% CI, 0.71 to 0.75]) had superior discrimination for mortality compared with mFI-5 (C-statistic 0.57 [95% CI, 0.54 to 0.59], P < 0.001). DISCUSSION: Increasing preoperative frailty scores, particularly as measured by the revised Risk Analysis Index, were independent predictors of mortality and morbidity in patients undergoing prophylactic femur fixation. Pathologic fracture fixation demonstrated higher risk of revision surgery and mortality compared with prophylactic fixation. These findings suggest that the RAI-rev may be a valuable tool for identifying high-risk patients and optimizing surgical candidate selection before prophylactic femur fixation, potentially improving outcomes in this complex patient population.
The Influence of Os Acromiale on Patient Outcomes After Reverse Total Shoulder Arthroplasty: A Matched Cohort Study.
Schneider BS, Pfaehler CD, Hao KA … +8 more , Benjamin JA, Hones KM, Schoch BS, Wright JO, Wright TW, Farmer KW, LaMonica TJ, King JJ
J Am Acad Orthop Surg · 2026 Jun · PMID 42328812 · Publisher ↗
BACKGROUND: Although os acromiale is often noted on preoperative imaging in patients undergoing reverse total shoulder arthroplasty (rTSA), its clinical significance is ill-defined. The purpose of this study was to compa...
BACKGROUND: Although os acromiale is often noted on preoperative imaging in patients undergoing reverse total shoulder arthroplasty (rTSA), its clinical significance is ill-defined. The purpose of this study was to compare the clinical outcomes in shoulders with an os acromiale undergoing rTSA with a matched control group. METHODS: We conducted a retrospective review of a prospectively collected shoulder arthroplasty database for patients who underwent primary rTSA with a minimum 2-year clinical follow-up. Preoperative imaging studies taken within 6 months of surgery were assessed for an os acromiale. Sixty-four shoulders with os acromiale were identified and were matched in a ratio of 1:5 to a control group (n = 320) based on age (within 3 years), sex (exact), preoperative diagnosis, preoperative forward elevation (within 5°) and American Shoulder and Elbow Surgeons score (within five points). Clinical outcome scores, shoulder strength, and active range of motion assessed preoperatively and at latest follow-up as well as the incidence of complications were compared between cohorts. Outcomes of meso- and meta-acromion were grouped and compared with preacromion shoulders. RESULTS: The incidence of os acromiale was 9.7% (64/663) in our institution. Of these, 55% (n = 34) were preacromion, 38% (n = 24) were mesoacromion, and 8% (n = 5) were meta-acromion. No statistically significant differences were found in any outcome score, shoulder strength, or range of motion measures between shoulders with os acromiale and matched controls. Similar proportions of each cohort achieved a clinically significant benefit (minimal clinically important difference/substantial clinical benefit) for the Shoulder Pain and Disability Index, Simple Shoulder Test, American Shoulder and Elbow Surgeons score, constant score, abduction, forward flexion, external rotation, and internal rotation. Shoulders with os acromiale had a similar overall complication rate compared with matched controls (14% vs. 12%; P = 0.658). No statistical difference in outcomes were observed between the pre- and meso-/meta-acromion shoulders. CONCLUSIONS: Patients with os acromiale undergoing rTSA have similar postoperative functional outcomes and pain relief compared with matched controls. LEVEL OF EVIDENCE: Ⅲ, Retrospective Matched Cohort Study.
Clinical Outcomes and Complications of Surgical and Conservative Treatment for Jones Fractures: A Systematic Review.
Encinas R, Hall Kiriluk S, DePaolo S … +3 more , Jackson JB, Shaath MK, Gonzalez T
J Am Acad Orthop Surg · 2026 Jun · PMID 42319275 · Publisher ↗
BACKGROUND: Forefoot fractures are among some of the most common orthopaedic injuries. Treatment of zone 2 fifth metatarsal or Jones fractures is controversial and many times dependent on surgeon preference. Management o...
BACKGROUND: Forefoot fractures are among some of the most common orthopaedic injuries. Treatment of zone 2 fifth metatarsal or Jones fractures is controversial and many times dependent on surgeon preference. Management of these injuries remains without clear guidelines. Accordingly, the goal of the current systematic review is to compare the clinical outcomes and complications for both surgical fixation and conservative treatment. METHODS: Two independent authors completed a systematic review using the PubMed, EMBASE, and Cochrane Library databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol and Cochrane Handbook guidelines were followed. In addition, the Methodological Index for Non-Randomized Studies score was used to evaluate the quality and bias of the nonrandomized controlled trials. Our criteria included only studies that reported on both conservative and surgical treatment of Jones fractures. RESULTS: Ten studies including 998 patients met our criteria for inclusion. A total of 787 patients underwent conservative management while 211 patients underwent surgical fixation. The surgical cohort had a significantly lower rate of total complications (18/211 (8.5%)) in comparison with the conservative cohort (123/787 (15.6%; P = 0.02). Similarly, those who underwent surgery had a lower rate of nonunion (7/211 (3.3%) versus 91/787 (11.6%; P = 0.04)). Patient-reported outcome scores, including American Orthopaedic Foot and Ankle Society scores were significantly better at final follow-up in the surgical group (96.5) in comparison with the conservative group (84.1; P = 0.005). CONCLUSION: This systematic review found markedly fewer total complications, a lower nonunion rate, and higher mean American Orthopaedic Foot and Ankle Society scores in patients who underwent surgical management for Jones fractures in comparison with those who were treated nonoperatively. Although, conservative treatment is also a successful method of treatment, our findings support surgical treatment of Jones fractures.
Comparison of 90-Day Medical Complications, Emergency Department Utilizations, and Readmissions for Corticosteroid Users Undergoing Hip Arthroscopy.
Gordon AM, Nian PP, Singh R … +2 more , Mahadevan N, Gilat R
J Am Acad Orthop Surg · 2026 Jun · PMID 42319273 · Publisher ↗
INTRODUCTION: Hip arthroscopy has increased in utilization with the improvement of surgical technique and technology. Although the rate of complications has historically been low, patient-specific factors may increase co...
INTRODUCTION: Hip arthroscopy has increased in utilization with the improvement of surgical technique and technology. Although the rate of complications has historically been low, patient-specific factors may increase complication risk. The effects of preoperative corticosteroid use and resultant immunosuppression on outcomes following hip arthroscopy are not well understood. This study aimed to compare the rates and odds of 90-day medical complications, emergency department (ED) utilizations, and readmissions between corticosteroid users and nonusers undergoing hip arthroscopy. METHODS: Using the PearlDiver nationwide claims database (2010 to 2021), corticosteroid users (N = 1,735) were propensity score matched in a 1:5 ratio to controls (N = 8,643) based on age, sex, and comorbidities, and Elixhauser comorbidity index. Ninety-day medical complications, ED utilization, and readmissions were compared. Logistic regression models were used to compute odds ratios (ORs) of medical complications, and 90-day ED visits and readmissions in corticosteroid users. Following Bonferroni correction, statistical significance was set at P < 0.01. RESULTS: Corticosteroid users demonstrated markedly higher odds of medical complications (OR, 4.75; P < 0.0001) compared with controls. Corticosteroid users had elevated rates and odds of deep vein thrombosis (1.27% vs. 0.25%; OR, 5.04; P < 0.0001), pneumonia (5.01% vs. 0.69%; OR, 7.81; P < 0.0001), blood transfusion (0.98% vs. 0.20%; OR, 5.06; P < 0.0001), surgical site infections (0.81% vs. 0.23%; OR, 3.51; P = 0.0003), and deep wound infections (0.69% vs. 0.22%; OR, 3.17; P = 0.001). Corticosteroid users had higher incidence and odds of ED visits (4.27% vs. 2.04%; OR, 2.15; P < 0.0001) and readmissions (4.84% vs. 2.07%; OR, 2.43; P < 0.0001) within 90 days. CONCLUSION: Corticosteroid users undergoing hip arthroscopy are at higher risk of 90-day medical complications, ED visits, and readmissions compared with noncorticosteroid users. These findings emphasize the need for careful perioperative planning and risk mitigation strategies for this high-risk group.
Z-type Clavicle Fractures in Adults: A Retrospective Comparative Study of Outcomes.
Muhammad M, Borgida JS, Wagner RK … +9 more , Griffin JT, Sierra-Arce CR, Musick AN, Gregg AT, Policicchio TJ, van Duuren D, Lehle CH, Ly TV, Aneja A
J Am Acad Orthop Surg · 2026 Jun · PMID 42319269 · Publisher ↗
INTRODUCTION: Midshaft clavicle fractures with a "Z" deformity have historically been considered a surgical indication, although evidence is limited. This study compared rates of surgery to promote fracture healing betwe...
INTRODUCTION: Midshaft clavicle fractures with a "Z" deformity have historically been considered a surgical indication, although evidence is limited. This study compared rates of surgery to promote fracture healing between Z-type and non-Z-type clavicle fractures managed nonoperatively (nonsurgical cohort) and all-cause unplanned (re)operation rates among operatively and nonoperatively managed Z-type fractures (Z-type cohort). METHODS: This retrospective cohort study included adult patients with midshaft clavicle fractures treated at two level 1 trauma centers between 2010 and 2023. Z-type fractures were defined as comminuted fractures with complete displacement and a vertically oriented butterfly fragment of ≥1 cm. The primary outcome was the rate of surgery to promote fracture healing in the nonsurgical cohort and the all-cause unplanned surgery rate in the Z-type cohort. RESULTS: In total, 35 nonsurgical Z-type fractures, 157 nonsurgical non-Z-type fractures, and 95 surgical Z-type fractures were included. Rates of surgery to promote healing were similar between nonoperatively managed Z-type and non-Z-type fractures (17% vs. 22%, P = 0.552). Multivariable analysis showed no association between Z-type fractures and surgery to promote fracture healing (odds ratio, 0.84; 95% confidence interval, 0.29 to 2.17; P = 0.737). Among Z-type fractures, all-cause unplanned surgery rates were comparable between nonsurgical and surgical management (20% vs. 28%, P = 0.333). However, when excluding implant removal, nonoperatively managed Z-type fractures had a significantly higher all-cause unplanned surgery rate (20% vs. 4.2%, P = 0.009). Surgical management of Z-type fractures had a lower rate of surgery to promote fracture healing compared with nonsurgical management (1.1% vs. 17%, P = 0.002). CONCLUSIONS: Among fractures initially treated nonoperatively, Z-type and non-Z-type midshaft clavicle fractures had similar rates of surgery to promote fracture healing. Surgical management of Z-type fractures demonstrated a lower rate of surgery to promote fracture healing compared with nonsurgical management. Regardless of initial treatment, all-cause unplanned surgery rates were comparable for Z-type fractures. LEVEL OF EVIDENCE: Therapeutic Level III.
The Effects of Surgeon Workforce Diversity on Total Joint Arthroplasty Patient Demographics.
Ruberto RA, Mastroianni MA, Geller J … +7 more , Cooper HJ, Shah R, Neuwirth A, Herndon CL, Levine W, Tyler W, Sarpong NO
J Am Acad Orthop Surg · 2026 Jun · PMID 42319268 · Publisher ↗
INTRODUCTION: Racial disparities in total joint arthroplasty (TJA) utilization are persistent and well-characterized. Improving surgeon workforce diversity may attract patients from diverse backgrounds. We sought to dete...
INTRODUCTION: Racial disparities in total joint arthroplasty (TJA) utilization are persistent and well-characterized. Improving surgeon workforce diversity may attract patients from diverse backgrounds. We sought to determine whether the recent hiring of an arthroplasty surgeon of underrepresented minority (URM) background in a predominantly non-URM arthroplasty practice was associated with increased patient diversity. METHODS: We retrospectively reviewed all primary and revision elective TJAs by six arthroplasty surgeons at our institution from September 2022 to September 2023. Primary outcomes included patient age, sex, and race/ethnicity. Secondary outcomes included patient-reported outcome measures (PROMs) at preoperative and 3-month postoperative follow-up. Comparison cohorts included the following: (1) a recently hired URM attending surgeon; (2) a recently hired non-URM attending surgeon; and (3) four senior non-URM attending surgeons. Unpaired t-tests were used to compare means for continuous variables and chi-squared tests for qualitative variables. RESULTS: Overall, 2,101 patients were included, and 168 patients were included in group 1 (URM surgeon), 75 in group 2 (non-URM surgeon); and 1,858 in group 3 (non-URM senior surgeons). Compared with groups 2 and 3, patients within group 1 comprised a markedly greater proportion of female, Black, and Hispanic/Latino patients (64.8%, 33.3% and 59.7%, respectively, P < 0.01). Racial and ethnic demographic differences persisted when examining patients treated by the non-URM division in the year before the hiring of the URM surgeon. Subgroup analysis of URM patients showed markedly improved SF-12 mental scores for URM patients treated by the URM surgeon compared with those treated by senior surgeons (P < 0.05). CONCLUSION: Compared with an experience-matched non-URM surgeon and non-URM senior surgeons in the same division, the URM surgeon saw a markedly greater proportion of minority patients in their first year of practice. Hiring diverse orthopaedic faculty may represent a viable strategy for improving health care utilization for minority patients in arthroplasty practices.
Radiation Exposure in the Orthopaedic Surgeon: Guidelines, Impact, and Reduction Techniques.
Stockwell E, Stimson L, Williams A
J Am Acad Orthop Surg · 2026 Jun · PMID 42319263 · Publisher ↗
Exposure to ionizing radiation is a common occupational hazard for the orthopaedic surgeon, ubiquitous among subspecialities. There are known detrimental effects of radiation exposure including cataracts and increased ca...
Exposure to ionizing radiation is a common occupational hazard for the orthopaedic surgeon, ubiquitous among subspecialities. There are known detrimental effects of radiation exposure including cataracts and increased cancer risk. It is imperative for both practicing orthopaedic surgeons and trainees to recognize that these risks exist and to understand what effect our occupational exposure can have over the length of a career. The purpose of this review is to highlight current recommendations and guidelines regarding ionizing radiation dose exposure, summarize the available literature specifically evaluating the effect of radiation exposure among orthopaedic surgeons, and to provide readers with strategies to mitigate radiation exposure and subsequent harmful sequelae.
Functional Outcomes by Ethnicity and Sex Following Tumor Resection and Endoprosthetic Reconstruction: A Secondary Analysis of the Parity Trial.
Gonzalez MR, Goh MH, Werenski JO … +4 more , Gebhardt MC, Ghert M, Lozano-Calderon SA, PARITY Investigators
J Am Acad Orthop Surg · 2026 Jul · PMID 42313674 · Publisher ↗
BACKGROUND: Despite advances in limb-salvage surgery in orthopaedic oncology, the effect of ethnicity and sex on patient function recovery remains unclear. Our study examined the influence of sex and ethnicity on functio...
BACKGROUND: Despite advances in limb-salvage surgery in orthopaedic oncology, the effect of ethnicity and sex on patient function recovery remains unclear. Our study examined the influence of sex and ethnicity on functional outcomes for patients with bone tumors undergoing lower extremity endoprosthetic reconstruction. METHODS: This study was a secondary analysis of the Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) trial. Functional outcomes were assessed preoperatively and at 3, 6, and 12 months postoperatively using the Musculoskeletal Tumor Society 1993 (MSTS-93) and Toronto Extremity Salvage Score questionnaires. Delta scores (postoperative minus preoperative) and minimal clinically important difference thresholds were calculated by ethnicity and sex, and group differences were analyzed. RESULTS: Among the 604 patients included, the main ethnic groups were White (63.6%), Asian (18.7%), Black (7.1%), Hispanic (5.6%), and Other (5%). Asian patients had markedly higher preoperative and postoperative MSTS-93 and TESS scores than other groups, although delta scores were similar across all ethnicities. Although MCID achievement rates for MSTS-93 did not differ by ethnicity, Asian patients showed a higher MCID achievement rate for TESS at 3 and 6 months. Sex-based analyses revealed that men had higher baseline functional scores, but women demonstrated greater postoperative improvements, as reflected by higher delta scores. Although postoperative MSTS-93 MCID achievement rates were similar between sexes, women exhibited higher TESS MCID achievement across all postoperative timepoints. CONCLUSION: Asian patients had higher functional outcomes after endoprosthetic reconstruction, and ethnic minorities did not show worse outcomes than White patients. Additional research should explore these trends in different settings. LEVEL OF EVIDENCE: I.
Fertility Outcomes in 104 Consecutive Pediatric and Young Adult High-Grade Osteosarcoma Survivors Followed Over a 45-Year Period.
Lamo-Espinosa JM, San-Julián M
J Am Acad Orthop Surg · 2026 Jul · PMID 42313673 · Publisher ↗
INTRODUCTION: Chemotherapy regimens in high-grade osteosarcoma have markedly improved survival rates, currently reaching approximately 70%. Concerns persist regarding a long-term effect on fertility. Despite the systemat...
INTRODUCTION: Chemotherapy regimens in high-grade osteosarcoma have markedly improved survival rates, currently reaching approximately 70%. Concerns persist regarding a long-term effect on fertility. Despite the systematic application of many fertility preservation techniques, few studies specifically address fertility in survivors. Our goal was to assess fertility in patients treated for pediatric and young adult osteosarcoma in a long-term follow-up period. METHODS: This study was retrospective analysis of osteosarcoma survivors treated at our center from 1980 to 2005. All followed a standardized chemotherapy protocol. In cases where contact could not be established at the time of the follow-up for their osteosarcoma, telephone interviews were conducted, querying about pregnancy desires and difficulties. In case of difficulties, we further investigated about the possible reasons behind them. RESULTS: Of 116 consecutive patients initially enrolled, 104 were contacted; 67 (36 women, 31 men) desired pregnancy. Mean age at the beginning of treatment was 16.9 (4 to 33) years. The mean age at the end of follow-up was 46.8 (31 to 64) years, with an average follow-up period of 359 (156 to 480) months. Among the 36 women desiring pregnancy, only 1 (2.7%) faced fertility challenges due to chemotherapy. Of the 31 men desiring pregnancy, 4 (12.9%) experienced difficulties due to azoospermia secondary to chemotherapy and in two cases, the cause is unknown because no fertility studies were conducted for the couple. No discernible chemotherapy dosage differences were found between patients with fertility issues and those without. CONCLUSIONS: Survivors of pediatric and young adult osteosarcoma exhibit a high success rate in achieving normal conception and childbirth, aligning with the general population. To inform pediatric and adolescent patients with osteosarcoma, as well as their parents, about the high success rate associated with achieving a normal conception and childbirth should be the standard.
Effectiveness of Antigravity Treadmill Therapy After Lower Extremity Periarticular Fracture: A Randomized Clinical Trial.
Major Extremity Trauma Research Consortium (METRC)
J Am Acad Orthop Surg · 2026 Jul · PMID 42313672 · Publisher ↗
BACKGROUND: Early, controlled weight-bearing using an antigravity treadmill may improve outcomes following definitive fixation of lower extremity periarticular fractures. We hypothesized that patients randomized to 10 we...
BACKGROUND: Early, controlled weight-bearing using an antigravity treadmill may improve outcomes following definitive fixation of lower extremity periarticular fractures. We hypothesized that patients randomized to 10 weeks of antigravity treadmill therapy would report better 6-month joint-specific patient-reported function compared with standard of care. METHODS: This prospective, multicenter, randomized trial included patients 18 to 55 years of age with fractures of the knee and distal tibia randomly assigned to either 10 weeks of antigravity treadmill therapy (intervention) or standard of care (control). The primary outcome was 6-month patient-reported function (Knee injury Osteoarthritis Outcome Score) for patients with knee fractures and Ankle Osteoarthritis Scale for patients with distal tibia fractures. Secondary outcomes included 6-month Patient-Reported Outcomes Measurement Information Systems Physical Function scores, 12-month fracture healing and complications, and 6-week, 3- and 6-month satisfaction with therapy. RESULTS: Of 80 randomized patients, 78 were included in the final analysis (intervention n = 38; control n = 40). Their mean age was 37 years; 55 (71%) had knee fracture and 23 (29%) had distal tibia fracture. The average Knee injury Osteoarthritis Outcome Score were 54 and 61 in the intervention and control groups, respectively (adjusted difference: -6.1; 95% confidence interval, -18.4, 6.2; P = 0.32). The average Ankle Osteoarthritis Scale scores were 28 and 50 for the intervention and control groups, respectively (adjusted difference: -19.5; 95% confidence interval, -39.3, 0.30; P = 0.05). No difference was found between treatment groups in Patient-Reported Outcomes Measurement Information Systems Physical Function, fracture healing, or complications. Patients in the intervention group reported higher satisfaction with their therapy at 6 weeks (9.5 vs. 8.5; P = 0.01) and 3 months (9.5 vs. 8.6; P = 0.04). CONCLUSION: This study suggests that antigravity treadmill therapy may be beneficial for patients with distal tibia fractures. Moreover, the study demonstrates that a 10-week antigravity treadmill therapy program is safe and feasible with high patient satisfaction, providing foundation for future effectiveness trials for patients with periarticular injuries.
Risk Factors Driving "No-Shows" Across Orthopaedic Subspecialty Outpatient Clinics.
Martin J, Rivas G, Silvestre J … +7 more , Martin B, Crawford E, Glaser J, Reitman C, Lawrence J, Leddy L, Ravinsky R
J Am Acad Orthop Surg · 2026 Jul · PMID 42313671 · Publisher ↗
INTRODUCTION: Unattended clinic visits, or patient no-shows, can have harmful effects on patient health and well being and an unfavorable impact on the revenue stream and financial efficiency of the health system. The ob...
INTRODUCTION: Unattended clinic visits, or patient no-shows, can have harmful effects on patient health and well being and an unfavorable impact on the revenue stream and financial efficiency of the health system. The objective of this study was to assess potential risk factors associated with clinic no-shows across orthopaedic subspecialties in a large, tertiary care, academic, medical center. METHODS: Clinic appointments labeled as "completed" or "no-show" between January 1, 2021 and June 30, 2023, were retrospectively collected from an outpatient orthopaedic department at a single institution. Patient demographic, socioeconomic, and visit characteristics evaluated as potential risk factors for no-shows included patient age, sex, race, social deprivation index (SDI) at the zip code level, documented social support, employment status, insurance coverage, time between appointment creation and appointment date, orthopaedic subspecialty, appointment type (ie, new versus established patient status), and referral status (ie, self-referred versus referral from a medical provider). Variable selection was done with univariate logistic regression analysis, and adjusted risk of no-shows was estimated using multivariable logistic regression. Matching was done to control for potential confounding from patient age and sex, subspecialty, and appointment type. RESULTS: Overall, 148,352 clinic appointments were included in the primary analysis. Multivariable logistic regression analysis before matching cohorts demonstrated statistically significant associations between no-show appointments and advanced age, female sex, self-identified Black or African American race, unemployment, lack of social support, and Foot and Ankle visits. After cohorts were matched, a total of 22,154 clinic appointments were included in the final analysis with an equal number of "completed" and "no-show" visits. Multivariable logistic regression modeling of the matched no-shows and completed visits demonstrated a higher odds of no-show appointments among patients self-identifying as Black/African American, lacking social support, being unemployed, being a student or retiree, having Medicare insurance, and a having a higher SDI. CONCLUSION: Higher odds of patient no-shows were determined for several patient- and visit-level variables, including Black/African American race, lack of social support, unemployment, Medicare insurance, and higher SDI. LEVEL OF EVIDENCE: III.
Glenoid Pathology Is Similar Between Osteoarthritis and Postcapsulorrhaphy Arthropathy: A Propensity-Matched Analysis.
Bowler AR, Diestel DR, Stevens CS … +6 more , Jo S, McDonald-Stahl M, Chan PA, Le K, Jawa A, Kirsch JM
J Am Acad Orthop Surg · 2026 Jun · PMID 42307571 · Publisher ↗
BACKGROUND: Postcapsulorrhaphy arthropathy (PCA) may result as a long-term sequela of instability surgery, eventually necessitating shoulder arthroplasty. Alterations to the soft tissue and bony anatomy during the index...
BACKGROUND: Postcapsulorrhaphy arthropathy (PCA) may result as a long-term sequela of instability surgery, eventually necessitating shoulder arthroplasty. Alterations to the soft tissue and bony anatomy during the index surgery may lead to unique wear patterns of the glenohumeral joint compared with what is observed in primary glenohumeral osteoarthritis (GHOA). We sought to characterize the three-dimensional glenoid morphology of patients with PCA to understand whether arthritic wear patterns are distinct from those observed in GHOA. METHODS: Patients diagnosed with GHOA or PCA were retrospectively propensity matched in a 4:1 ratio by age and sex. Radiographic measurements-including glenoid inclination, version, humeral head subluxation, glenoid vault loss, and maximum erosion depth-were assessed using Materialise Surgicase Preoperative Planner. The presence of biplanar glenoid deformity, defined as glenoid inclination and version ≥10° was assessed. The PCA cohort was further stratified by capsulorrhaphy technique (open vs. arthroscopic). Univariate analysis was conducted to compare glenoid morphology between cohorts and subcohorts. RESULTS: After matching, the GHOA and PCA cohorts consisted of 264 and 67 patients, respectively, with no notable differences in age (GHOA 64.9 ± 7.0 years vs. PCA 63.6 ± 8.1 years; P = 0.236) or sex (85.0% male GHOA vs. 82.1% male PCA; P = 0.714). The PCA cohort demonstrated a markedly greater degree of superior inclination compared with the GHOA cohort (7.5 ± 5.4 vs. 4.3 ± 5.7; P = <0.001), although this is not likely clinically relevant. No other notable differences in any of the other radiographic measurements or parameters between GHOA and PCA cohorts were found. The arthroscopic and open PCA subcohorts consisted of 34 and 25 patients, respectively, with no notable differences in radiographic parameters observed between the open and arthroscopic cohorts (P > 0.05). CONCLUSION: Arthritic glenoid wear patterns in patients with PCA and GHOA demonstrate no notable differences despite the altered soft tissue and bony anatomy inherent to instability surgery. Subcohort analysis of open versus arthroscopic capsulorrhaphy revealed no notable differences in glenoid morphology. Although PCA presents unique surgical challenges, these may be more closely tied to soft-tissue alterations than to variations in glenoid morphology. LEVEL OF EVIDENCE: Level III; Retrospective Comparative Study.
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