The Journal Of The American Academy Of Orthopaedic Surgeons[JOURNAL]
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200 papers
Trends of E-Scooter-Related Pediatric Orthopaedic Injuries: 20 Years of Nationally Representative Data.
Lu S, Williams CJ, Marsh IG … +5 more , Nian PP, Beber SA, Ross S, Logterman S, Heyer JH
J Am Acad Orthop Surg · 2026 Jun · PMID 42133527 · Publisher ↗
INTRODUCTION: The rise in popularity of battery-powered 2-wheeled electric scooters (e-scooters) has fostered safety concerns, particularly because of a lack of universally recommended safety precautions. Orthopaedic inj...
INTRODUCTION: The rise in popularity of battery-powered 2-wheeled electric scooters (e-scooters) has fostered safety concerns, particularly because of a lack of universally recommended safety precautions. Orthopaedic injuries are common in the pediatric population, yet little is known about the trends of e-scooter-related orthopaedic injuries in this population. The aim of this study was to investigate the national trends in orthopaedic injuries among children operating e-scooters over a twenty-year period. METHODS: The National Electronic Surveillance System, a publicly available database of 102 emergency departments, was retrospectively queried for patients aged 0 to 21 years with an orthopaedic injury related to e-scooter usage between 2005 and 2024. Each case was assigned a sampling weight to produce nationally representative estimates. Linear regressions were used to calculate trends. RESULTS: An estimated 55,653 pediatric orthopaedic injuries were reported during the study period. The weighted estimates of orthopaedic injuries related to e-scooter use had an upward trend from 2005 to 2024, with notable peaks in 2020 and 2024, which were paralleled by annual incident rates. The estimated average annual incidence rate was 204 injuries per 100,000 children per year. Most (65%) of the injuries occurred in male individuals. Children (aged 0-13) accounted for 63% of injuries, and adolescents (aged 14-21) accounted for 37% of injuries. Fractures were the most common injury (71.7%), followed by strain or sprain (25.2%). Most commonly injured anatomical areas were in the upper extremities, particularly the wrist (21.5%), forearm (15.6%), and shoulder (8.4%). Most (90.2%) of the injuries were treated and discharged on the same day. CONCLUSION: Pediatric orthopaedic-related e-scooter injuries have increased over the past 20 years, with injuries occurring more commonly in male individuals and children sustaining mostly fractures and upper body injuries. As new technologies facilitating high-speed travel emerge, orthopaedic surgeons should be cognizant of the injuries associated with the new products.
Surgical Spine Techniques for Small-Statured Surgeons and Assistants.
Ibrahim MT, Harris H, Larson AN … +1 more , Yu EM
J Am Acad Orthop Surg · 2026 May · PMID 42117706 · Publisher ↗
Equitable working environment for surgeons of all sizes is crucial. Present-day operating rooms (ORs) may not be best suited for all surgeons. This review discusses techniques and suggestions for OR improvements for spin...
Equitable working environment for surgeons of all sizes is crucial. Present-day operating rooms (ORs) may not be best suited for all surgeons. This review discusses techniques and suggestions for OR improvements for spine surgeons who do not fit this stereotype. Emphasis should be on adopting good posture throughout the surgery, using powered tools, ergonomically designed equipment, and body support devices whenever possible. If such tools are not available, surgeons should select items that offer the greatest leverage, such as T-handles instead of round knobs. Microbreaks, defined as short breaks of less than 1 minute taken every half an hour of operating, should be taken to stretch and reduce strain on muscles and joints. Moreover, in addition to appropriate ergonomic best practices, strength training, stretching, and aerobic exercises should also be part of the routine outside the OR to minimize the risk of musculoskeletal injuries inside the OR.
Immediate Weight Bearing Is Safe Following Combined Extended Trochanteric Osteotomy and Revision Total Hip Arthroplasty.
Abwini LZ, Tang A, Zeiman M … +6 more , Andriani NT, Gillinov L, Shichman I, Schwarzkopf R, Liporace FA, Yoon RS
J Am Acad Orthop Surg · 2026 May · PMID 42114103 · Publisher ↗
INTRODUCTION: An extended trochanteric osteotomy (ETO) is used in complex cases to enhance access to the femoral canal and aid implant and cement removal during revision total hip arthroplasty (RTHA). However, there is n...
INTRODUCTION: An extended trochanteric osteotomy (ETO) is used in complex cases to enhance access to the femoral canal and aid implant and cement removal during revision total hip arthroplasty (RTHA). However, there is no consensus regarding postoperative rehabilitation protocols. The aim of this study was to assess the efficacy and safety of immediate weight-bearing (WB) protocols in patients undergoing ETO during RTHA. METHODS: A multicenter retrospective review was conducted at two academic medical centers between 2014 and 2021 to identify patients undergoing an ETO during RTHA with a minimum 1-year follow-up. Thirty-nine patients underwent an immediate WB protocol postoperatively. Union rates, ambulatory status, 90-day orthopaedic-related complications, revision surgeries, revisions, and Hip Disability and Osteoarthritis Outcome Score Joint Replacement (HOOS JR) scores were collected. RESULTS: Fifty-three patients were included in the final analysis. The average follow-up time was 15.8 ± 20.4 months, with a mean age of 63.7 ± 11.5 years. Bony union was achieved in 46 patients (86.8%). The mean earliest time to union was 4.2 ± 5.4 months. Average HOOS JR scores significantly improved from preoperative to 1-year follow-up (mean 16.4 ± 4.1 vs 3.5 ± 4.2), P ≤ 0.000001). At the final follow-up, ambulatory status improved, with fewer patients kept as non-weight bearing (11 (21.6%) versus 7 (15.2%)). Two complications (3.8%) due to deep infection, 5 revision surgeries (9.4%), and 6 revisions (11.0%) were observed within 90 days. CONCLUSION: Most patients who underwent ETO during RTHA and were placed on an immediate WB protocol achieved union at 4.2 months on average. HOOS JR scores improved as early as 2 weeks. More importantly, a greater proportion of patients experienced an improved ambulatory status at the final follow-up. These findings suggest that an immediate WB protocol-particularly WBAT-may be effective and safely implemented in patients undergoing an ETO during RTHA. LEVEL OF EVIDENCE: Level III retrospective cohort comparison study.
Bone Graft Substitutes Used in Non-spinal Orthopaedic Arthrodesis Surgery: A Systematic Review.
MacDonald J, Glazebrook H, Morash J … +2 more , Burgesson B, Glazebrook M
J Am Acad Orthop Surg · 2026 May · PMID 42101444 · Publisher ↗
Bone graft is commonly used to promote joint arthrodesis. Currently, the bone graft options used surgically include autograft, allograft, and bone graft substitutes (BGS). Limited availability, potential morbidity (assoc...
Bone graft is commonly used to promote joint arthrodesis. Currently, the bone graft options used surgically include autograft, allograft, and bone graft substitutes (BGS). Limited availability, potential morbidity (associated with autograft harvest), efficacy concerns, costs, and the theoretical risk of disease transmission have led to an increased use of BGS. Although there are numerous BGS available, it remains unclear which BGS provide the best clinical outcomes. This systematic review is intended to evaluate the quantity and quality of published BGS clinical outcome studies in non-spinal orthopaedic arthrodesis surgery. A comprehensive literature search of PubMed, Embase, and the Cochrane Library identified 1,751 studies of which 15 met inclusion criteria. All of these studies were of the foot and ankle and represented eight commercially available BGS. Among them, Augment had the most evidence and received a grade A recommendation. All other BGS received grade I recommendations due to insufficient published clinical outcome data. These findings highlight the limited published evidence on the clinical outcomes associated with the use of BGS in non-spinal orthopaedic arthrodesis surgery. Surgeons should continue to use the best available evidence when selecting BGS while recognizing the need for additional high-quality clinical studies.
An Investigation of Chronic Pain Prevalence and Severity Among Spine Surgeons and Trainees.
Blake S, Lauinger AR, Fullenkamp A … +4 more , Kemprecos H, Nyaaba W, Polites GM, Arnold PM
J Am Acad Orthop Surg · 2026 May · PMID 42101438 · Publisher ↗
BACKGROUND: Operating room ergonomics uniquely predispose spine surgeons to chronic musculoskeletal pain. We surveyed the Lumbar Spine Research Society to better characterize the prevalence, surgical challenges, institut...
BACKGROUND: Operating room ergonomics uniquely predispose spine surgeons to chronic musculoskeletal pain. We surveyed the Lumbar Spine Research Society to better characterize the prevalence, surgical challenges, institutional response, and nonoccupational factors of chronic pain among spine surgeons as well as its effects on their careers and well-being. METHODS: A survey of demographic, lifestyle, occupational, and symptomatic information was distributed at the 2024 Lumbar Spine Research Society Annual Meeting. Univariate and multivariate analyses were conducted to assess chronic pain prevalence and severity. Owing to the sample size, a P value of 0.10 was considered statistically significant. RESULTS: Forty surgeons responded; chronic pain affected 82.5%, limited daily activities in 58%, and affected overall fitness in 33%. All reported that ergonomic advancement could improve their practice. Institutions had addressed ergonomic challenges for 5% of respondents and made improvements for 2.5%. In univariate analysis, age correlated with pain prevalence (P = 0.016), while height (P = 0.021), weight (P = 0.050), sleep (P = 0.089), work hours (P = 0.070), and robotic assistance (P = 0.010) were inversely correlated with pain prevalence. Age (P = 0.027), weight (P = 0.0054), and robotic assistance (P = 0.0030) were also inversely correlated with pain severity. Multivariate analysis showed that sleep was inversely correlated with pain (P = 0.062). CONCLUSIONS: Chronic musculoskeletal pain is up to four times more common among spine surgeons than it is among other adults. Sleep and robotic assistance may represent protective factors, but other risk factors and protective factors remain unclear. Ubiquitous symptoms and lack of institutional interventions underscore opportunities to better support spine surgeons and improve career longevity.
Bone Loss Progression in Two-stage Revision Total Knee Arthroplasty: The Potential Role of Reimplantation Timing in Prosthetic Joint Infection Management.
Najafi F, Hahn AK, Sherman M … +3 more , Stein JM, Parvizi J, Grosso MJ
J Am Acad Orthop Surg · 2026 May · PMID 42095646 · Publisher ↗
BACKGROUND: Periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) and its management with two-stage exchange arthroplasty can lead to notable femoral and tibial bone loss, further complicating subseque...
BACKGROUND: Periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) and its management with two-stage exchange arthroplasty can lead to notable femoral and tibial bone loss, further complicating subsequent reconstruction. This study aims to characterize the extent of bone loss in two-stage TKA revision for infection and assess the effect of reimplantation timing on bone loss progression. METHODS: We conducted a retrospective cohort study of patients who underwent a two-stage TKA revision for PJI between 2007 and 2022. The primary outcome was the degree of bone loss between the index and reimplantation procedures, and whether it was influenced by the rate of timing of reimplantation. Patients undergoing single-stage revisions were excluded. A total of 160 patients met the inclusion criteria. Bone loss was characterized using the Anderson Orthopaedic Research Institute (AORI) classification (1/2A/2B/3) before the index procedure and after reimplantation, with progression defined as an increase in AORI classification. RESULTS: Among the 160 patients, 100 (62.5%) experienced bone loss progression. This included 19 patients (11.9%) with a progression score of 1, 75 patients (46.9%) with a progression score of 2, and six patients (3.75%) with a progression score of 3. A higher AORI score at the index procedure showed a statistically significant association with bone loss progression (P < 0.001). Time to reimplantation was statistically significant (P = 0.034), with patients progressing from AORI 1 to AORI 3 experiencing the longest reimplantation interval (mean: 147 days). No notable differences were observed in revision surgery rates, time to revision surgery, infection eradication rates, or baseline medical comorbidities across progression groups. CONCLUSION: This study demonstrates that two-stage revision TKA for PJI is associated with a notable degree of bone loss, particularly in cases of delayed reimplantation. These findings emphasize the importance of timely reimplantation, or other strategies, to mitigate bone loss and surgical complexity.
Who Gets Five Stars? Surgeon-Level Predictors of Patient Ratings in Hand Surgery.
Chopra KN, Khawaja SR, Desai KR … +7 more , Khawaja OR, Udoudo SE, Gillis JW, Ghareeb PA, Gottschalk MB, Dempsey AL, Wagner ER
J Am Acad Orthop Surg · 2026 May · PMID 42089628 · Publisher ↗
INTRODUCTION: Online physician ratings are a model for patient satisfaction and play a key role in patient recruitment. This study examines the influence of different variables on hand surgeons' average ratings and patie...
INTRODUCTION: Online physician ratings are a model for patient satisfaction and play a key role in patient recruitment. This study examines the influence of different variables on hand surgeons' average ratings and patient engagement on physician review websites (PRWs). METHODS: The American Society for Surgery of the Hand directory was queried for all actively practicing orthopaedic or plastic-trained hand surgeons in the United States. Individuals were randomly selected and searched on various social media platforms for professional accounts. A summated online presence score was calculated to identify the top 20% of social media users. The use of a practice group or personal website was also recorded, as was a surgeon's practice setting and region of practice. H-index was searched on Scopus. Patient rating information was collected from Healthgrades, Google, and Vitals. Physicians' medical school and residency programs were noted for being a top 20 program based on US News and Doximity rankings. RESULTS: A total of 97 orthopaedic and 102 plastic-trained surgeons were reviewed. Private practice orthopaedic surgeons had higher mean ratings on Healthgrades than those in academic practice. The top 20% of social media users had markedly higher mean patient satisfaction ratings. H-index was positively associated with patient ratings and social media usage. Male surgeons had higher ratings and engagement than female surgeons. Younger hand surgeons had greater ratings and engagement compared with surgeons who have been in practice longer. Medical school or residency program prestige did not markedly affect patient satisfaction ratings. DISCUSSION: Social media utilization and research productivity can influence patient satisfaction, measured by ratings and comments on PRWs. Given that most patients read PRWs before making an appointment, hand surgeons can use these data to optimize their online presence and overall ratings. LEVEL OF EVIDENCE: IV.
Assessment of Inappropriate Questions Asked by Program Directors and Faculty During Orthopaedic Residency Interviews.
Jones E, Everett E, Morin S … +7 more , Saraf SM, Rumps MV, Ponce B, Ames SE, McKown L, Templeton K, Mulcahey MK
J Am Acad Orthop Surg · 2026 May · PMID 42065611 · Publisher ↗
INTRODUCTION: Notable strides have been made in reducing inappropriate questions during residency interviews. However, this trend has not reached orthopaedic surgery. The purpose of this study was to evaluate the level o...
INTRODUCTION: Notable strides have been made in reducing inappropriate questions during residency interviews. However, this trend has not reached orthopaedic surgery. The purpose of this study was to evaluate the level of knowledge of orthopaedic surgery residency program directors and faculty about the appropriateness of residency interview questions. METHODS: An anonymous 18-question survey was distributed to program directors and other faculty involved in orthopaedic surgery residency interviews. Data analysis was completed using Statistical Package for the Social Sciences. RESULTS: A total of 86 respondents (66 men, 17 women, 3 N/A) were included. Most respondents (34, 36.8%) had 0 to 5 years of experience. Questions on applicant health and disability were most likely to be incorrectly identified. CONCLUSION: The results of this study revealed gaps in knowledge about appropriateness of interview questions. Frequent training for conducting interviews could help standardize the interview process and eliminate inappropriate questions.
Anterior Versus Posterior Lumbar Fusion for Adult Isthmic Spondylolisthesis.
Frei A, Shahzad H, Callaway J … +7 more , Bhale R, Higginbotham D, Vander Voort W, Roberto R, Khan S, Javidan Y, Le H
J Am Acad Orthop Surg · 2026 May · PMID 42065610 · Publisher ↗
INTRODUCTION: Surgical management for isthmic spondylolisthesis (IS) can be accomplished with either an anterior, posterior, or combined approach. This study compares 90-day medical and surgical complications of anterior...
INTRODUCTION: Surgical management for isthmic spondylolisthesis (IS) can be accomplished with either an anterior, posterior, or combined approach. This study compares 90-day medical and surgical complications of anterior, posterior, and combined lumbar fusion for adults with single-level IS. METHODS: Deidentified patient data were obtained through the PearlDiver database using relevant ICD and current procedural terminology codes from 2015 to 2022. Patients ≥18 years with single-level IS who had undergone either anterior lumbar fusion (ALIF), posterior lumbar fusion (PLF), or combined AP lumbar fusion (CLF) were evaluated. Patients undergoing more than one level lumbar fusion were excluded, and 90-day postoperative complications were compared across cohorts. RESULTS: Of 43,619 patients who underwent surgery for IS, 4,622 (10.6%) had ALF, 35,550 (81.5%) PLF, and 3,447 (7.90%) CLF. At 90 days postoperatively, multivariate analysis controlling for demographics, tobacco use, and obesity reveals that odds of readmission were significantly lower in patients who underwent PLF (odds ratio [OR] 0.81, P < 0.01) compared with ALF. A markedly higher odds of revision surgery was observed in patients undergoing PLF (OR 2.65) or CLF (OR 2.40) compared with ALF. Both PLF (OR 0.35) and CLF (OR 0.62) cohorts had lower odds of developing postoperative ileus. No significant difference was noted in rate of postoperative hematoma, pneumonia, sepsis, cauda equina syndrome, or deep vein thrombosis at 90 days between PLF or CLF cohorts compared with ALF (P value >0.05). CONCLUSION: Among adult patients with IS undergoing single-level lumbar fusion, 81.5% had posterior surgery while 7.9% had combined AP surgery. Compared with the anterior approach, patients undergoing the posterior approach had lower 90-day readmission rates and postoperative ileus rates. However, patients undergoing posterior or combined surgery had higher odds of requiring revision surgery within 90 days. These differences in complication profile may help surgeons in surgical decision making on which approach to consider in their patients with IS.
Insurance Denials: A Comprehensive Review and Navigating the Peer Review Process.
Berger RJ, Gaudiani MA, Fortin PT … +1 more , Taliaferro K
J Am Acad Orthop Surg · 2026 May · PMID 42065609 · Publisher ↗
Insurance companies and third-party reviewers use the peer review process including prior authorization (PA) and the peer-to-peer (P2P) process to manage healthcare costs and ensure appropriate care, citing principles of...
Insurance companies and third-party reviewers use the peer review process including prior authorization (PA) and the peer-to-peer (P2P) process to manage healthcare costs and ensure appropriate care, citing principles of value-based care. As the volume of initial denials increases, physicians face notable time burdens and increased administrative costs while patients can incur delays and possibly worse health outcomes. We aim to explore the legal and ethical framework of utilization management; examine the effect on treating physicians, patients, and reviewers; offer suggestions for navigating peer-to-peer reviews; and propose future directions and improvement opportunities.
Effect of Tendon Gap Distance on Clinical Outcomes Following Nonsurgical Management of Acute Achilles Tendon Rupture: A Systematic Review and Meta-Analysis.
Odunukwe C, Ward PM, Lee W
J Am Acad Orthop Surg · 2026 Apr · PMID 42053088 · Publisher ↗
BACKGROUND: The prognostic value of initial tendon gap distance following acute Achilles tendon rupture (ATR) remains unclear. The present systematic review and meta-analysis aimed to investigate the effect of tendon gap...
BACKGROUND: The prognostic value of initial tendon gap distance following acute Achilles tendon rupture (ATR) remains unclear. The present systematic review and meta-analysis aimed to investigate the effect of tendon gap distance on clinical outcomes following nonsurgical management of acute ATR. METHODS: Our review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and used PubMed, EMBASE, and Cochrane Library databases for studies investigating the influence of tendon gap distance on functional outcomes following nonsurgical management of acute ATR. Data investigated included patient demographics, functional scores, including the Achilles Tendon Rupture Score (ATRS), gap size, and rupture location. The association between tendon gap distance and functional outcomes was investigated. Additional analyses examined secondary associations among age, sex, and rupture location and functional outcomes. RESULTS: A total of eight studies comprising 288 patients with acute ATRs were included in our review. Of these, four studies met criteria for quantitative synthesis and were included in the meta-analysis. With a cutoff of 10-mm gap distance, the pooled analysis demonstrated a markedly lower ATRS in patients with a larger gap size (>10 mm versus ≤10 mm; Cohen d = -0.39; 95% CI = -0.76 to -0.02; P = 0.04). Secondary analyses revealed lower ATRS in patients older than 50 years (d = -0.70; P < 0.001) and female patients (d = -0.58; P = 0.01), whereas rupture location had no notable effect (P = 0.85). CONCLUSION: Our review demonstrated that a larger initial tendon gap is associated with lower functional outcomes following nonsurgical management of acute ATR, particularly with a cutoff of 10 mm. Furthermore, factors such as age and sex may also influence clinical outcomes. However, the result should be interpreted with caution due to heterogeneity across studies. LEVEL OF EVIDENCE: Level 3, systematic review and meta-analysis.
Lateral UKA Is Associated With Mixed 90-Day and 5-Year Outcomes Relative to Medial UKA and TKA.
Slevin JP, Seddio AE, Ajjawi IB … +4 more , Padela MT, Kaplan MJ, Grauer JN, Rubin LE
J Am Acad Orthop Surg · 2026 Apr · PMID 42053079 · Publisher ↗
BACKGROUND: Unicompartmental knee arthroplasty (UKA) is an option for unicompartmental osteoarthritis. With medial or multicompartment joint wear being the most common clinical scenarios, lateral UKA (L-UKA) is less comm...
BACKGROUND: Unicompartmental knee arthroplasty (UKA) is an option for unicompartmental osteoarthritis. With medial or multicompartment joint wear being the most common clinical scenarios, lateral UKA (L-UKA) is less commonly considered than other knee joint arthroplasty procedures. As such, the postoperative outcomes of L-UKA relative to medial UKA (M-UKA) and total knee arthroplasty (TKA) remain poorly characterized at a national level in the United States. METHODS: Patients undergoing L-UKA were identified from the PearlDiver M170Ortho Database and separately matched 1:4 with M-UKA and TKA patients by age, sex, and Elixhauser Comorbidity Index. Multivariable logistic regression compared 90-day adverse events, emergency department visits, readmissions, and 5-year implant-related issues. RESULTS: First, 343 L-UKAs were assessed relative to 1,295 M-UKAs. L-UKA demonstrated higher odds of 90-day severe adverse events (odds ratio [OR], 1.83; P = 0.037), infection (OR, 1.41; P = 0.022), wound dehiscence (OR, 3.60; P = 0.008), readmission (OR, 1.67; P = 0.047), and 5-year prosthetic joint infection (OR, 2.57; P = 0.001). Second, 425 L-UKAs were assessed relative to 1,700 TKAs. L-UKA demonstrated higher odds of 90-day wound dehiscence (OR, 2.13; P = 0.025), 5-year prosthetic joint infection (OR, 1.64; P = 0.028), and revision (OR, 2.00; P = 0.007), but lower odds of 5-year stiffness (OR, 0.45; P < 0.001). DISCUSSION: In the first study of L-UKA using national-level US data, L-UKA demonstrated mixed outcomes compared with both M-UKA and TKA. While L-UKA demonstrated lower stiffness rates than TKA, the elevated risk of 90-day postoperative complications and inferior 5-year revision-free survival suggest the need for careful consideration of L-UKA and future prospective analysis to further elucidate whether these associations can be generalized across surgeons with differing case volumes.
Implementing Evidence-based Opioid Prescribing in Pediatric Orthopaedics.
Kogan M, Jan K, Hummel A
J Am Acad Orthop Surg · 2026 Jul · PMID 42048673 · Publisher ↗
Effective pain management is essential in pediatric orthopaedic procedures to ensure optimal patient outcomes and recovery. Although opioids are an important component of pain control, their misuse remains a notable publ...
Effective pain management is essential in pediatric orthopaedic procedures to ensure optimal patient outcomes and recovery. Although opioids are an important component of pain control, their misuse remains a notable public health concern. Pediatric patients often encounter opioids for the first time after orthopaedic procedures, underscoring the need for stringent prescribing protocols. The Pediatric Orthopaedic Society of North America guidelines provide a comprehensive framework for tailoring pain management to procedure intensity. Despite their potential, implementation challenges and variability persist. This review examines the Pediatric Orthopaedic Society of North America guidelines, barriers to adoption, and opportunities to optimize postoperative pain management while mitigating risks. Future research and guideline evolution are necessary to uphold patient safety and combat the opioid crisis.
Evaluating the Effects of Perioperative Ketorolac Use on Outcomes After Surgical Treatment of Open Reduction and Internal Fixation of Ankle Fractures.
Tummala S, Chavda H, Sontam TR … +3 more , Wood B, Mittal MM, Wukich DK
J Am Acad Orthop Surg · 2026 Apr · PMID 42017927 · Publisher ↗
BACKGROUND: Ketorolac is commonly used as part of multimodal analgesia after orthopaedic surgery; however, concerns persist regarding its potential effects on postoperative wound healing and fracture union. While previou...
BACKGROUND: Ketorolac is commonly used as part of multimodal analgesia after orthopaedic surgery; however, concerns persist regarding its potential effects on postoperative wound healing and fracture union. While previous studies have evaluated ketorolac use in arthroplasty and long bone fractures, data specific to ankle open reduction and internal fixation (ORIF) remain limited. This study evaluated the association between perioperative ketorolac use and short-term postoperative complications and longer term healing outcomes after ankle ORIF. METHODS: This retrospective cohort study obtained data from a healthcare database platform from January 1, 2015, to January 1, 2025. Adult patients (≥18 years) who underwent ankle ORIF were identified using standardized Current Procedural Terminology (CPT) codes. Patients were stratified based on perioperative ketorolac exposure on the day of surgery and compared with a control cohort without ketorolac exposure within a defined perioperative washout window. Cohorts were balanced using 1:1 propensity score matching. Outcomes were assessed at 90 days and 2 years postoperatively. RESULTS: After propensity score matching, 29,920 patients remained in each cohort. At 90 days, perioperative ketorolac use was associated with higher rates of deep and superficial surgical site infection, wound dehiscence, and implant-related infection. Ketorolac use was also associated with lower transfusion rates, although transfusion was rare in both cohorts, and a modestly lower rate of opioid prescribing, although this reflects prescription documentation rather than analgesic efficacy. No significant differences were observed in pulmonary embolism, acute renal failure, or inpatient readmissions. At 2 years, there were no significant differences between cohorts in rates of nonunion, malunion, revision surgery, or below-knee amputation. CONCLUSIONS: In this retrospective database analysis, perioperative ketorolac use after ankle ORIF was associated with increased early wound-related and infection-related complications but not with adverse long-term fracture healing or limb outcomes. These findings suggest a nuanced risk-benefit profile for ketorolac in ankle fracture fixation and underscore the importance of individualized perioperative analgesic decision making, particularly for patients at higher risk of soft-tissue complications. LEVEL OF EVIDENCE: Level 3, systematic review and meta-analysis.
Does Specialty Matter? A Comparison of Early Postoperative Clinical Outcomes Following Lower Extremity Amputation Between Orthopaedic and Vascular Surgeons.
Reddy S, Subramanian T, Lee W
J Am Acad Orthop Surg · 2026 Apr · PMID 42017920 · Publisher ↗
BACKGROUND: Lower extremity amputation (LEA) is performed by diverse specialties, including orthopaedic surgery and vascular surgery; whether outcomes differ by specialty remains uncertain. This study compared early post...
BACKGROUND: Lower extremity amputation (LEA) is performed by diverse specialties, including orthopaedic surgery and vascular surgery; whether outcomes differ by specialty remains uncertain. This study compared early postoperative outcomes after LEA performed by orthopaedic and vascular surgeons. METHODS: Patients who underwent LEA surgeries were identified within the National Surgical Quality Improvement Program database. National Surgical Quality Improvement Program was queried for above-knee amputation, below-knee amputation, and foot amputations performed by orthopaedic or vascular surgeons. Patients were matched in a 1:1 ratio using propensity scores using a mixed exact/caliper approach. Primary outcomes were 30-day mortality, readmission, and revision surgery; secondary outcomes included cardiac, pulmonary, wound-related issues, and discharge disposition. RESULTS: A total of 26,925 LEA cases were identified. After propensity matching, 3,580 cases remained: orthopaedic surgery 1790 versus vascular surgery 1790, including 3,180 matched below-knee amputation, 806 matched above-knee amputation, and 334 matched foot amputations. Final cohorts had a similar distribution of demographic variables, indicating appropriate matching. Mortality of 4.0% versus 4.0%, readmission of 10.7% versus 11.7%, and revision surgery of 7.6 versus 8.3% were equivalent between orthopaedics and vascular surgery, respectively. The vascular cohort demonstrated higher rates of any postoperative complication: the sum of secondary outcomes (77.9% vs 70.4%; P < 0.001), driven primarily by increased non-home discharge (69.7% vs 60.8%) and transfusion within 72 hours (19.5% vs 16.3%). When non-home discharge was removed, there was no difference in early postoperative complication (32.2% vs 35.5%; P = 0.382). By contrast, the orthopaedic group had slightly higher rates of organ/space infection (4.1% vs 2.2%; P = 0.001) and postoperative pneumonia (3.8% vs 2.5%; P = 0.029), consistent with the higher proportion of contaminated/dirty wounds: 44.4% versus 36.0% and longer surgical duration: 79.5 ± 43.5 versus 68.3 ± 46.1 observed in this group. CONCLUSIONS: The present analysis represents the first matched comparison of LEA outcomes by surgical specialty. When baseline patient risk is balanced, orthopaedic and vascular surgeons achieve comparable 30-day major outcomes: mortality, readmission, and revision surgery following LEA. Residual differences in complication profiles appear driven by clinical context, such as wound class, transfusion exposure, and rehabilitation needs, rather than by specialty itself. LEVEL OF EVIDENCE: Level III.
Factors Associated With Readmission to the Hospital Within 90-Days Following Elective Lumbar Fusion Surgery.
Lu S, Vander Voort W, Saade A … +6 more , Shahzad H, Zhao A, Javidan Y, Klineberg E, Khan S, Le H
J Am Acad Orthop Surg · 2026 Apr · PMID 42017918 · Publisher ↗
STUDY DESIGN: A retrospective cohort study. OBJECTIVE: To evaluate the impact of discharge disposition on the rates of return to the emergency department (ED) and readmission following elective lumbar fusion surgery (ELF...
STUDY DESIGN: A retrospective cohort study. OBJECTIVE: To evaluate the impact of discharge disposition on the rates of return to the emergency department (ED) and readmission following elective lumbar fusion surgery (ELFS). METHODS: This study retrospectively reviewed patients aged ≥18 years old who underwent ELFS for degenerative pathology at a single academic institution between 2018 and 2022. A review of medical records was conducted to collect data on patient and surgical characteristics. Patients were categorized into two groups: Home Health and Skilled Nursing Facility (SNF) and Inpatient Rehabilitation Facility (IRF). ED visits and readmissions within 3 months postoperatively were recorded. Univariate and multivariate regression models were used to identify independent factors associated with ED presentation or readmission. RESULTS: A total of 495 patients were included. Of the patients, 414 were discharged home, and 81 were discharged to a SNF/IRF. In the univariate analysis, discharge to a SNF or IRF was associated with 3.81 times higher odds of readmission (P < 0.01) and 1.51 times higher odds of ED visits (P = 0.15) compared with discharge to home. After adjusting for confounders in the multivariate analysis, the odds ratios for readmission and ED visits were 2.24 (P = 0.012) and 1.03 (P = 0.927), respectively. CONCLUSION: Patients discharged to a SNF or IRF after ELFS had markedly higher odds of readmission within 3 months postoperatively, even after adjusting for patient and surgical factors. However, this association was not observed for ED visits. These findings underscore the need for careful consideration of discharge planning to optimize postoperative outcomes and reduce healthcare utilization following ELFS.
Global Patterns of Bone Health Screening and Treatment in Spine Surgery: An AO Spine Survey.
Shen Y, Malka MS, Hassan FM … +8 more , Coury JR, Shi T, Ortega DA, Lombardi JM, Lenke LG, Wetzel FT, Reyes JL, Sardar ZM
J Am Acad Orthop Surg · 2026 Apr · PMID 42017917 · Publisher ↗
INTRODUCTION: Bone health is critical to spine surgery. Studies have demonstrated the role and benefit of optimizing bone health before spinal surgery. However, bone health screening and treatment patterns vary considera...
INTRODUCTION: Bone health is critical to spine surgery. Studies have demonstrated the role and benefit of optimizing bone health before spinal surgery. However, bone health screening and treatment patterns vary considerably among spine surgeons. The purpose of this study was to assess the global screening, prevention, and treatment of osteoporosis and bone health in spine surgery. METHODS: A 34-item questionnaire was created and distributed anonymously, globally to AO Spine subscribers. The word responses were analyzed manually and categorized. Each participant was assigned a region: Asia, Africa, Central America, Europe, North America, or South America. Quantitative outcomes include the frequency and proportion of respondents who selected each answer. Qualitative outcomes include written responses to select prompts. Chi-squared tests was performed to compare proportions based on categories. RESULTS: The response rate was 3.4%; 36.2% of respondents were from Asia, 28.7% Europe, 12.8% South America, 9.8% North America, 9.6% Africa, and 2.9% Central America. 69.8% finished residency in orthopaedic surgery, 24.5% in neurosurgery, and 5.7% in others; 58.6% completed a spine fellowship. Before instrumented fusion, 61.1% routinely checked dual-energy radiograph absorptiometry (DXA). If osteoporosis is detected on DXA before an instrumented fusion, 65.1% would alter their treatment plan; 64.7% refer the patient to treatment first. The rate of DXA screening before instrumented fusion differed based on the region (P < 0.001): the highest was in North America at 89.5%, and the lowest was in Africa at 36.6%. Before instrumented fusion, fellowship-trained surgeons screened DXA more routinely than those without a fellowship, at 67.9% and 52.5%, respectively (P = 0.002). CONCLUSIONS: Globally, bone health screening before spine surgery has increased. However, large regional variations in practice patterns exist regarding the screening of bone health pre- and perioperatively.
Identifying Risk Factors of Venous Thromboembolism in Adolescents With Lower Extremity Fractures Treated Surgically.
Mittal MM, Acevedo KV, Boukind A … +3 more , Tummala S, Pereira DE, Hosseinzadeh P
J Am Acad Orthop Surg · 2026 Jul · PMID 42017911 · Publisher ↗
BACKGROUND: Venous thromboembolism (VTE) is uncommon in adolescents but remains a serious postoperative complication in orthopaedic surgery. Current prophylaxis practices are largely based on adult data. This study evalu...
BACKGROUND: Venous thromboembolism (VTE) is uncommon in adolescents but remains a serious postoperative complication in orthopaedic surgery. Current prophylaxis practices are largely based on adult data. This study evaluated independent risk factors of postoperative VTE in adolescents undergoing lower extremity (LE) fracture surgery using a large multicenter data set. METHODS: A retrospective case-control study using the TriNetX Research Network identified adolescents aged 13 to 20 years who underwent LE fracture surgery from 2003 to 2025. Patients were grouped by the presence or absence of VTE within 90 days. Demographics and comorbidities were analyzed with univariate and multivariate logistic regression. RESULTS: Of 86,134 patients, 627 (0.73%) developed VTE. Overweight/obesity, diabetes, and tobacco use were significant on univariate analysis, but only overweight/obesity remained independently associated with VTE (adjusted OR 1.8). CONCLUSION: Obesity was the only independent predictor of postoperative VTE. These findings highlight the need to incorporate BMI into preoperative risk assessment and develop adolescent-specific prophylaxis guidelines. LEVEL OF EVIDENCE: Therapeutic Level III.
Demographic and Radiographic Predictors of Subsequent Fusion Within 2 Years of Isolated Posterior Lumbar Decompression.
Ezeonu T, Dalton J, Fano A … +12 more , Lee Y, Narayanan R, Ng M, Singh A, Christianson A, Goodman P, Pena J, Canseco JA, Hilibrand AS, Vaccaro AR, Schroeder GD, Kepler CK
J Am Acad Orthop Surg · 2026 Apr · PMID 42017905 · Publisher ↗
INTRODUCTION: Isolated posterior lumbar decompression (PLD) is commonly performed for degenerative indications. However, the various factors that predict revision surgery for subsequent fusion remain poorly understood. T...
INTRODUCTION: Isolated posterior lumbar decompression (PLD) is commonly performed for degenerative indications. However, the various factors that predict revision surgery for subsequent fusion remain poorly understood. To this end, the purpose of the current study was to investigate demographic and lumbar imaging findings at the time of PLD that are associated with subsequent fusion. METHODS: Adult patients who underwent isolated 1-2-level PLD between L3-S1 (2014 to 2020) were retrospectively identified. Subsequent fusion within 2 years was determined. Preoperative lumbar magnetic resonance imaging (MRI) was reviewed for (1) sagittally aligned facet (SAF) joints, (2) facet tropism, (3) facet degeneration, (4) disk height, and (5) Pfirrmann grade. Radiology reports were used to categorize the foraminal stenosis severity. Associations between MRI findings before PLD and the need for revision surgery for fusion were investigated using multivariable logistic regression. RESULTS: Among the 202 PLD patients, 21.3% underwent fusion within 2 years. Patients requiring fusion had a higher Charlson comorbidity index (2.07 ± 2.19 versus 1.30 ± 1.73, P = 0.023). No differences were observed in facet tropism, SAF joints, disk height, or stenosis severity between the subsequent fusion and no fusion groups. Patients who did not undergo fusion had higher average facet degeneration scores (1.90 ± 0.76 versus 1.64 ± 0.71, P = 0.030) and a greater proportion of Pfirrmann grade 5 disks (37.8% versus 18.6%, P = 0.013). Multivariable regression identified CCI as the only independent predictor of subsequent fusion (odds ratio: 1.32, cI, 1.03 to 1.72, P = 0.034). CONCLUSION: This study found that higher CCI at the time of PLD is an independent predictor of requiring fusion within 2 years. Increased lumbar degeneration alone was not associated with a greater risk of fusion. Decreased remaining motion, lower functional demands, or a greater propensity for autofusion may have lowered the need for subsequent fusion among these PLD patients with greater degeneration. Further research is needed to support these results.
A Propensity-Matched Analysis of the Impact of Sternal Fractures on Outcomes in Concurrent Thoracic Spine Fractures: The Fourth Column of the Spine.
Carroll AH, Quinonez A, Perez-Albela A … +8 more , Bellaire CP, Griffin D, Benn L, Ruijie Y, Yoon K, Japa JP, Ehioghae M, Mesfin A
J Am Acad Orthop Surg · 2026 Apr · PMID 42012372 · Publisher ↗
BACKGROUND: The thoracic vertebrae, ribs, and sternum, provide structural and protective support for the upper body. The unique framework of the region suggests that fractures involving both the thoracic spine and sternu...
BACKGROUND: The thoracic vertebrae, ribs, and sternum, provide structural and protective support for the upper body. The unique framework of the region suggests that fractures involving both the thoracic spine and sternum occur with notable spinal instability. Despite their clinical relevance, the short-term medical and surgical outcomes of combined sternal and thoracic spinal fractures remain poorly understood compared with thoracic fractures alone. This study aims to compare the 90-day complication rates and surgical intervention requirements in patients with concomitant sternal and thoracic vertebral fractures with those with isolated thoracic vertebral fractures. METHODS: Patients presenting with acute sternal and thoracic spine fractures in the same admission were identified using the PearlDiver database. Patients with sternal and vertebral fractures were propensity matched in a 1:1 ratio with a control group by age and Elixhauser comorbidity index. Medical complications, rate of spinal cord injury, and rates of surgical intervention were assessed at 90 days. RESULTS: A total of 9,026 patients were identified in this study with 4,513 patients presenting with sternal and thoracic spine fractures and 4,513 patients in the control group. Sternal and vertebral fracture coinjury was associated with higher rates of spinal cord injury (P < 0.0001), higher rates for spinal decompression/fusion (odds ratio = 4.38, P < 0.0001), and higher rates of thoracic surgery (odds ratio = 3.0, P < 0.0001). These patients were also statistically markedly more likely to develop hemodynamic, respiratory, cardiac, and renal complications (P < 0.001) at 90 days. DISCUSSION: Patients with thoracic spine fractures who sustain simultaneous sternal fractures are markedly more likely to have concomitant spinal cord injury, require spinal stabilization or decompression, and develop medical complications. Our findings point toward the role of the sternum as a fourth column of stability in cases of thoracic spinal fractures, which mitigate complications, surgery, and neurologic injury in cases of trauma.
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