The Journal Of The American Academy Of Orthopaedic Surgeons[JOURNAL]
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200 papers
Further Displacement After Initial Nonsurgical Treatment of Minimally Displaced Olecranon Fractures in Children.
Siddabattula R, Habib F, Pereira DE … +4 more , Wall LB, Goldfarb CA, Najera Saltos D, Hosseinzadeh P
J Am Acad Orthop Surg · 2026 Apr · PMID 41505728 · Publisher ↗
INTRODUCTION: Pediatric olecranon fractures are uncommon periarticular injuries with unclear treatment guidelines for varying magnitudes of intra-articular displacement. Similar to other pediatric elbow fractures, minima...
INTRODUCTION: Pediatric olecranon fractures are uncommon periarticular injuries with unclear treatment guidelines for varying magnitudes of intra-articular displacement. Similar to other pediatric elbow fractures, minimally displaced fractures are treated nonsurgically, and potential for further displacement following nonsurgical treatment exists. This study assesses the incidence and risk factors for further displacement after nonsurgical treatment of minimally displaced pediatric olecranon fractures. METHODS: A retrospective review was conducted on patients aged 0 to 15 years with isolated olecranon fractures treated nonsurgically at a single institution. Radiographic measurements of intra-articular and nonarticular displacement on lateral views were collected with follow-up imaging done until confirmed radiographic union. Patients with more than 1-mm change in displacement on the articular side during treatment were identified. Fractures were classified at specified locations, including zone 1 (proximal 1/3), zone 2 (middle 1/3), and zone 3 (distal 1/3). RESULTS: A total of 64 patients met inclusion criteria, 42 (65.6%) were males, and the average age at injury was 8.25 years. Casting without closed reduction was the definitive treatment method in 59 patients (92.2%). Of the fractures observed, 30 (46.9%) occurred in zone 1, followed by 23 patients (35.9%) in zone 2 and 11 patients (17.2%) in zone 3. Interval displacement was seen in 14 patients at follow-up visits (21.9%) with greater body mass index observed in the redisplacement group ( P = 0.053). Change in management was required in two patients (3.1%). Displacement of ≥1 mm at initial evaluation did not affect the rate of subsequent displacement at follow-up visit ( P = 0.571). Neither fracture zone nor fracture configuration were statistically significant for change in fracture displacement. CONCLUSION: Further displacement was observed in 20% of minimally displaced olecranon fractures regardless of the zone and magnitude of initial displacement with a small percentage leading to a change in the management. Close radiographic follow-up for nonsurgically treated olecranon fractures is recommended.
Postoperative Weight-bearing Status Is Not Associated With Patient Mortality After Geriatric Distal Femur Fracture.
Haller JM, Lee C, Brodke D … +13 more , Perdue P, DeKeyser G, Working Z, Zhang C, El Naga A, Shymon S, Fairres M, Walters M, Gillon H, Morellato J, Atassi O, O'Toole R, Marchand L
J Am Acad Orthop Surg · 2026 Jan · PMID 41505718 · Publisher ↗
BACKGROUND: To investigate the effect of immediate weight-bearing (WB) status on mortality in geriatric distal femur patients. Secondary aims included determining the effect of WB status on surgical complications and amb...
BACKGROUND: To investigate the effect of immediate weight-bearing (WB) status on mortality in geriatric distal femur patients. Secondary aims included determining the effect of WB status on surgical complications and ambulatory ability at 90 days. METHODS: This was a retrospective review of geriatric (age >60 years) patients with distal femur fracture (OTA/AO 33 A, 33C) from 9 level 1 trauma centers that underwent surgical fixation from 2012 to 2019. Mortality, ambulatory ability at 90 days, and surgical complications were compared between postoperative non-WB (NWB) versus WB (touch-down/partial/WB as tolerated) groups. A propensity-weighted regression model including demographics, tobacco-use, preinjury ambulatory status, injury mechanism, and American Society of Anesthesiologists classification was used to compare outcomes between the NWB and WB cohorts. RESULTS: Four hundred four patients were included where most of the patients (72%) underwent open reduction, internal fixation and most of the patients were NWB after surgery (63%). Most of the patients (328/404, 81%) were discharged to a nursing facility. Older patients, patients with ground-level fall, and American Society of Anesthesiologists I/II patients were more likely to be WB. Six-month mortality was 14%. Sixty-nine percentage of patients were able to ambulate without human assistance by 90 days. In the propensity-weighted analysis, there was no association with WB and mortality (hazard ratio [HR], 1.50; confidence interval [CI, 0.77, 2.92]; P = 0.24). No association was observed between WB and deep infections (HR, 2.86; [CI, 0.82, 9.93]; P = 0.10) or nonunion surgery (HR, 1.7; [CI, 0.71, 4.09]; P = 0.23). Finally, there was no association with WB and in ambulatory ability within 90 days (odds ratio [OR], 1.48; [CI, 0.65, 3.35]; P = 0.35). HRs/ORs >1 indicate higher risk/odds for the WB group. CONCLUSIONS: Based on this study, there was no association with prescribed postoperative WB and patient mortality, reoperations, or ambulatory ability within 90 days of surgery. LEVEL OF EVIDENCE: III PROGNOSTIC.
Epidemiological Trends and Projections of Adolescent Idiopathic Scoliosis Patients Among 118 Thousand Patients.
Sanghvi PA, Burkhart RJ, Abid R … +5 more , Berk AN, Adelstein JM, Moyal AJ, Glotzbecker MP, Mistovich RJ
J Am Acad Orthop Surg · 2026 Jan · PMID 41505716 · Publisher ↗
INTRODUCTION: Suspected changes in adolescent idiopathic scoliosis (AIS) demographic distribution compared with historical cohorts emphasize the need for an updated understanding of epidemiological trends. We aimed to ch...
INTRODUCTION: Suspected changes in adolescent idiopathic scoliosis (AIS) demographic distribution compared with historical cohorts emphasize the need for an updated understanding of epidemiological trends. We aimed to characterize AIS trends in the United States from 2016 to 2023, compare these findings with historical cohorts, and project trends through 2030. METHODS: AIS cases from 2016 to 2023 were identified using the TriNetX US Collaborative platform. A subanalysis examined patients who underwent posterior spinal fusion (PSF) and cases during the COVID-19 pandemic. Primary outcomes included prevalence, incidence proportion (IP), and incidence rate (IR). Historical AIS cohorts were identified through a systematic search. Regression modeling projected trends to 2030. RESULTS: In 2023, the TriNetX platform reported a notable rise in AIS prevalence of 110 cases per 100,000 patients compared with 2016 (P < 0.05). The IP and IR of AIS also rose, with 14,733 additional cases identified in 2023. PSF occurred in 5,990 cases per 100,000 AIS patients. Female patients had higher AIS prevalence than male patients (140 vs. 71.3 cases per 100,000) and higher PSF prevalence (6,400 vs. 5,350 cases per 100,000 AIS patients) in 2023. Incidence of AIS was markedly lower compared with historical cohorts; however, the female-to-male ratio was comparable. The most marked decrease (16.52% decrease from 2019 to 2020) and increase (22.15% increase from 2020 to 2021) in cases occurred during the COVID-19 pandemic. Regression analysis indicated linear increases in both AIS and PSF, projecting a national AIS prevalence of 17,000 cases per 100,000 patients nationally and PSF prevalence among AIS patients of 10,230 cases per 100,000 patients by 2030. CONCLUSION: These findings highlight rising national rates of AIS diagnoses and PSF procedures among AIS patients. Further research is warranted on the etiology underlying increased incidence of AIS in male patients and potential healthcare burdens associated with projected increases in AIS prevalence.
Factors That Influence Orthopaedic Surgeons to Change Practices: A Survey of American Academy of Orthopaedic Surgeons Members.
Razzak E, Huttner J, Christiansen MJ … +1 more , Mulcahey MK
J Am Acad Orthop Surg · 2026 Jun · PMID 41505636 · Publisher ↗
INTRODUCTION: An estimated 50% of orthopaedic surgeons change practices early in their careers, with recent data showing that approximately 6% make a transition within just two years. Currently, the factors that lead to...
INTRODUCTION: An estimated 50% of orthopaedic surgeons change practices early in their careers, with recent data showing that approximately 6% make a transition within just two years. Currently, the factors that lead to orthopaedic surgeons changing jobs are not well understood. The purpose of this preliminary study was to analyze the self-reported factors that influence an orthopaedic surgeon's decision to change practices. METHODS: Upon obtaining institutional review board exemption status, a 25-question unvalidated survey was created using Microsoft Forms. A total of 100 orthopaedic surgeons who are members of the American Academy of Orthopaedic Surgeons were randomly selected to participate in this study. Consent was obtained through the survey, followed by questions related to demographics, including age, race, and sex, and region of practice. Respondents were asked to indicate the factors that played a role in their most recent change of practice. Descriptive statistical analysis was then conducted. RESULTS: In total, 27 participants completed our survey (response rate = 27%). Among them, 17 (63.0%) had changed practices at least once. The most frequently reported factors that influenced their decision to change practices included compensation (12, 70.6%), work flexibility (10, 58.8%), cost of living (5, 29.4%), and proximity to friends and family (4, 23.5%). Those who did not change practices (n = 10) were asked to convey the factors that contributed to their decision to remain at their current practice. Those factors included proximity to friends and family (6, 60%), work flexibility (5, 50%), and compensation (4, 40%). CONCLUSION: In this preliminary study, compensation and work flexibility were the most important factors that orthopaedic surgeons considered when deciding to change practices. Such information may provide trainees with greater insight into what they might need to consider when pursuing jobs. Hospitals and administrators may also choose to emphasize such factors, thereby encouraging greater surgeon recruitment and retention.
The Key and the Door: Universal Concepts of Reduction in Fracture Surgery.
Brodke D, DeKeyser G, Working Z … +1 more , Friess D
J Am Acad Orthop Surg · 2026 May · PMID 41505631 · Publisher ↗
Anatomic reduction is fundamental to successful osteosynthesis, yet it remains one of the most challenging surgical skills to teach and master. Although no framework can encompass the full complexity of fracture surgery,...
Anatomic reduction is fundamental to successful osteosynthesis, yet it remains one of the most challenging surgical skills to teach and master. Although no framework can encompass the full complexity of fracture surgery, this article distills some aspects of the "art" of reduction into foundational concepts to guide surgical strategy. We review these principles through intuitive metaphors: the "key" (distract, reorient, compress), the "door" (establish a hinge and close), and the "puzzle" (reduce the easiest piece first). These concepts are integrated with the biomechanical distinction between tension-sided failures, which are often amenable to direct reduction, and compression-sided failures, sometimes better suited for indirect reduction through ligamentotaxis. The practical application of this conceptual framework is demonstrated across a spectrum of common fractures, including those of the proximal and distal humerus, acetabulum, femoral neck, and tibial plateau. By providing a systematic toolkit, these principles aim to transform fracture reduction from an abstract challenge into a more logical, approachable problem for surgeons at all levels of training.
Patient Comorbidities Drive 90-Day Emergency Department Revisits and Readmissions After Trimalleolar Ankle Fracture Open Reduction and Internal Fixation: A National Database Analysis.
Said M, Cameron R, Mastrokostas PG … +6 more , Rodriguez AN, Debasitis A, Sheth B, Ng MK, Abdelgawad AA, Razi AE
J Am Acad Orthop Surg · 2026 Jan · PMID 41505622 · Publisher ↗
INTRODUCTION: Trimalleolar ankle fractures are associated with high complication rates and unplanned healthcare utilization. This study aimed to (1) characterize the demographic and clinical profile of patients requiring...
INTRODUCTION: Trimalleolar ankle fractures are associated with high complication rates and unplanned healthcare utilization. This study aimed to (1) characterize the demographic and clinical profile of patients requiring 90-day readmission; (2) identify risk factors for 90-day emergency department (ED) utilization; and (3) determine comorbidities most strongly linked to 90-day readmissions following trimalleolar open reduction and internal fixation (ORIF). METHODS: Using the PearlDiver Mariner database from 2010 to 2021, patients undergoing trimalleolar ankle fracture ORIF were identified through current procedural terminology codes 27822 and 27823. Ninety-day postoperative ED visits and hospital readmissions were evaluated. Patients with ED utilization (N = 636) were compared with controls without ED visits (N = 79,956). Logistic regression was used to identify demographic and comorbidity risk factors for both ED utilization and readmission, with statistical significance set at P < 0.05. RESULTS: ED utilization was higher among older patients (peak 70 to 74 years, P < 0.001). Comorbidities markedly associated with 90-day ED revisits included congestive heart failure (CHF) [odds ratio (OR) 1.55, P = 0.001], fluid and electrolyte disorders (OR 1.35, P = 0.001), pathologic weight loss (OR 1.34, P = 0.012), hypertension (OR 1.26, P = 0.043), and peripheral vascular disease (PVD) (OR 1.25, P = 0.038). Risk factors for 90-day readmission included fluid and electrolyte disorders (OR 1.98, P < 0.001), coagulopathy (OR 1.44, P < 0.001), CHF (OR 1.35, P < 0.001), PVD (OR 1.33, P < 0.001), and pathologic weight loss (OR 1.44, P < 0.001). CONCLUSION: Postoperative ED visits and readmissions following trimalleolar ORIF are driven largely by patient comorbidities. Older, medically complex patients represent a high-risk group, and targeted perioperative optimization may reduce complications and unplanned healthcare utilization.
A Scoping Review of the WRIST Trial and Its Subanalyses: Implications for Care of Elderly Distal Radius Fractures.
Faidley KN, London DA
J Am Acad Orthop Surg · 2026 Jan · PMID 41505620 · Publisher ↗
BACKGROUND: Distal radius fractures are common injuries in older adults. There is disagreement on the optimal treatment options for distal radius fractures in this patient population. The Wrist and Radius Injury Surgical...
BACKGROUND: Distal radius fractures are common injuries in older adults. There is disagreement on the optimal treatment options for distal radius fractures in this patient population. The Wrist and Radius Injury Surgical Trial (WRIST) was a randomized clinical trial comparing the most common treatment options for distal radius fractures in this population (casting, closed reduction and percutaneous pinning [CRPP], external fixation [EFP], and volar locking plate systems [VLPS]). The objective of this review is to summarize the findings across all articles stemming from the data collected in the WRIST study. METHODS: This was a scoping review that involved identification of and data collection from all articles published by the WRIST group, including the initial WRIST study and all secondary analyses of the data collected. RESULTS: No notable differences were found in functional outcomes between patients treated with casting vs. surgery (or between the three surgical options) at 12 months posttreatment. Patients treated with VLPS recovered faster and had improved outcomes at 6 weeks posttreatment. Complications were common and highest in the casting group, although malunion was not associated with inferior outcomes. Highly active patients recovered faster, especially when treated with VLPS. Casting was the most cost-effective option, followed by CRPP. CONCLUSION: There is no single best option for the treatment of distal radius fractures in older adults across all domains. This allows physicians to engage in a shared decision-making conversation with each patient about their goals posttreatment in the context of their fracture pattern and overall lifestyle.
Evaluation of a Novel Educational Three-Dimensionally-Printed, Unstable, Distal Radius Fracture Model for Reduction and Splinting.
Sullivan BT, Miles M, Lee ND … +7 more , Aziz KT, Raeker-Jordan EA, Yohe G, Shimada K, LaPorte D, Giladi AM, Means KR
J Am Acad Orthop Surg · 2026 Jan · PMID 41505618 · Publisher ↗
INTRODUCTION: We conducted an initial orthopaedic resident-based evaluation of a novel three-dimensionally (3D) printed model simulating a displaced, unstable distal radius fracture (DRF). We hypothesized the model would...
INTRODUCTION: We conducted an initial orthopaedic resident-based evaluation of a novel three-dimensionally (3D) printed model simulating a displaced, unstable distal radius fracture (DRF). We hypothesized the model would have construct validity, enhance beginner resident performance when used for teaching, and be rated as beneficial. METHODS: Thirty-three residents across all postgraduate years (PGY) from multiple institutions participated. We gathered baseline clinical DRF experience levels for each through Accreditation Council for Graduate Medical Education case logs. We block randomized 14 PGY-1 residents into two groups: no exposure versus formal teaching with the model before testing. All other residents carried out testing without prior exposure. All PGY residents completed a single model testing session including reduction, splinting, and fluoroscopy, with standardized performance assessments by a board-certified hand surgery fellowship-trained orthopaedic surgeon. Performance metrics for each session included a global rating scale (GRS), an objective structured assessment of technical skills, reduction/splinting time, final radiographic sagittal tilt, and a DRF written examination. We also gathered anonymous feedback on the model. RESULTS: PGY-1 residents taught with the model scored markedly better per GRS (P < 0.05). No notable differences were found between the randomized PGY-1 groups for the objective structured assessment of technical skills, procedure times, or examinations (P > 0.05). PGY-1 residents with no prior exposure had markedly longer group-level procedure times than all other PGY residents with no prior exposure, supporting construct validity for the model (P < 0.05). Furthermore, PGY level markedly correlated with better GRS and examination scores and procedure times (P < 0.05). Baseline DRF experience was also markedly associated with better GRS scores (P < 0.05). Anonymous resident feedback indicated that they would recommend the 3D-printed DRF models to improve education. DISCUSSION: Our 3D-printed unstable DRF model demonstrated construct validity across multiple domains. PGY-1 residents taught with the model scored better on the GRS, suggesting potential improved skill acquisition and assessment. All PGY residents recommended the models for DRF education.
Letter to the Editor: Use of Oral Antibiotics in the Treatment of Spinal Infections.
Greig JR, Fok R
J Am Acad Orthop Surg · 2026 Mar · PMID 41505617 · Publisher ↗
Abstract loading — click title to view on PubMed.
Single-Stage Press-Fit Femoral Osseointegrated Limb Replacement: A Prospective Cohort Study.
Burns DM, LoPolito AG, Glassband Z … +3 more , Hoellwarth JS, Reif TJ, Rozbruch SR
J Am Acad Orthop Surg · 2026 Apr · PMID 41494162 · Publisher ↗
BACKGROUND: Press-fit femoral osseointegrated limb replacement (FOLR) allows for a direct transcutaneous skeletal connection between an artificial leg and the residual femur in a single-stage procedure that can be perfor...
BACKGROUND: Press-fit femoral osseointegrated limb replacement (FOLR) allows for a direct transcutaneous skeletal connection between an artificial leg and the residual femur in a single-stage procedure that can be performed open or percutaneously. A skeletally anchored prosthesis can offer enhanced mobility, balance, and proprioception to amputees, as well as eliminate problems associated with socket mounted prostheses, such as skin problems, ulcers, and pain. The purpose of this research is to describe the safety, functional, and patient-reported outcomes for this technique. METHODS: We retrospectively reviewed all patients at our institution who underwent press-fit FOLR between January 2017 to May 2023 (at least 1 year postsurgery). The primary outcome was adverse events prompting additional surgery. Secondary outcomes were changes in mobility (timed up and go), 2-minute walk test (2MWT), 6-minute walk test (6MWT), prosthetic use, walking aids, and patient-reported quality of life surveys (Limb Deformity-Scoliosis Research Society, QTFA, and patient-reported outcomes measurement information system). RESULTS: Sixty-seven FOLR procedures in 65 patients were included in this cohort. The total revision surgery rate was 40.3%, including 12 débridements (17.9%), six fracture repairs (9.0%), 14 soft-tissue revisions (20.9%), and two implant removals (3.0%). Thirty limbs (44.8%) developed drainage or inflammation around their aperture and were successfully treated with antibiotics alone. Implant survival was 98.4% at 1 year, 98.4% at 2 years, and 93.0% at 5 years. Large statistically significant improvements were found in mobility (2MWT, 6MWT), walking aids, and patient-reported outcomes scores (Limb Deformity-Scoliosis Research Society, patient-reported outcomes measurement information system) in patients who underwent FOLR, as well as improvements in prosthetic use in patients who initially presented with a prosthesis. CONCLUSION: Osseointegration of the femur reliably improves function and quality of life for transfemoral amputees. There is a high rate of complications and revision surgery, but the problems encountered are manageable in most instances.
Reply to Letter to the Editor: Use of Oral Antibiotics in the Treatment of Spinal Infections.
Rawall S, Hiatt LA, Rajaram SM … +1 more , Theiss S
J Am Acad Orthop Surg · 2026 Mar · PMID 41494133 · Publisher ↗
Abstract loading — click title to view on PubMed.
A Machine Learning Approach to Predicting Radiographic Outcomes of Nonsurgically Treated Distal Radius Fractures.
Taleghani ER, Lyu R, Shackleford T … +4 more , Rex J, Hale I, Talavage TM, Florczynski MM
J Am Acad Orthop Surg · 2026 Jan · PMID 41490406 · Publisher ↗
INTRODUCTION: Several statistical models have been developed to predict the stability of distal radius fractures after closed reduction, but their findings have not been consistently reproduced. We aimed to develop a mac...
INTRODUCTION: Several statistical models have been developed to predict the stability of distal radius fractures after closed reduction, but their findings have not been consistently reproduced. We aimed to develop a machine learning (ML) model to predict radiographic outcomes of nonsurgically treated distal radius fractures based on pre-reduction and postreduction radiographic parameters and demographic variables. METHODS: Adults with displaced distal radius fractures at a single institution between 2012 and 2024 were identified through retrospective chart review. Inclusion criteria required closed reduction in the emergency department, with radiographs obtained before reduction, immediately after reduction, and 6 weeks after reduction. At 6 weeks, treatment outcomes were classified as "success" or "failure" based on American Academy of Orthopaedic Surgeons acceptable reduction parameters. Five ML models were trained to predict 6-week outcomes using demographic data and pre-reduction and postreduction radiographic measurements. The 10 parameters with highest Shapley values for predictive ability were used to create an interpretable composite model. RESULTS: Among 1,227 patients, 152 met the inclusion criteria (mean age: 61.4 ± 20.2 years; 75.7% female). The composite model correctly predicted outcomes in 25 of 31 patients, achieving an accuracy, precision, and recall of 81%; area under the curve of 0.84; and F1 score of 0.81. Restoration of postreduction palmar tilt, radial height, and excellent reduction based on the Lindstrom score were most predictive of 6-week radiographic outcomes. The best performing decision tree showed the following cutoffs predictive of treatment failure: +4.7 mm of pre-reduction ulnar variance, 8° of postreduction dorsal tilt, and <18.8° of postreduction radial inclination. CONCLUSION: This study developed an ML model that accurately predicts 6-week radiographic outcomes in nonsurgically treated distal radius fractures. Postreduction parameters were the strongest predictors, underscoring the importance of a high-quality closed reduction. This study validates the potential of ML as a predictive tool in this setting.
Evaluating the Safety of Prescription Sleep Medications in Patients Undergoing Total Knee Arthroplasty: A Propensity Matched Analysis.
Young B, Zhuang T, Fernando N … +3 more , Manner P, Kamal RN, Hernandez NM
J Am Acad Orthop Surg · 2025 Dec · PMID 41490393 · Publisher ↗
BACKGROUND: Impaired sleep is reported in over 50% of patients after a total knee arthroplasty (TKA). Clinicians often treat postoperative sleep disturbances with medications; however, the risks associated with the use o...
BACKGROUND: Impaired sleep is reported in over 50% of patients after a total knee arthroplasty (TKA). Clinicians often treat postoperative sleep disturbances with medications; however, the risks associated with the use of sleep medications after TKA are not well understood. We assessed the association between sleep medication use after TKA and postoperative complications. METHODS: Using a national administrative claims database, we identified 101,806 patients undergoing primary TKA from 2011 to 2022 who were taking sleep medications within 90 days after surgery and 509,030 patients who were not, which formed the control group. We further analyzed the effects of standard prescription sleep medications (daridorexant, eszopiclone, lemborexant, suvorexant, temazepam, triazolam, zaleplon, zolpidem) and less potent prescription sleep medications (doxepin, ramelteon). Ninety-day and 365-day outcomes investigated were falls, revision surgery, dislocation, fractures, and emergency department (ED) visits. Multivariable logistic regressions were used to calculate odds ratios, adjusting for age, sex, region, insurance plan, Elixhauser Comorbidity Index, preoperative sleep medication usage, and history of mood and anxiety disorders. RESULTS: Use of any sleep medication was associated with an increased risk of 90-day prosthetic joint dislocations (OR, 1.26; 95% CI, 1.02 to 1.54; P = 0.031), revision surgery (OR, 1.12; 95% CI, 1.02 to 1.24; P = 0.019), falls (OR, 1.10; 95% CI, 1.03 to 1.18; P = 0.008), and ED visits (OR, 1.12; 95% CI, 1.09 to 1.15; P < 0.001). Standard sleep medication usage was correlated with an increased risk of 90-day and 365-day revision surgery, falls, distal radius fractures, and ED visits (P < 0.05). CONCLUSIONS: Use of any prescription sleep medication or only standard sleep medications is associated with increased surgical complications. Additional research is needed to find medications that may be safer for routine postoperative use.
Frailty Is Associated With Increased Odds of 30-Day Periprosthetic Joint Infection Following Primary Total Hip Arthroplasty.
Koltenyuk V, Sasaki J, Nowak K … +3 more , Fuller SI, Kovacs AR, Lucas TS
J Am Acad Orthop Surg · 2025 Dec · PMID 41490324 · Publisher ↗
INTRODUCTION: Periprosthetic joint infection (PJI) following total hip arthroplasty (THA) is associated with notable morbidity and mortality. Previous studies have explored risk scores for predicting complications follow...
INTRODUCTION: Periprosthetic joint infection (PJI) following total hip arthroplasty (THA) is associated with notable morbidity and mortality. Previous studies have explored risk scores for predicting complications following THA, such as wound infection and PJI. Despite an aging population with the number of elderly patients requiring THA increasing, few analyses have explored frailty as a risk factor. We analyzed a national database to determine whether frailty as measured by the modified 5-item frailty index (mFI-5) was associated with PJI within 30 days following THA. METHODS: The ACS-NSQIP database was queried from 2015 to 2020 for cases of primary THA with readmission or revision surgery within 30 days due to PJI. The variables used in the mFI-5 were heart failure, chronic obstructive pulmonary disease, hypertension, diabetes, and non-independent functional status. Patients were stratified into one of four frailty groups: robust (mFI-5 = 0), prefrail (mFI-5 = 1), frail (mFI-5 = 2), and severely frail (mFI-5 ≥ 3). Multivariable logistic regression controlling for age, female sex, smoking status, body mass index, and total operative time was performed to evaluate the influence of frailty on PJI. RESULTS: This study included 147,597 patients undergoing primary THA. Of these patients, 352 (0.2%) developed PJI within 30 days. A lower proportion of PJI patients were classified as robust, whereas a higher proportion were categorized as frail. Multivariable logistic regression demonstrated that frail patients were at an increased odds of developing PJI with each additional unit on the mFI-5 scale increasing the odds by 27.4%. CONCLUSION: This study is the first to demonstrate that frailty is an independent predictor of PJI following primary THA. Incorporating frailty screening during surgical candidate selection may assist with identifying high-risk patients.
Current Indications and Outcomes of Arthroscopic Treatment for Radial-Sided Wrist Injuries.
Vilai P, Kakar S
J Am Acad Orthop Surg · 2025 Dec · PMID 41490303 · Publisher ↗
Wrist arthroscopy has become an essential tool for treating intraarticular pathologies, with advancements in techniques and instruments expanding its indications over the past few decades. It is the benchmark for diagnos...
Wrist arthroscopy has become an essential tool for treating intraarticular pathologies, with advancements in techniques and instruments expanding its indications over the past few decades. It is the benchmark for diagnosing intraarticular ligament pathologies, such as scapholunate ligament and triangular fibrocartilage complex injuries. In addition, it can be used an adjunct in the management of intraarticular fractures, particularly distal radius and scaphoid fractures. The objective of this article is to outline the role of arthroscopy in the management of common radial-sided wrist disorders and evaluate the surgical outcomes.
Two-Incision Anterior Cruciate Ligament Reconstruction.
Bernholt DL, Spindler KP, Azar FM … +1 more , Wright RW
J Am Acad Orthop Surg · 2026 Jun · PMID 41490278 · Publisher ↗
Two-incision anterior cruciate ligament reconstruction (ACLR) is a well-established technique used to perform an arthroscopically assisted ACLR. Historically, this approach to ACLR was once considered the benchmark; howe...
Two-incision anterior cruciate ligament reconstruction (ACLR) is a well-established technique used to perform an arthroscopically assisted ACLR. Historically, this approach to ACLR was once considered the benchmark; however, with evolving arthroscopic technology and the rise of more minimally invasive techniques, this approach to ACLR has become less popular. The two-incision technique still has notable clinical utility because it can (1) increase the surgeon's ability to perform a single-stage revision ACLR and (2) help avoid graft-tunnel mismatch in primary ACLR with a patellar tendon autograft when encountering a long tendon. This technique, when coupled with metal screws and an autograft tendon, is also the lowest cost ACLR technique that allows independent femoral tunnel positioning and thus should be considered as an option for primary ACLR by surgeons prioritizing cost containment without compromising surgical outcomes.
Hip Fracture Surgery Performed <24 Hours vs. >24 Hours (Next Calendar Day) After Emergency Department Presentation Yields Equivalent Outcomes.
Hammond B, Olson D, Ganta A … +2 more , Egol KA, Konda SR
J Am Acad Orthop Surg · 2026 May · PMID 41481861 · Publisher ↗
INTRODUCTION: To compare outcomes of patients with geriatric hip fracture undergoing surgery <24 hours from emergency department (ED) arrival to those who underwent surgery >24 hours from arrival but within the next cale...
INTRODUCTION: To compare outcomes of patients with geriatric hip fracture undergoing surgery <24 hours from emergency department (ED) arrival to those who underwent surgery >24 hours from arrival but within the next calendar day. METHODS: A retrospective review of a single-institution hip fracture database (2014 to 2024) was performed. The study cohort was divided into two groups based on time from ED arrival to surgery start time: <24-hour surgery (<24h) and next calendar day surgery >24 hours from arrival (>24h [next calendar day]). Univariate analysis was performed to compare baseline health, injury factors, and outcomes. Multivariate linear and logistic regression analyses were performed to adjust for procedure type and risk profile. RESULTS: There were 1,694 patients included in the study analysis, of whom 964 (56.91%) were <24h and 730 (43.09%) were >24h (next calendar day). The mean time to surgery for cohorts were <24h: 17.66 ± 5.05 vs. >24h (next calendar day): 28.78 ± 3.86 hours; P < 0.001. Univariate analysis revealed no differences between <24h and >24h (next calendar day) cohorts for in-hospital complication incidence (35.5% vs. 35.1%; P = 0.862), inpatient mortality (0.5% vs. 1.0%; P = 0.285), 30-/90-day readmission (5.6% vs. 6.2%; P = 0.625; 8.2% vs. 11.0%; P = 0.053), and 30-day/1-year mortality (2.4% vs. 2.3%; P = 0.939; 5.0% vs. 6.2%; P = 0.289). Length of stay (5.15 ± 3.15 vs. 5.58 ± 3.31; P = 0.006) and discharge location (36.4% home discharge vs. 31.0%; P = 0.019) favored the <24h cohort. After adjusting for baseline health with Score for Trauma Triage in the Geriatric and Middle-Aged and procedure type, only longer length of stay was found to be associated with the >24h (next calendar day) cohort (B = 0.407; P = 0.010). CONCLUSION: No notable differences were observed in key outcomes for patients undergoing <24 hours from ED arrival versus those who undergo surgery >24 hours after arrival but on the next calendar day. This study suggests that "next day hip fracture surgery" appears safe for patients with geriatric hip fracture.
Prognostic Role of BUN-to-Albumin Ratio, Albumin-to-ALP Ratio, and Mortality in Critically Ill Patients With Hip Fracture: Analysis of the MIMIC-IV Database, 2008 to 2019.
Chen CH, Chen CL, Li YA … +1 more , Lo YC
J Am Acad Orthop Surg · 2026 Jun · PMID 41481860 · Publisher ↗
INTRODUCTION: Hip fractures in critically ill patients are associated with high morbidity and mortality. Simple, accessible biomarkers that can predict outcomes are crucial for early risk stratification. This study aimed...
INTRODUCTION: Hip fractures in critically ill patients are associated with high morbidity and mortality. Simple, accessible biomarkers that can predict outcomes are crucial for early risk stratification. This study aimed to evaluate the prognostic value of blood urea nitrogen-to-albumin (BUN/albumin) and albumin-to-alkaline phosphatase (albumin/ALP) ratios in predicting mortality in critically ill patients with hip fractures. METHODS: This retrospective cohort study included data (including BUN, albumin, and ALP values at admission) of adults with hip fracture admitted to the intensive care unit (ICU) extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Primary outcomes were 28-day and 1-year all-cause mortality. Multivariable logistic regression and Cox proportional hazards models were used to assess associations between BUN/albumin and albumin/ALP and 28-day and 1-year all-cause mortality. Receiver operating characteristic analysis was used to evaluate discrimination. RESULTS: In total, 265 patients with hip fractures were included. Higher BUN/albumin were independently associated with increased 1-year mortality (adjusted hazard ratio [aHR] = 1.39, 95% CI, 1.06 to 1.82, P = 0.018), with the highest tertile showing significantly greater risk (aHR = 2.67, 95% CI, 1.10 to 6.47, P = 0.030). A higher albumin/ALP was associated with reduced 1-year mortality (aHR = 0.13, 95% CI, 0.02 to 0.81, P = 0.029). Receiver operating characteristic analysis demonstrated only modest improvements in biomarker predictive performance. CONCLUSION: BUN/albumin and albumin/ALP are independently associated with long-term mortality in critically ill patients with hip fractures and may serve as practical tools for early risk assessment.
Under the Radar: Low Rates of Dual-Energy Radiograph Absorptiometry Screening and Associated Fracture Risk in Female Total Shoulder Arthroplasty Patients.
Mousavi SZ, Buettner C, Saha P … +4 more , Perez VC, Fox H, Weisberg-Tannenbaum M, Srikumaran U
J Am Acad Orthop Surg · 2025 Dec · PMID 41468589 · Publisher ↗
INTRODUCTION: Osteoporosis is prevalent in patients undergoing total shoulder arthroplasty (TSA) and affects perioperative management and outcomes, including fragility fractures. Despite guidelines recommending dual-ener...
INTRODUCTION: Osteoporosis is prevalent in patients undergoing total shoulder arthroplasty (TSA) and affects perioperative management and outcomes, including fragility fractures. Despite guidelines recommending dual-energy radiograph absorptiometry (DXA) screening in women at risk for osteoporosis, screening before TSA remains low. With TSA procedures rising, it is important to identify factors that may contribute to low DXA utilization rates. This study aims to (1) evaluate the influence of demographic and social determinants of health on preoperative DXA screening and (2) identify predictors of postoperative fragility fractures. METHODS: We retrospectively reviewed female patients who underwent TSA from 2016 to 2024 by a single surgeon. Patients meeting guideline-based indications for DXA were included. Multivariable logistic regression identified predictors of DXA utilization. Among patients without prior fragility fractures, time-to-event analysis using Firth penalized Cox regression assessed predictors of postoperative fractures. A bootstrap sensitivity analysis (1,000 iterations) evaluated the stability of smoking-related risk estimates. RESULTS: Of 432 eligible women, only 39.7% (n = 176) received a preoperative DXA screening. In adjusted analysis, married patients had 52% higher odds of receiving screening (odds ratios 1.52, 95% confidence intervals [1.01 to 2.29], P = 0.044), whereas those with public insurance had 54% lower odds compared with privately insured patients (odds ratios 0.46 [0.29 to 0.74], P = 0.001). Among 358 patients without prior fragility fractures, current tobacco use markedly increased postoperative fracture risk (hazard ratios [HR] 14.87 [1.69 to 130.88], P = 0.015). Higher body mass index was protective: overweight (HR 0.27 [0.08 to 0.87], P = 0.028) and obese (HR 0.03 [0.003 to 0.29], P = 0.002) patients had a lower fracture risk. DISCUSSION: DXA screening is underused in women undergoing TSA. Marital status and insurance type markedly affect screening rates, whereas low body mass index and tobacco use remain strong predictors of fragility fractures. These findings suggest a need for comprehensive bone health management strategies, including improved screening, risk counseling, and optimized osteoporosis management. LEVEL OF EVIDENCE: III.
Liposomal Bupivacaine + Bupivacaine Versus Bupivacaine Interscalene Nerve Block Effect on Pain After Rotator Cuff Repair: A Randomized Control Trial.
Fedorka CJ, Tornberg HN, Rivera-Pintado C … +8 more , Gentile PM, Russo D, Boniello M, Hunter K, Desai R, Soni D, Kleiner MT, Dodson G
J Am Acad Orthop Surg · 2025 Dec · PMID 41468585 · Publisher ↗
BACKGROUND: Interscalene nerve blocks (ISB) are commonly used for perioperative pain control after shoulder arthroscopy. Bupivacaine has historically been the primary anesthetic used in ISBs. In 2018, the U.S. Food and D...
BACKGROUND: Interscalene nerve blocks (ISB) are commonly used for perioperative pain control after shoulder arthroscopy. Bupivacaine has historically been the primary anesthetic used in ISBs. In 2018, the U.S. Food and Drug Administration approved liposomal bupivacaine for ISBs. This study aims to identify the effect of ISBs using bupivacaine alone (B) versus liposomal bupivacaine + bupivacaine (LBB) on postoperative pain control after arthroscopic rotator cuff repair (RCR). METHODS: A single-center, prospective, double-blinded, randomized, control trial following Consolidated Standards of Reporting guidelines was conducted from January 2020 to April 2024; 128 opiate naive patients undergoing arthroscopic RCR were randomized 1:1 into the B-only group (25 cc of 0.5% bupivacaine) versus the LBB group (133 mg [10 mL] of liposomal bupivacaine + 15 cc 0.5% bupivacaine). Demographics, comorbidities, additional procedures performed, daily morphine milligram equivalents (MME) consumed, and daily visual analog scale (VAS) pain scores for 14 days were collected. RESULTS: No differences were noted between age, sex, comorbidities, or American Society of Anesthesiologists physical classification system scores. On postoperative day 2, the LBB group consumed markedly lower MMEs (0.0 [0.0 to 7.5] versus 0.0 [0.0 to 15.0]; [P = 0.04]) and demonstrated a notable improvement in VAS scores on postoperative day 2 (4.8 ± 3.0 versus 6.0 ± 2.8; [P = 0.03]). No notable difference was seen in other daily MMEs consumed, daily VAS scores, or total 14-day MMEs. Total median MME consumed in both groups was low (MME 35.6 [7.5 to 88.1] or 5 [1 to 12] oxycodone pills). CONCLUSION: Although the use of LBB in ISBs led to markedly lower VAS scores and less narcotic consumption on postoperative day (POD2), these findings can be regarded as not clinically notable. The difference was the equivalent of one oxycodone tablet, and VAS did not meet minimal clinically important difference. No other differences were found in MME consumed or VAS scores during the first 2 weeks postoperatively following RCR. Overall narcotic consumption was low in both groups. LEVEL OF EVIDENCE: I.
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