Abstract:
OBJECTIVES:Through an international survey, we assessed whether deciding to operatively treat an intra-articular distal radius fracture (DRF) is guided by identifiable patient and surgeon factors. In addition, we compared surgeons' treatment decisions with the American Academy of Orthopaedic Surgeons' Appropriate Use Criteria (AUC) treatment recommendations. METHODS:This cross-sectional survey asked 224 surgeons to operatively or nonoperatively treat 28 hypothetical patients with radiographs of an intra-articular DRF. We randomized patient age (50/70 years), gender, mechanism of injury, activity level, and OTA/AO fracture type. We classified 6 fractures as "nonclinically significant displacement" and 22 as "potentially clinically significant displacement." Multilevel logistic regression analysis was performed. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported. Statistical significance was P < 0.05. RESULTS:Patient factors independently associated with surgery included younger age (OR 6.7, P = 0.003), clinically significant fracture displacement (type B: OR 122, CI, 20-739, P < 0.001; type C: OR 59, CI, 12-300, P < 0.001), normal activity level (OR 5.0, P < 0.001), and high-energy mechanisms (OR 1.3, P = 0.002). Surgeon factors associated with recommending surgery included practicing outside the United States (Europe: OR 2.6, P < 0.001; "other": OR 4.8, P < 0.001). Hand surgeons most often selected surgery, as compared to orthopaedic trauma surgeons (OR 2.3, P = 0.001) and "other orthopaedists" (OR 2.2, P = 0.022). Thirty-seven percent of treatment decisions for patients with normal activity levels were rated by AUC recommendations as "rarely appropriate," which included 91% disagreement for 70-year-olds with nonclinically significant displacement. CONCLUSIONS:Surgeons use patient age and fracture displacement to make treatment recommendations for intra-articular DRF. We recommend that the AUC be updated to include these clinical factors as essential components in its algorithm. LEVEL OF EVIDENCE:Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.
journal_name
J Orthop Traumajournal_title
Journal of orthopaedic traumaauthors
Kyriakedes JC,Crijns TJ,Teunis T,Ring D,Bafus BT,Science of Variation Group.doi
10.1097/BOT.0000000000001517subject
Has Abstractpub_date
2019-10-01 00:00:00pages
e394-e402issue
10eissn
0890-5339issn
1531-2291journal_volume
33pub_type
杂志文章,随机对照试验abstract:BACKGROUND:Accurate prediction of likelihood of reoperation in patients with tibial shaft fractures would facilitate optimal management. Previous studies were limited by small sample sizes and noncomprehensive examination of possible risk factors. OBJECTIVE:We conducted an observational study to determine which progno...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-200305000-00006
更新日期:2003-05-01 00:00:00
abstract:OBJECTIVES:Fellowship-trained orthopaedic traumatologists are presumably taught skill sets leading to "best practice" outcomes and more efficient use of hospital resources. This should result in more favorable economic opportunities when compared with general orthopaedic surgeons (GOSs) providing similar clinical servi...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e3182a59d6b
更新日期:2014-05-01 00:00:00
abstract::Rupture of the medial head of the gastrocnemius muscle ("tennis leg") is an affliction generally associated with athletic activity. The diagnosis is made by careful history and physical examination. Although its findings are characteristic, previous reports have documented misdiagnosis of this lesion as thrombophlebit...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199406000-00016
更新日期:1994-01-01 00:00:00
abstract:OBJECTIVE:To determine if a dual-purpose bone graft can regenerate bone and reduce infection in highly contaminated bone critical size defects in rats. METHODS:Biodegradable polyurethane (PUR) scaffolds were loaded with recombinant human bone morphogenetic protein-2 (BMP-2) and vancomycin (Vanc). The release kinetics ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e31821f624c
更新日期:2011-08-01 00:00:00
abstract:OBJECTIVES:To assess mechanism of injury as a clinical course predictor in patients with complete anterior and posterior pelvic ring disruptions [innominosacral dissociation (ISD)]. DESIGN:Retrospective review of radiographs and medical data. SETTING:R Adams Cowley Shock Trauma Center, Baltimore, Maryland, statewide ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199702000-00002
更新日期:1997-02-01 00:00:00
abstract:OBJECTIVES:To compare the accuracy of 5 commonly available fine wire tensioners used in hybrid and ring external fixation. DESIGN:A laboratory investigation. SETTING:The testing of 5 commonly available tensioners was performed with a servohydraulic test frame (MTS Bionix 858, Minneapolis, MN). MAIN OUTCOME MEASUREME...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-200403000-00006
更新日期:2004-03-01 00:00:00
abstract::Periprosthetic fractures after shoulder arthroplasty occur in up to 2% of patients. In patients with stable components who fail or cannot undergo nonoperative management, stable fixation is required. We present a new technique to obtain proximal fixation around the humeral component using a 4.5-mm large fragment plate...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000935
更新日期:2017-12-01 00:00:00
abstract:OBJECTIVES:To explore the effect of intramedullary pin size on the biology of a healing fracture, specifically endochondral angiogenesis. We hypothesized that fracture fixation with a smaller pin would permit greater interfragmentary strain resulting in increased total amount of vascular endothelial growth factor withi...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001555
更新日期:2019-10-01 00:00:00
abstract:OBJECTIVE:Heterotopic ossification (HO) develops frequently after modern high-energy penetrating war injuries. The purpose of this prospective study was to identify and characterize the unique cytokine and chemokine profile associated with the development of HO as it pertained to the systemic inflammatory response afte...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e31825d60a5
更新日期:2012-11-01 00:00:00
abstract:OBJECTIVES:To determine whether bundled payments are feasible in the orthopaedic fracture setting, and the potential economic implications of this reimbursement structure. DESIGN:Prospective. SETTING:Multicenter. PATIENTS/PARTICIPANTS:Between 2004 and 2014, a total of 23,643 operatively treated patients with fractur...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000742
更新日期:2017-03-01 00:00:00
abstract:OBJECTIVE:A new device for the treatment of intertrochanteric fractures that uses 2 cephalocervical screws in an integrated mechanism allowing linear intraoperative compression and rotational stability of the head/neck fragment has been developed. The aim of this study was to describe the results using this device for ...
journal_title:Journal of orthopaedic trauma
pub_type: 临床试验,杂志文章
doi:10.1097/BOT.0b013e31819211b2
更新日期:2009-01-01 00:00:00
abstract::Our purpose was to determine the incidence of deep-vein thrombosis (DVT) in patients who have had early operative fixation of fractures of the lower extremity distal to the hip. There is a high incidence of distal thrombosis in patients who have undergone early operative fixation of lower-extremity fractures. The inci...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199605000-00002
更新日期:1996-01-01 00:00:00
abstract::Minifragment implants provide several advantages for the stabilization of distal humerus fractures. Compared with small fragment implants, minifragment implants may provide enhanced fracture fixation because a greater number of screws can be placed into the distal fragments. In addition, minifragment plates are easier...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/01.bot.0000157908.45939.d7
更新日期:2005-08-01 00:00:00
abstract:OBJECTIVE:To report our experience with computed tomography (CT) scans to detect traumatic arthrotomies of the knee (TAK) joint based on the presence of intra-articular air. DESIGN:Retrospective review. SETTING:Level I trauma center. PATIENTS:Sixty-two consecutive patients (63 knees) underwent a CT scan of the knee ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e31828219bc
更新日期:2013-09-01 00:00:00
abstract::Aggressive treatment of the multiply injured patient often requires early fixation of many fractures, some of which may be open. Often, patients develop postoperative fevers requiring a thorough workup to rule out infection. Recently, indium-111 white blood cell (WBC) imaging has become a valuable adjunct in the diagn...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:
更新日期:1988-01-01 00:00:00
abstract:OBJECTIVES:External fixator pins are thought to have improved pullout strength if inserted into both cortices and if pilot holes are drilled. We tested these hypotheses and investigated effects of osteoporosis and pin location on pin pullout strength. METHODS:Self-drilling external fixator pins were inserted using 4 t...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e3182511ed7
更新日期:2013-02-01 00:00:00
abstract:OBJECTIVES:The purpose of this study was to review the outcome of late revision surgery in a series of patients with posterior wall fractures having recurrent hip instability after failed initial open reduction and internal fixation. DESIGN:Retrospective analysis of consecutive patients. SETTING:Level 1 trauma center...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e31819a07cf
更新日期:2009-03-01 00:00:00
abstract:OBJECTIVES:The objective of this study was to evaluate donor site morbidity associated with anterior iliac crest bone graft harvesting for orthopaedic trauma reconstructions. DESIGN:Retrospective case series. SETTING:Level 1 trauma center. PATIENTS:Forty-Six consecutive patients who had undergone anterior iliac cres...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000551
更新日期:2016-06-01 00:00:00
abstract:OBJECTIVES:A sheep model of osteoporosis suitable for implant testing for osteoporotic fractures was evaluated with regard to normalization of hormonal status and possible rebound of bone mineral density subsequent to the termination of steroid application. DESIGN:Osteoporosis was induced in 10 aged, female white alpi...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-200501000-00005
更新日期:2005-01-01 00:00:00
abstract::We present a rare case of complete talar extrusion after trauma. Treatment of this severe injury remains controversial as a result of the lack of congruent evidence-based literature, associated high complication rate with primary repair, and difficulty in objectively assessing long-term outcomes. Recent small sampled ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e318210f236
更新日期:2011-11-01 00:00:00
abstract:OBJECTIVES:Iliosacral screw pathways in the first (S1) and second (S2) sacral segments are commonly used for adult pelvic ring stabilization. We hypothesize that radiographically "safe" pathways exist in pediatric patients. SETTING:Academic level I Trauma Center. PATIENTS:All patients between ages 2 and 16 years with...
journal_title:Journal of orthopaedic trauma
pub_type: 临床试验,杂志文章
doi:10.1097/BOT.0000000000000421
更新日期:2016-01-01 00:00:00
abstract::Periprosthetic humerus fractures are relatively uncommon occurrence that can be difficult to manage nonoperatively. Locking plate technology has enhanced the surgical management of these fractures. However, adequate fixation around the stem remains of some concern. We describe an osteosynthesis technique using a locki...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000646
更新日期:2016-11-01 00:00:00
abstract:PURPOSE:The purpose of this video is to demonstrate the surgical technique of a shoulder arthrodesis for a patient with multidirectional instability and multiple failed previous surgeries. METHODS:A 25-year-old woman with a long history of left shoulder multidirectional instability in the setting of Ehlers-Danlos synd...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001212
更新日期:2018-08-01 00:00:00
abstract::Use of cephalomedullary nails is an option for treatment of subtrochanteric femur fractures. However, the magnitude of bending forces in this area of the femur often can lead to implant failure before union. We report on a case of hardware failure of a specific device (Synthes spiral blade) and a method for removal. ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199803000-00010
更新日期:1998-03-01 00:00:00
abstract::Road traffic accidents are a leading cause of global mortality. In March 2010, the United Nations General Assembly and the World Health Organization (WHO) officially proclaimed 2011-2020 as the "Decade of Action for Road Safety." Researchers must focus on vulnerable road users and low- and middle-income countries (LMI...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000103
更新日期:2014-01-01 00:00:00
abstract:OBJECTIVE:To assess surgical and functional results after corrective reconstruction of malunited, scapula neck or body fractures in patients who presented with chronic pain, limited range of motion, weakness, and gross deformity of the shoulder. DESIGN:Case series. SETTING:Level I teaching trauma center. PATIENTS:Be...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e31820af67f
更新日期:2011-11-01 00:00:00
abstract::Transverse fractures at the distal tip of a well-fixed femoral prosthesis are difficult to stabilize using plates and screws due to the presence of the underlying intramedullary stem. The attachment of plates using cerclage wires obviates the need for screws, but the stability provided by cerclage plating is a clinica...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199505000-00004
更新日期:1995-01-01 00:00:00
abstract:OBJECTIVES:To compare failure rates between short and long cephalomedullary nails used for the treatment of intertrochanteric hip fractures in patients over 65 years of age. DESIGN:Retrospective cohort study. Data were collected from medical records and radiographs. SETTING:Three level 1 trauma centers. PATIENTS/PAR...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000036
更新日期:2014-07-01 00:00:00
abstract:OBJECTIVES:To analyze long-term functional outcomes in patients with posttraumatic infected tibial nonunions having undergone bone transport with hexapod external fixator. DESIGN:Retrospective cohort study. SETTING:Level 1 trauma center. PATIENTS/PARTICIPANTS:Thirty-eight patients with infected nonunions of the tibi...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001005
更新日期:2018-01-01 00:00:00
abstract:OBJECTIVES:The aim of this study was analyze modes of mechanical failure in a consecutive cohort of patients and establish possible risk factors. DESIGN:This was a retrospective cohort study. SETTING:The study was conducted at an academic level-1 trauma center. PATIENTS:Twenty-nine patients (mean age 56 years, range...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e318251930d
更新日期:2013-01-01 00:00:00