Int Orthop. 2025 Apr 11. doi: 10.1007/s00264-025-06526-z. Online ahead of print.

ABSTRACT

PURPOSE: Revision total hip arthroplasty (rTHA) is an increasingly common procedure due to the growing number of primary total hip arthroplasties (THAs) performed worldwide. This study evaluates the long-term implant survival, functional outcomes, and radiographic performance of cemented femoral stem (Beznoska s.r.o., Kladno, Czechia) in rTHA.

METHODS: A retrospective analysis was conducted on 183 patients who underwent rTHA with cemented stem between March 2012 and December 2023. The mean follow-up duration was 71.26(± 39.31) months. Implant survival was analyzed using Kaplan-Meier survival estimates, and failure modes were assessed. Radiographic changes were classified using the Gruen Zones system. Functional outcomes were evaluated using the Harris Hip Score (HHS). Cox proportional hazard models were applied to identify prognostic factors influencing implant survival.

RESULTS: The five-year implant survival rate was 98.1%, declining to 83.9% at twelve years. The overall failure rate was 3.83%, with periprosthetic infection (4 cases) being the most common cause, followed by aseptic loosening (2 cases). Radiographic changes were observed in 24.03% of cases, predominantly in Gruen Zones 2, 6, and 1. Functional outcomes were favorable, with a mean HHS of 81.28(± 5.74), comparable to outcomes reported for uncemented revision stems. Age, stem diameter, and stem length did not significantly impact implant survival.

CONCLUSION: The cemented stem demonstrated favourable long-term survival, with high implant retention rates. Functional outcomes indicated overall satisfactory performance. Radiographic evaluation revealed localized changes around the implant, predominantly in Gruen Zones 2, 6, and 1. Implant failure was relatively rare, with periprosthetic infection being the most common cause.

PMID:40214745 | DOI:10.1007/s00264-025-06526-z

Int Orthop. 2025 Apr 10. doi: 10.1007/s00264-025-06528-x. Online ahead of print.

NO ABSTRACT

PMID:40208270 | DOI:10.1007/s00264-025-06528-x

Int Orthop. 2025 Apr 10. doi: 10.1007/s00264-025-06517-0. Online ahead of print.

ABSTRACT

PURPOSE: The "weekend effect" suggests that patients operated upon weekends may experience worse outcomes. This study evaluates whether the day of the week impacts outcomes and costs of open reduction and internal fixation (ORIF) surgery for distal radius fractures (DRF) in a large nationwide cohort.

METHODS: A retrospective cohort study was conducted using data from the PearlDiver Mariner M165Ortho dataset, which covers a U.S. population of over 165 million from 2010 to 2022. Patients who underwent ORIF surgery for DRF were categorized into weekday and weekend groups. Demographics, comorbidities, and adverse outcomes within six months and two years post-surgery were analyzed.

RESULTS: Of the 266,378 patients who underwent ORIF for DRF with at least two years of follow-up, 252,866 had surgery on weekdays, while 13,512 had surgery on weekends. The weekend group exhibited higher rates of surgical site infection (SSI) (OR: 2.29[95%CI = 1.51-3.48], P < 0.001), hardware failure (OR: 5.80[95%CI = 1.13-31.25], P = 0.042), and readmissions (OR: 2.48[95%CI = 2.12-2.91], P < 0.001) at six months post-operatively. At two years post-operatively, the weekend group continued to show higher rates of complications including SSI (OR: 1.66[95%CI = 1.16-2.36], P = 0.005), malunion (OR: 1.44[95% CI = 1.06-1.93], P = 0.017), and readmission (OR: 1.55[95%CI = 1.39-1.74], P < 0.001). Mean total surgical costs were 16.4% higher in the weekend group ($2,394.85 vs. $2,057.88, P < 0.001).

CONCLUSIONS: This nationwide analysis demonstrates a significant "weekend effect" in ORIF surgery for DRF, with weekend surgeries associated with substantially higher complication rates, readmissions, and costs. These findings highlight the need for systemic changes to ensure consistent quality of care throughout the week, including improved weekend staffing, standardized protocols, and resource allocation.

LEVEL OF EVIDENCE: III (Retrospective cohort).

PMID:40208269 | DOI:10.1007/s00264-025-06517-0

Int Orthop. 2025 Apr 9. doi: 10.1007/s00264-025-06516-1. Online ahead of print.

NO ABSTRACT

PMID:40202543 | DOI:10.1007/s00264-025-06516-1

Int Orthop. 2025 Apr 9. doi: 10.1007/s00264-025-06521-4. Online ahead of print.

ABSTRACT

PURPOSE: This research was designed to explore the incidence of anaemia before surgery and the rate of mortality one year after surgery for femoral neck fractures in older adults. It also investigated whether anaemia prior to surgery influences the likelihood of mortality within one year after the procedure.

METHODS: A retrospective cohort analysis was undertaken at Honghui Hospital, a tertiary academic medical institution affiliated with Xi'an Jiaotong University in China. This investigation included elderly individuals who underwent surgery for femoral neck fractures within the year spanning from January to December 2021. The research team gathered data encompassing demographic details, levels of haemoglobin prior to surgery, existing comorbid conditions, and mortality statistics after one year.

RESULTS: In this retrospective study, 994 patients were analyzed, with 84 reported fatalities. The incidence of anaemia in this group was 71.1%, affecting 707 individuals. Of these, 486 (48.8%) had mild anaemia, and 221 (22.2%) exhibited moderate to severe anaemia. Independent factors correlating with heightened one-year mortality risk included operative blood transfusions (odds ratio [OR] = 1.8, p = 0.0327), coronary artery disease presence (OR = 1.85, p = 0.0077), and moderate to severe anaemia (OR = 3.18, p = 0.0006). In contrast, higher body mass index (OR = 0.8, p < 0.0001) and red blood cell count (OR = 0.6, p = 0.0253) were linked to reduced one-year mortality risk. Multivariate logistic regression analyses underscored the independent association of moderate to severe anaemia with increased one-year mortality risk, with varying ORs across models: non-adjusted OR at 3.18 (p = 0.0006), Adjust I model OR at 3.08 (p = 0.0191), and Adjust II model OR at 2.96 (p = 0.0278).

CONCLUSION: At Honghui Hospital, affiliated with Xi'an Jiaotong University in China, anemia has been identified as a common condition among elderly patients undergoing surgery for femoral neck fractures, and it significantly contributes to an elevated risk of mortality within one year post-surgery. It is advisable to implement interventions aimed at managing anaemia before surgery, which should include setting haemoglobin thresholds that are not specific to any gender for its diagnosis.

PMID:40199757 | DOI:10.1007/s00264-025-06521-4

Int Orthop. 2025 Apr 8. doi: 10.1007/s00264-025-06524-1. Online ahead of print.

ABSTRACT

We study Hernigou P's paper "Is synovectomy still of benefit today in total knee arthroplasty with rheumatoid arthritis?" It highlights the need for further research and progress in this field. Future studies should address limitations like small sample sizes, inadequate patient stratification, lack of quantifiable metrics for synovectomy extent, and limited early postoperative analyses to provide stronger evidence for clinical practice.

PMID:40198386 | DOI:10.1007/s00264-025-06524-1

Int Orthop. 2025 Apr 8. doi: 10.1007/s00264-025-06522-3. Online ahead of print.

NO ABSTRACT

PMID:40198385 | DOI:10.1007/s00264-025-06522-3

Int Orthop. 2025 Apr 7. doi: 10.1007/s00264-025-06507-2. Online ahead of print.

ABSTRACT

BACKGROUND: Modular dual mobility (MDM) cups are constituted by a cobalt-chromium (CoCr) liner inserted into a standard acetabular shell, allowing for intra-operative decision and supplementary screw fixation of the acetabular component. MDM could face mechanical issues and biological issues, with the associated risk of elevated blood metal ions levels and adverse local tissue reactions (ALTRs).

MATERIALS AND METHODS: A systematic review of the literature on minimum five years outcomes of modular dual mobility in primary total hip arthroplasty (THA) was performed on PubMed, Cochrane, and Google Scholar databases, in adherence with PRISMA guidelines. Risk of bias in each study was assessed through the JBI checklist for case series.

RESULTS: A total of 381 primary THAs with MDM acetabular cup were performed. At minimum five years follow-up, mean revision rate was 2.3% and implant survivorship was 98.2%. No MDM acetabular construct was revised specifically due to liner mechanical failure, neck-rim impingement, or ALTRs. No intraprosthetic dislocation or iliopsoas tendinitis was observed. No cases of THA dislocation were reported. Mean serum metal ion levels were observed to be within laboratory reference ranges. Greater-than-normal values of serum Co were observed in 9.4% of cases, while greater-than-normal values of serum Cr were observed in 1.6% of patients.

CONCLUSIONS: The main finding of this systematic review is that modular dual mobility acetabular construct appears to be a safe and effective option for primary THA at minimum five years follow-up. Longer follow-up time is needed in order to investigate modular dual mobility long-term survivorship, revision and complication rates, clinical and radiological outcomes.

PMID:40192789 | DOI:10.1007/s00264-025-06507-2

Int Orthop. 2025 Apr 7. doi: 10.1007/s00264-025-06470-y. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to investigate the incidence and associated risk factors of ischaemic muscle sequelae in patients with traumatic femoropopliteal artery injuries following revascularization, as well as to develop a nomogram to predict the risk of ischaemic muscle sequelae.

METHODS: Data from patients with acute traumatic femoropopliteal artery injuries between January 2008 and December 2022 were collected. All patients with successful limb salvage were divided into two groups based on the occurrence of ischaemic muscle sequelae: the ischemic muscle sequelae group (IG) and the non-ischaemic muscle sequelae group (NG). Univariate and multivariate logistic regression analyses were used to identify potential predictive factors associated with ischaemic muscle sequelae. A predictive nomogram was constructed and internally validated.

RESULTS: Among the 102 patients, 30 cases (29.41%) developed ischaemic muscle sequelae. Independent predictors of ischaemic muscle sequelae were identified as crush injury, HCT, and CKMB. A nomogram was constructed based on these three parameters. The area under the receiver operating characteristic (ROC) curve of the predictive model was 0.894, indicating excellent discrimination. The calibration curve demonstrated a high degree of consistency between the predicted probabilities and the observed outcomes. Additionally, the decision curve analysis (DCA) showed that the nomogram model had good predictive capability.

CONCLUSIONS: Our study demonstrated that crush injury, HCT, and CKMB were independent predictors of ischaemic muscle sequelae in patients with acute traumatic femoropopliteal artery injuries following revascularization. The nomogram integrating clinical factors and blood markers can assist physicians in conveniently predicting the risk of ischaemic muscle sequelae in patients.

PMID:40192788 | DOI:10.1007/s00264-025-06470-y

Int Orthop. 2025 Apr 7. doi: 10.1007/s00264-025-06510-7. Online ahead of print.

ABSTRACT

PURPOSE: There is a lack of data evaluating the impact of tourniquet versus no tourniquet surgery in patients with sickle cell disease (SCD).

METHODS: The records of 233 sickle cell patients who underwent orthopaedic surgery with a tourniquet between 1978 and 2018 were retrospectively reviewed. This study group (233 patients) was compared to a control group of 574 SCD patients followed by the same surgical team in the same hospital undergoing the same procedures in the same period between 1978 and 2018 but without a tourniquet. Outcomes assessed skin complications, thrombophlebitis, bone necrosis, muscle necrosis or abnormal muscle function, peripheral nerve impairment, elevated blood pressure, post-operative sickle cell crises, and blood loss under a tourniquet.

RESULTS: The pneumatic tourniquet was primarily applied proximally in both lower and upper limbs. The median tourniquet duration was 65 minutes, with most procedures lasting between 30 and 90 minutes . Postoperative medical complications occurred in both groups, with no significant difference in hospital stay (6.7 vs. 7.1 days). Painful sickling crises affected 86 patients, with a lower prevalence in transfused patients (p = 0.04). Blood loss was significantly lower in the tourniquet group during knee surgeries (438 ml vs. 731 ml, p = 0.031), resulting in fewer transfusions. Skin complications did not affect wound healing. The 90-day incidence of venous thromboembolism (VTE) was 0.4%, with no significant difference between groups. Muscle biopsies showed no necrosis immediately post-surgery, but some necrosis appeared after 12 weeks in the tourniquet group. New bone osteonecrosis cases and infection rates were similar between groups.

CONCLUSION: this study provides valuable insights into the use of tourniquets in sickle cell disease.

PMID:40192787 | DOI:10.1007/s00264-025-06510-7

Int Orthop. 2025 Apr 4. doi: 10.1007/s00264-025-06513-4. Online ahead of print.

ABSTRACT

PURPOSE: This study investigated the relationship between BMI and microorganism profiles, with a particular focus on gut microorganisms in patients with PJI following total hip arthroplasty (THA). It also explored comorbidities, that may contribute to these variations.

METHODS: This study included all patients treated at our institution for a PJI of a THA between 1996 and 2021. Patients were categorized into four distinct BMI groups: <30; 30-34.9; 35-39.9; ≥ 40. Bivariate and logistic regression analysis were conducted, with presentation of odds ratio (OR) and 95% confidence interval (CI).

RESULTS: A total of 3645 hip PJI cases were recruited for the final analysis. Patients with a BMI ≥ 40 had approximately a ten fold higher risk for Streptococcus dysgalactiae (p < 0.001; OR = 9.92; 95% CI 3.87-25.44) and a seven fold higher risk for Proteus mirabilis (p < 0.001; OR = 7.43; 95% CI 3.13-17.67) and Klebsiella pneumoniae (p < 0.001; OR = 6.9; 95% CI 2.47-19.31). Furthermore, polymicrobial infections (p < 0.001; OR = 2.17; 95% CI 1.50-3.15) were found to be significantly more prevalent in patients with a BMI ≥ 40.

CONCLUSION: Obese patients (BMI ≥ 30) displayed a distinct microorganism profile in hip PJIs, mainly dominated by Firmicutes and Proteobacteria. Comorbidities such as diabetes, hypertension, and hyperlipidaemia may contribute to a leaky gut syndrome, increasing PJI risk caused by gut microorganisms. Optimizing comorbidities may help reduce the risk of hip PJI. Further research is needed to clarify the relationship between obesity, gut microbiome alterations and hip PJI development.

PMID:40183945 | DOI:10.1007/s00264-025-06513-4

Int Orthop. 2025 Apr 3. doi: 10.1007/s00264-025-06430-6. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: Standard recommendations for fast-track hip arthroplasty suggest using 8-10 mg of dexamethasone to reduce opioid consumption, with potential benefits of higher doses but scarce data on glycaemic control and complications. This study compares the effects of higher doses versus the standard doses on postoperative opioid consumption, and secondarily, numerical pain scale, glycaemic control, hospital length of stay and postoperative complications.

METHODS: Retrospective cohort study of patients scheduled for FAST-TRACK primary hip arthroplasty between 2016 and 2021. Propensity score-matched analyses compared the standard dose group (4-8 mg) versus the high-dose group (16-24 mg).

RESULTS: 168 patients were included (56 with 4-8 mg, 112 with 16-24 mg). After one-to-one propensity score matching, 52 patients were included in the standard group and 52 in the high-dose group. After matching, the median [IQR] opioid consumption in the low-dose group was 10 [0-12] and in the high-dose group was 0 [0-10], with a 95% CI of -1 to 0 (p = 0.016). In the matched group, there was a median difference of 8 mg/dL (95% CI, -2 to 7, P < 0.05) in the immediate postoperative glycaemia, of 17 mg/dl (95% CI, -2 to 14, P < 0.05) in glycaemia at 24 h and of -1 day (95% CI, -1 to 0, P < 0.05) in hospital stay. No differences in the numerical pain scale and postoperative complications were found.

CONCLUSION: High-dose dexamethasone slightly increased perioperative glycaemia while reducing opioid consumption and shortening hospital length of stay.

PMID:40178624 | DOI:10.1007/s00264-025-06430-6

Int Orthop. 2025 Apr 2. doi: 10.1007/s00264-025-06509-0. Online ahead of print.

ABSTRACT

PURPOSE: Pelvic ring and acetabular fractures pose significant morbidity and mortality risks due to substantial haemorrhage and internal organ injury. Many percutaneous reduction techniques involve manipulating the injured side while stabilizing the uninjured side, often requiring specific or costly equipment. This article presents a technique for creating a pelvic reduction frame using a standard external fixator.

METHOD: We included surgical pelvic ring fractures between 2018 and 2022. Pelvic reduction was achieved using an external fixator (Hoffmann III, Stryker Corporation, Kalamazoo, Michigan, USA). Reduction quality was assessed according to the technique described by Lefaivre et al., based on the following criteria: mean asymmetry (mm), mean deformity index (mm), and mean maximum horizontal or vertical displacement (mm).

RESULTS: 15 patients (10 men, 5 women, mean age 35 years) underwent surgical treatment for pelvic fractures using an external fixator and percutaneous fixation. Mean operative time was 130 min (range, 80-276). Postoperative imaging showed a mean maximum displacement of 5.4 mm and a mean asymmetry of 3.7 mm, with excellent or good reductions in 11 cases.

CONCLUSION: This system uses widely available equipment and enables the benefits of percutaneous techniques, but surgical expertise remains the key to success.

PMID:40172657 | DOI:10.1007/s00264-025-06509-0

Int Orthop. 2025 Apr 2. doi: 10.1007/s00264-025-06503-6. Online ahead of print.

ABSTRACT

PURPOSE: Effective patient comprehension is critical for informed consent, particularly in Total Hip Arthroplasty (THA), a globally prevalent procedure. This study evaluates the efficacy of an informational video to improve the patients' understanding, self-perceived knowledge, and emotional comfort in the context of THA informed consent. This randomized controlled trial investigates the impact of an additional informational video on (I) the patients' understanding, (II) self-precepted knowledge and (III) emotional comfort during the informed consent process for THA.

METHODS: Participants were randomized to receive either the standard informed consent procedure or the standard procedure supplemented with an informational video. The effect of the video was tested with post-consent questionnaires.

RESULTS: The informational video significantly (p = 0.014) improved the patients' understanding from 78.6% to 86.5%. Self-precepted knowledge and Emotional comfort was not effected by the video (p = 0.986; p = 0.333).

CONCLUSIONS: The informational video significantly improved patient comprehension during the informed consent process before THA.

PMID:40169412 | DOI:10.1007/s00264-025-06503-6

Int Orthop. 2025 Apr 1. doi: 10.1007/s00264-025-06511-6. Online ahead of print.

ABSTRACT

PURPOSE: The aim is to showcase the urgent need for improved data infrastructure and international collaboration by highlighting the barriers to comprehensive orthopaedic documentation and quantifying the scope and nature of scholarly research on Gaza's healthcare crisis.

METHODS: Data was collected through integration of observational field notes, informal interviews, patient record reviews and a bibliometric analysis of peer-reviewed articles on the 2023-2025 armed escalations in Gaza.

RESULTS: The review of patient documentation during surgical missions in Gaza revealed significant gaps in critical clinical information, including surgical history, microbiology data, and postoperative instructions, which hindered patient care. Frequent damage to records due to resource shortages and bombardments, along with issues in retrieving imaging data, further exacerbated these challenges. Bibliometric analysis showed that most studies were retrospective, focusing on trauma care and limb salvage, reflecting the difficulty of conducting prospective research in a conflict zone. Of the 114 publications reviewed, only three (2.6%) met inclusion criteria, with two of them involving Gaza-based Palestinian authors, despite barriers like power outages, limited journal access, and resource constraints.These findings highlight the resilience of Gaza's healthcare workers and the need for improved infrastructure, standardized documentation, and international partnership to enhance patient outcomes and strengthen global orthopaedic research.

CONCLUSION: Orthopaedic documentation in Gaza is hampered by the compound impacts of recurrent conflict, infrastructural decay, and constrained academic output. Observational findings reveal the fragility of paper-based systems, while a bibliometric survey underscores the paucity of locally driven, empirical research. International efforts are needed to overcome these barriers for improved data infrastructure.

PMID:40167759 | DOI:10.1007/s00264-025-06511-6

Int Orthop. 2025 Mar 31. doi: 10.1007/s00264-025-06515-2. Online ahead of print.

ABSTRACT

PURPOSE: In orthopaedic surgery, achieving optimal exposure for acetabular and pelvic ring fractures with minimal invasiveness remains a challenge. This study compares bone exposure in key pelvic zones using an endoscopic approach versus the AIP (Modified Stoppa) in cadaveric specimens.

MATERIALS AND METHODS: We dissected ten adult cadaveric bodies, obtained from our institution's body donation program, using an extraperitoneal endoscopic dissection on one side and an AIP approach on the other. Bone areas were marked at each step of dissection by drill holes to measure the bone exposure surface for each zone (true and false pelvis) between the laparoscopic and open approaches. A Student's t test was used to compare the exposure areas obtained.

RESULTS: The average age of the cadavers was 83 years, with a balanced representation of genders (60% male, 40% female). Comparison of zones between endoscopy and AIP found for Zone 1: 1.4 cm2 (range - 3.813 to 1.013) for AIP with no statistical significance. For Zone 2: 0.5 cm2 (range - 1.9141 to 2.9141) for AIP with no statistical significance. For Zone 3: 0,6 cm2 (range - 1.0243 to 2.2243) for AIP with no statistical significance. And for Zone 4: 3.5 cm2 (1.874; 5.126) for endoscopy with statistical significance (p = 0.001).

CONCLUSION: Our study demonstrates that the endoscopic method provides comparable visualization of the different pelvic zones compared to the open method (AIP), with enhanced access to Zone 4, a crucial area in managing acetabulum and pelvic ring fractures.

LEVEL OF EVIDENCE: Level V, cadaveric study.

PMID:40163078 | DOI:10.1007/s00264-025-06515-2

Int Orthop. 2025 Mar 29. doi: 10.1007/s00264-025-06484-6. Online ahead of print.

ABSTRACT

PURPOSE: Despite the increasing understanding of femoroacetabular impingement (FAI), the impact of specific patient characteristics, including inflammatory pathologies like axial spondyloarthritis (axSpA), on its pathophysiology and clinical outcomes following treatment remains inadequately defined. Therefore, the purpose of this scoping review was to evaluate the relationship between FAI and sacroiliac (SI) joint abnormalities and FAI and axSpA.

METHODS: The study was conducted following the framework established by Arksey and O'Malley and Levac et al., adhering to the PRISMA scoping review extension checklist. A systematic search was performed across MEDLINE, EMBASE, and Cochrane Library databases for articles published until August 2024. A total of 120 articles were screened and eight finally met the inclusion criteria.

RESULTS: The review analysed data from the eight retrospective studies with a total of 1,723 patients. We found that the prevalence of SI joint abnormalities in patients with FAI can be as high as 25-28%. Furthermore, the prevalence of FAI morphology in patients with axial spondyloarthritis can be as high as 20-37%. Finally, patients undergoing hip arthroscopy for FAI with axSpA and/or SI joint abnormalities have lower postoperative outcome scores reported in comparison with those patients who do not have these comorbidities.

CONCLUSION: Over a quarter of patients with FAI can have concomitant radiographic SI joint abnormalities. We cannot overemphasise the importance of assessing the spine, specifically the SI joint, and ruling out symptoms emanating from the SI joint in all patients with FAI. There is clearly a knowledge gap in understanding the underlying pathophysiology linking FAI and axSpA. We require further research to elucidate the underlying mechanisms of this relationship, standardise evaluation methods, and explore long-term outcomes in this cohort of patients.

PMID:40156722 | DOI:10.1007/s00264-025-06484-6

Int Orthop. 2025 Mar 29. doi: 10.1007/s00264-025-06514-3. Online ahead of print.

ABSTRACT

We discuss the study by Xiao Han et al., titled " Comprehensive Comparison Between Conservative Therapy and Surgical Management for Completely Displaced and Comminuted Mid-Shaft Clavicle Fractures " The authors compared outcomes between conservative and surgical treatments in 105 patients, finding higher union rates, faster healing, and no malunion in the surgical group, albeit with a notable incidence of postoperative numbness. While long-term functional outcomes were comparable, surgery offered quicker recovery of strength and return to work. However, as a retrospective study, potential selection bias exists-more active, younger patients tended to undergo surgery, while older patients with comorbidities opted for conservative care. The absence of propensity score matching (PSM) further limits comparability. Moreover, the relatively short follow-up (mean: 21.24 months) restricts insights into long-term complications. Previous long-term studies suggest surgical benefits may wane over time. Future randomized, long-term, and cost-focused studies would be valuable to guide treatment decisions more robustly.

PMID:40155447 | DOI:10.1007/s00264-025-06514-3

Int Orthop. 2025 Mar 28. doi: 10.1007/s00264-025-06505-4. Online ahead of print.

NO ABSTRACT

PMID:40152988 | DOI:10.1007/s00264-025-06505-4

Int Orthop. 2025 Mar 28. doi: 10.1007/s00264-025-06506-3. Online ahead of print.

ABSTRACT

PURPOSE: Firearm-related injuries in children and adolescents have increased over the past decade. The standard of care for ballistic fractures in children is complex, resulting in a burden of healthcare follow-up that many families find challenging. Consistent follow-up is crucial, especially in orthopaedic trauma and firearm cases, to prevent complications. This study aims to identify demographic and clinical variables associated with loss to follow-up (LTFU) in paediatric patients with ballistic fractures.

METHODS: This is a retrospective registry study at a Level I trauma centre for patients aged zero to 21 who presented with a ballistic-induced fracture. Patients with isolated skull, facial, or rib fractures were excluded. Follow-up was dichotomized at the median number of follow-up days for analysis. Logistic regression analysis was used to identify predictors of LTFU.

RESULTS: The study included 144 patients with a median age of 18 years. The majority were male (89%) and White (72%). Most patients had government insurance (44%) or were uninsured (33%). The mechanism of injury was primarily assault (71%). Operative intervention occurred in 55% of cases. Key factors increasing follow-up adherence included male sex (p = 0.011), higher injury severity scores (p = 0.009), requiring operative intervention (p < 0.001), air transportation (p < 0.001), or injury at a private residence (p = 0.040). Uninsured status (p = 0.007), opioid use (p = 0.047), and greater distance from the hospital (p = 0.002) were associated with low follow-up.

CONCLUSIONS: This study identifies key factors influencing follow-up adherence in pediatric patients with ballistic fractures. Identifying these factors allows for tailoring future interventions to improve follow-up adherence for this vulnerable population.

PMID:40152987 | DOI:10.1007/s00264-025-06506-3