JBJS

Preseason Patellar Tendon Thickness Predicts Symptomatic Patellar Tendinopathy in Male NCAA Division I Basketball Players

J Bone Joint Surg Am. 2025 Mar 18. doi: 10.2106/JBJS.24.00680. Online ahead of print.

ABSTRACT

BACKGROUND: The purpose of this study was to evaluate whether increased anteroposterior (AP) thickness of the proximal patellar tendon at preseason evaluation is predictive of symptomatic patellar tendinopathy and associated sequelae.

METHODS: Thirty-one male National Collegiate Athletic Association (NCAA) Division I basketball players voluntarily participated in this study (n = 52 tendons from 27 athletes after application of exclusion criteria, with evaluation at preseason, midseason, and postseason time points). At each time point, Victorian Institute of Sport Assessment-Patellar Tendon (VISA-P) scores, patellar tendon tenderness, patellar tendon AP thickness, and the presence of a proximal patellar tendon hypoechoic region were evaluated. Measurement of patellar tendon AP thickness and the identification of hypoechoic regions were performed using a portable ultrasound device. Outcome measures included a proximal patellar tendon hypoechoic region, a trip to the training room (TTR), time-loss symptomatic patellar tendinopathy (TLPT), and patellar tendon rupture. Covariates evaluated in the multivariable regression model included body mass index and a patient-reported history of patellar tendinopathy (α = 0.05).

RESULTS: The mean preseason tendon thickness was 4.78 ± 1.22 mm. Nine (17.3%) of the tendons were symptomatic to the point of requiring a TTR. Preseason tendon thickness was associated with increased odds of a TTR (adjusted odds ratio [aOR] = 3.68 [95% confidence interval (CI) = 1.73 to 7.81]; p < 0.01). The predicted probability of a TTR was 86.0% with a preseason tendon thickness of 8 mm versus 3.4% with a preseason tendon thickness of 4 mm. Preseason tendon thickness was also predictive of TLPT (aOR = 1.96 [95% CI = 1.03 to 3.71]; p = 0.04). Preseason VISA-P scores were not predictive of a TTR (p = 0.66) or TLPT (p = 0.60).

CONCLUSIONS: Increased patellar tendon thickness on preseason ultrasound is predictive of symptomatic patellar tendinopathy and associated sequelae during an NCAA Division I basketball season. Ultrasound identification of at-risk individuals may allow triage toward additional physical therapy and activity modification for these athletes to prevent progression to irreversible patellar tendon disease. These data support the use of ultrasound as a screening tool for elite jumping athletes.

LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

PMID:40100945 | DOI:10.2106/JBJS.24.00680

Anterior Glenohumeral Instability: Clinical Anatomy, Clinical Evaluation, Imaging, Nonoperative and Operative Management, and Postoperative Rehabilitation

J Bone Joint Surg Am. 2025 Jan 1;107(1):81-92. doi: 10.2106/JBJS.24.00340. Epub 2024 Nov 14.

ABSTRACT

➢ Anterior glenohumeral instability is a complex orthopaedic problem that requires a detailed history, a thorough physical examination, and a meticulous review of advanced imaging in order to make individualized treatment decisions and optimize patient outcomes.➢ Nonoperative management of primary instability events can be considered in low-demand patients, including elderly individuals or younger, recreational athletes not participating in high-risk activities, and select in-season athletes. Recurrence can result in increased severity of soft-tissue and osseous damage, further increasing the complexity of subsequent surgical management.➢ Surgical stabilization following primary anterior instability is recommended in young athletes who have additional risk factors for failure, including participation in high-risk sports, hyperlaxity, and presence of bipolar bone loss, defined as the presence of both glenoid (anteroinferior glenoid) and humeral head (Hill-Sachs deformity) bone loss.➢ Several surgical treatment options exist, including arthroscopic Bankart repair with or without additional procedures such as remplissage, open Bankart repair, and osseous restoration procedures, including the Latarjet procedure.➢ Favorable results can be expected following arthroscopic Bankart repair with minimal (<13.5%) bone loss and on-track Hill-Sachs lesions following a primary instability event. However, adjunct procedures such as remplissage should be performed for off-track lesions and should be considered in the setting of subcritical glenoid bone loss, select high-risk patients, and near-track lesions.➢ Bone-grafting of anterior glenoid defects, including autograft and allograft options, should be considered in cases with >20% glenoid bone loss.

PMID:40100014 | DOI:10.2106/JBJS.24.00340

The Impact of Sustained Outreach Efforts on Gender Diversity in Orthopaedic Surgery

J Bone Joint Surg Am. 2025 Jan 1;107(1):e1. doi: 10.2106/JBJS.24.00210. Epub 2024 Nov 22.

ABSTRACT

BACKGROUND: Orthopaedic surgery is one of the least gender-diverse surgical specialties, with only 7% women in practice and 20.4% in residency. There are numerous "leaks" in the talent pipeline for women orthopaedic surgeons that lead to the field as a whole falling short of a critical mass (30%) of women. For over a decade, a network of professional and nonprofit organizations, including the Ruth Jackson Orthopaedic Society, The Perry Initiative, Nth Dimensions, and others, have focused on targeted outreach and mentoring of women in the talent pipeline; they report a positive effect of these interventions on recruitment and retention of women in the field.

METHODS: In this study, we applied mathematical models to estimate the historic and future impacts of current outreach and hands-on exposure efforts to recruit more women into orthopaedic surgery. The model uses published data on program reach and impact from one of the largest and longest-running programs, The Perry Initiative, and combines it with AAMC and AAOS Census data. These data were used to forecast the percentage of women entering the profession as postgraduate year 1 (PGY1) residents and among practicing orthopaedic surgeons.

RESULTS: The results of the mathematical models suggest that the increase in women in the PGY1 population from 14.7% to 20.9% from 2008 to 2022 is at least partially attributable to current mentoring and outreach efforts by The Perry Initiative and others. Assuming continued intervention at present levels, the PGY1 residency class will reach peak diversity of 28% women in 2028, and the field as a whole will reach a steady-state composition of approximately 25% practicing women orthopaedic surgeons by 2055.

CONCLUSIONS: The results of this study indicate that outreach and exposure efforts, such as those of The Perry Initiative, are having a substantive impact on gender diversity in orthopaedic surgery. With continued intervention, the field as a whole should approach a critical mass of women within a generation. The collective efforts of the orthopaedics community over the past decade to close the gender gap serve as a guidebook for other professions seeking to diversify.

PMID:40100013 | DOI:10.2106/JBJS.24.00210

Thoracolumbar Fracture: A Natural History Study of Survival Following Injury

J Bone Joint Surg Am. 2025 Jan 1;107(1):73-79. doi: 10.2106/JBJS.24.00706. Epub 2024 Nov 19.

ABSTRACT

BACKGROUND: Fractures of the thoracic and lumbar spine are increasingly common. Although it is known that such fractures may elevate the risk of near-term morbidity, the natural history of patients who sustain such injuries remains poorly described. We sought to characterize the natural history of patients treated for thoracolumbar fractures and to understand clinical and sociodemographic factors associated with survival.

METHODS: Patients treated for acute thoracic or lumbar spine fractures within a large academic health-care network between 2015 and 2021 were identified. Clinical, radiographic, and mortality data were obtained from medical records and administrative charts. Survival was assessed using Kaplan-Meier curves. We used multivariable logistic regression to evaluate factors associated with survival, while adjusting for confounders. Results were expressed as odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS: The study included 717 patients (median age, 66 years; 59.8% male; 69% non-Hispanic White). The mortality rate was 7.0% (n = 50), 16.2% (n = 116), and 20.4% (n = 146) at 3, 12, and 24 months following injury, respectively. In adjusted analysis, patients who died within the first year following injury were more likely to be older (OR = 1.03; 95% CI = 1.01 to 1.05) and male (OR = 1.67; 95% CI = 1.05 to 2.69). A higher Injury Severity Score, lower Glasgow Coma Scale score, and higher Charlson Comorbidity Index at presentation were also influential factors. The final model explained 81% (95% CI = 81% to 83%) of the variation in survival.

CONCLUSIONS: We identified a previously underappreciated fact: thoracolumbar fractures are associated with a mortality risk comparable with that of hip fractures. The risk of mortality is greatest in elderly patients and those with multiple comorbidities. The results of our model can be used in patient and family counseling, informed decision-making, and resource allocation to mitigate the potential risk of near-term mortality in high-risk individuals.

LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:40100012 | DOI:10.2106/JBJS.24.00706

Clinical Outcomes After 1 and 2-Level Lumbar Total Disc Arthroplasty: 1,187 Patients with 7 to 21-Year Follow-up

J Bone Joint Surg Am. 2025 Jan 1;107(1):53-65. doi: 10.2106/JBJS.23.00735. Epub 2024 Nov 22.

ABSTRACT

BACKGROUND: In this study, we expand the supportive evidence for total disc arthroplasty (TDA) with results up to 21 years in a large patient cohort who received a semiconstrained ball-and-socket lumbar prosthesis. The objectives of the study were to compare the results for 1 versus 2-level surgeries and to evaluate whether prior surgery at the index level(s) impacts clinical outcomes.

METHODS: From 1999 to 2013, 1,187 patients with chronic lumbar degenerative disc disease (DDD) underwent lumbar TDA, of whom 772 underwent a 1-level procedure and 415 underwent a 2-level procedure. A total of 373 (31.4%) of the 1,187 patients had prior index-level surgery. Patients were evaluated preoperatively; at 3, 6, 12, 18, and 24 months postoperatively; and yearly thereafter. The follow-up duration ranged from 7 to 21 years (mean, 11 years and 8 months). Collected data included radiographic, neurological, and physical assessments, as well as self-evaluations using the Oswestry Disability Index (ODI) and visual analog scale (VAS) for back and leg pain. Perioperative data points, complication rates, and reoperation or revision rates were also assessed. Patients were divided into 4 groups: 1-level TDA with no prior surgery at the index level, 1-level TDA with prior surgery, 2-level TDA with no prior surgery, and 2-level TDA with prior surgery.

RESULTS: All groups showed dramatic reduction in the ODI at 3 months postoperatively and maintained these scores over time. Although VAS pain did not diminish to its final level as rapidly for patients with prior surgery, there was no significant difference between the groups in terms of pain reduction at 24 months postoperatively. Of 1,187 patients, 49 (4.13%) required either a new surgery at another level or revision or reoperation at the index level. Rates were too low in all groups to compare them statistically. Total TDA revision and adjacent-level surgery rates over 7 to 21 years were very low (0.67% and 1.85%, respectively).

CONCLUSIONS: This study demonstrates the robust long-term clinical success of 1 and 2-level lumbar TDA as assessed at 7 to 21 years postoperatively in one of the largest evaluated cohorts of patients with TDA. Patients had dramatic and maintained reductions in disability and pain scores over time and low rates of index-level revision or reoperation and adjacent-level surgery relative to published long-term fusion data. Additionally, patients who underwent 1-level lumbar TDA and those who underwent 2-level TDA demonstrated equivalent improvement, as did patients with prior surgery at the index level and those with no prior surgery.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:40100011 | PMC:PMC11665976 | DOI:10.2106/JBJS.23.00735

Intraoperative Facet Joint Block Reduces Pain After Oblique Lumbar Interbody Fusion: A Double-Blinded, Randomized, Placebo-Controlled Clinical Trial

J Bone Joint Surg Am. 2025 Jan 1;107(1):16-25. doi: 10.2106/JBJS.23.01480. Epub 2024 Nov 20.

ABSTRACT

BACKGROUND: Oblique lumbar interbody fusion (OLIF) results in less tissue damage than in other surgeries, but immediate postoperative pain occurs. Notably, facet joint widening occurs in the vertebral body after OLIF. We hypothesized that the application of a facet joint block to the area of widening would relieve facet joint pain. The purpose of this study was to evaluate the analgesic effects of such injections on postoperative pain.

METHODS: This double-blinded, placebo-controlled study randomized patients into 2 groups. Patients assigned to the active group received an intra-articular injection of a compound mixture of bupivacaine and triamcinolone, whereas patients in the placebo group received an equivalent volume of normal saline solution injection. Back and dominant leg pain were evaluated with use of a visual analog scale (VAS) at 12, 24, 48, and 72 hours postoperatively. Clinical outcomes were evaluated preoperatively and at 6 months postoperatively with use of the Oswestry Disability Index (ODI) and VAS for back and dominant leg pain.

RESULTS: Of the 61 patients who were included, 31 were randomized to the placebo group and 30 were randomized to the active group. Postoperative fentanyl consumption from patient-controlled analgesia was higher in the placebo group than in the active group at up to 36 hours postoperatively (p < 0.001) and decreased gradually in both groups. VAS back pain scores were significantly higher in the placebo group than in the active group at up to 48 hours postoperatively. On average, patients in the active group had a higher satisfaction score (p = 0.038) and were discharged 1.3 days earlier than those in the placebo group.

CONCLUSIONS: The use of an intraoperative facet joint block decreased pain perception during OLIF, thereby reducing opioid consumption and the severity of postoperative pain. This effect was also associated with a reduction in the length of the stay.

LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

PMID:40100010 | DOI:10.2106/JBJS.23.01480

Defining the Cost of Arthroscopic Rotator Cuff Repair: A Multicenter, Time-Driven Activity-Based Costing and Cost Optimization Investigation

J Bone Joint Surg Am. 2025 Jan 1;107(1):9-15. doi: 10.2106/JBJS.23.01351. Epub 2024 Nov 20.

ABSTRACT

BACKGROUND: Rotator cuff repair (RCR) is a frequently performed outpatient orthopaedic surgery, with substantial financial implications for health-care systems. Time-driven activity-based costing (TDABC) is a method for nuanced cost analysis and is a valuable tool for strategic health-care decision-making. The aim of this study was to apply the TDABC methodology to RCR procedures to identify specific avenues to optimize cost-efficiency within the health-care system in 2 critical areas: (1) the reduction of variability in the episode duration, and (2) the standardization of suture anchor acquisition costs.

METHODS: Using a multicenter, retrospective design, this study incorporates data from all patients who underwent an RCR surgical procedure at 1 of 4 academic tertiary health systems across the United States. Data were extracted from Avant-Garde Health's Care Measurement platform and were analyzed utilizing TDABC methodology. Cost analysis was performed using 2 primary metrics: the opportunity costs arising from a possible reduction in episode duration variability, and the potential monetary savings achievable through the standardization of suture anchor costs.

RESULTS: In this study, 921 RCR cases performed at 4 institutions had a mean episode duration cost of $4,094 ± $1,850. There was a significant threefold cost variability between the 10th percentile ($2,282) and the 90th percentile ($6,833) (p < 0.01). The mean episode duration was registered at 7.1 hours. The largest variability in the episode duration was time spent in the post-acute care unit and the ward after the surgical procedure. By reducing the episode duration variability, it was estimated that up to 640 care-hours could be saved annually at a single hospital. Likewise, standardizing suture anchor acquisition costs could generate direct savings totaling $217,440 across the hospitals.

CONCLUSIONS: This multicenter study offers valuable insights into RCR cost as a function of care pathways and suture anchor cost. It outlines avenues for achieving cost-savings and operational efficiency. These findings can serve as a foundational basis for developing health-economics models.

LEVEL OF EVIDENCE: Economic and Decision Analysis Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:40100009 | DOI:10.2106/JBJS.23.01351

Identifying Risk Factors from Preoperative MRI Measurements for Failure of Primary ACL Reconstruction: A Nested Case-Control Study with 5-Year Follow-up

J Bone Joint Surg Am. 2025 Mar 10. doi: 10.2106/JBJS.23.01137. Online ahead of print.

ABSTRACT

BACKGROUND: Identifying patients at high risk for failure of primary anterior cruciate ligament reconstruction (ACLR) on the basis of preoperative magnetic resonance imaging (MRI) measurements has received considerable attention. In this study, we aimed to identify potential risk factors for primary ACLR failure from preoperative MRI measurements and to determine optimal cutoff values for clinical relevance.

METHODS: Retrospective review and follow-up were conducted in this nested case-control study of patients who underwent primary single-bundle ACLR using hamstring tendon autograft at our institution from August 2016 to January 2018. The failed ACLR group included 72 patients with graft failure within 5 years after primary ACLR, while the control group included 144 propensity score-matched patients without failure during the 5-year follow-up period. Preoperative MRI measurements were compared between the 2 groups. Receiver operating characteristic (ROC) curve analyses were conducted to determine the optimal cutoff values for the significant risk factors. Odds ratios (ORs) were calculated, and survival analyses were performed to evaluate the clinical relevance of the determined thresholds.

RESULTS: A greater lateral femoral condyle ratio (LFCR) (p = 0.0076), greater posterior tibial slope in the lateral compartment (LPTS) (p = 0.0002), and greater internal rotational tibial subluxation (IRTS) (p < 0.0001) were identified in the failed ACLR group compared with the control group. ROC analyses showed that the optimal cutoff values for IRTS and LPTS were 5.8 mm (area under the curve [AUC], 0.708; specificity, 89.6%; sensitivity, 41.7%) and 8.5° (AUC, 0.655; specificity, 71.5%; sensitivity, 62.5%), respectively. Patients who met the IRTS (OR, 6.14; hazard ratio [HR], 3.87) or LPTS threshold (OR, 4.19; HR, 3.07) demonstrated a higher risk of primary ACLR failure and were significantly more likely to experience ACLR failure in a shorter time period.

CONCLUSIONS: Preoperative MRI measurements of increased IRTS, LPTS, and LFCR were identified as risk factors for primary ACLR failure. The optimal cutoff value of 5.8 mm for IRTS and 8.5° for LPTS could be valuable in the perioperative management of primary ACLR.

LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:40063685 | DOI:10.2106/JBJS.23.01137

Operative Treatment of Flail Chest Injuries Does Not Reduce Pain or In-Hospital Opioid Requirements: Results from a Multicenter Randomized Controlled Trial

J Bone Joint Surg Am. 2025 Mar 7. doi: 10.2106/JBJS.24.01099. Online ahead of print.

ABSTRACT

BACKGROUND: A previous randomized controlled trial (RCT) evaluating operative versus nonoperative treatment of acute flail chest injuries revealed more ventilator-free days in operatively treated patients who had been ventilated at the time of randomization. It has been suggested that surgery for these injuries may also improve a patient's pain and function. Our goal was to perform a secondary analysis of the previous RCT to evaluate pain and postinjury opioid requirements in patients with operatively and nonoperatively treated unstable chest wall injuries.

METHODS: We analyzed data from a previous multicenter RCT that had been conducted from 2011 to 2019. Patients who had sustained acute, unstable chest wall injuries were randomized to operative or nonoperative treatment. In-hospital pain medication logs were evaluated, and daily morphine milligram equivalents (MMEs) were calculated. The patients' symptoms were also assessed, including generalized pain, chest wall pain, chest wall tightness, and shortness of breath. Additionally, patients completed the 36-Item Short Form Health Survey (SF-36), and they were followed for 1 year postinjury.

RESULTS: In the original trial, 207 patients were analyzed: 99 patients received nonoperative treatment, and 108 received operative treatment. There were no significant differences in pain medication usage between the 2 groups at any of the examined time points (p = 0.477). There were no significant differences in generalized pain, chest wall pain, chest wall tightness, or shortness of breath at any time postinjury in the 2 groups. There were also no significant differences in the SF-36 scores.

CONCLUSIONS: This secondary analysis of a previous RCT suggested that operative treatment of patients with flail chest injuries does not reduce in-hospital daily opioid requirements. There were also no reductions in generalized pain, chest wall pain, chest wall tightness, or shortness of breath with operative treatment. The SF-36 scores were similar for both groups. Further work is needed to identify those patients most likely to benefit from operative treatment of flail chest injuries.

LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

PMID:40053576 | DOI:10.2106/JBJS.24.01099

Balancing Tumor Control and Cartilage Preservation for Patients with Giant Cell Tumor of Bone Around the Knee: A Clinical Report from a Single Institute

J Bone Joint Surg Am. 2025 Mar 6. doi: 10.2106/JBJS.23.01478. Online ahead of print.

ABSTRACT

BACKGROUND: When managing aggressive giant cell tumor of bone (GCTB) around the knee joint, surgeons are often caught in a dilemma when determining whether to perform marginal excision or intralesional curettage. The purpose of this study was to report the long-term results of different treatment strategies in our institute.

METHODS: We retrospectively reviewed 64 eligible cases (34 female and 30 male) with a GCTB (37 in the distal femur, 27 in the proximal tibia) treated from 2002 to 2013. Forty patients received intralesional curettage (group A). Twenty-four received marginal excision of the tumor, with 18 of them undergoing reconstruction with unicondylar osteoarticular allograft (UOA) (group B) and 6 receiving arthroplasty reconstruction (group C). The minimum follow-up was 8 years, and the oncological status, clinical outcomes, and cartilage condition were analyzed.

RESULTS: Tumor recurrence was most common in group A (10 of 40, 25.0%), followed by group B (1 of 18, 5.6%) and group C (0 of 6). Eleven patients in group A (27.5%) and 6 in group B (33.3%) developed osteoarthritis (Kellgren-Lawrence grade 3 or 4). Five patients in group A (12.5%) and 3 patients in group B (16.7%) received total knee arthroplasty. Risk factors for the development of osteoarthritis in group A included a centrally located tumor, tumor length of >6 cm, a tumor-cartilage distance of ≤3 mm, and >50% subchondral bone involvement. In group B, osteoarthritis mostly resulted from postoperative complications. The mean Musculoskeletal Tumor Society (MSTS) score was 87.9 in group A, 84.8 in group B, and 93.3 in group C.

CONCLUSIONS: Although intralesional curettage preserved cartilage and resulted in better function, it was associated with a higher tumor recurrence rate in our series. For advanced tumors close to the articular cartilage with significant subchondral bone involvement, marginal excision with UOA reconstruction might be a viable alternative. Arthroplasty should be reserved for patients who have bicondylar involvement with severe bone and cartilage loss making cartilage preservation impossible.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:40048502 | DOI:10.2106/JBJS.23.01478

Examining Preoperative Risk Factors for Nerve Injury in Pediatric Monteggia Fracture-Dislocations

J Bone Joint Surg Am. 2025 Mar 6. doi: 10.2106/JBJS.24.00640. Online ahead of print.

ABSTRACT

BACKGROUND: The risk factors for fracture-related nerve injury in pediatric Monteggia fracture-dislocations are not well understood. As such, this study aimed to determine the incidence of, and preoperative risk factors for, nerve injury in pediatric Monteggia fracture-dislocations.

METHODS: Patients aged ≤18 years with acute Monteggia or Monteggia-equivalent fracture-dislocations that underwent reduction in the operating room, including closed reduction and casting under general anesthesia and internal fixation of the ulnar fracture with or without opening the radiocapitellar joint, from 2011 to 2021 were retrospectively identified. Exclusion criteria included reduction in the emergency department, concomitant ipsilateral upper-extremity fractures, malunions, or patients without preoperative imaging. Nerve function was assessed preoperatively, and nerve injury was defined as persistent motor and/or sensory deficits on postoperative examination. Patients were followed until nerve-related symptoms resolved. Logistic regression controlled for age and fracture pattern to determine preoperative risk factors.

RESULTS: Of 148 patients (mean age, 6.4 ± 2.8 years), 18.2% (27) had preoperative nerve injury. The posterior interosseous nerve (PIN) was injured in 15 patients, the anterior interosseous nerve (AIN) was injured in 7 patients, and other nerves were injured in 6 patients. All the nerve injuries resolved spontaneously, with a mean resolution time of 63.6 days (range, 8 to 150 days). Risk factors for nerve injury included patient age of ≥8 years (odds ratio [OR], 7.7; 95% confidence interval [CI], 2.6 to 22.8; p < 0.001), lateral radial head dislocation (OR, 6.8; 95% CI, 2.0 to 22.4; p = 0.002), an open fracture (OR, 4.5; 95% CI, 1.2 to 16.5; p = 0.025), and a comminuted ulnar fracture (OR, 4.1; 95% CI, 1.4 to 12.2; p = 0.012). PIN injury was associated with lateral radial head dislocation (p < 0.001) and a comminuted ulnar fracture (p < 0.001). AIN injury was associated with an open fracture (p = 0.002) and diaphyseal ulnar fracture (p = 0.004).

CONCLUSIONS: The incidence of preoperative nerve-related injury in pediatric Monteggia fracture-dislocations was 18.2%. Risk factors for preoperative nerve injury included patient age of ≥8 years, lateral radial head dislocation, an open fracture, and a comminuted ulnar fracture. All the nerve injuries resolved within 150 days, suggesting that early operative intervention may be unnecessary.

LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:40048500 | DOI:10.2106/JBJS.24.00640

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