The objective of this study was to evaluate the rate of nonunion repair success in tibia nonunions treated with exchange nailing. This retrospective cohort study was conducted across five academic Level 1 trauma centers and included 63 patients with tibia nonunions. Patients who sustained a tibia fracture (AO/OTA 42) treated with intramedullary fixation that developed a nonunion and were subsequently treated with exchange nailing were retrospectively reviewed. The primary outcome measure was nonunion repair success based on osseous union. Additional analyses included union rate by AO/OTA classification, nonunion type, implant(s) used, graft used, time from initial procedure, and infection status. All patients sustained an AO/OTA type 42 fracture. Out of 63 patients, 47 tibias (75
BACKGROUND:This study evaluated the efficacy of woodcast (WC) versus thermoplastic (TP) splints for postoperative immobilization following carpometacarpal (CMC) joint suspensionplasty. The hypothesis was that WC splints would provide improved efficacy and compliance compared with TP splints, while also reducing waste generation. METHODS:A prospective, randomized controlled trial enrolled 26 patients, all older than 18 years old, undergoing CMC joint suspensionplasty. Participants were randomized to receive postoperative splinting with either a WC or TP splint. Exclusion criteria included additional procedures on the same arm or surgeon-determined unsuitability. Outcomes assessed included patient comfort, compliance, satisfaction, complication rates, and quantity of waste material generated by each splint type. RESULTS:The TP group demonstrated higher splint compliance and fewer splint-related complications than the WC group. Both groups reported similar satisfaction concerning their splints and overall treatment. However, the WC group generated significantly less waste (3.14 ± 1.38 g) compared with the TP group (20.88 ± 9.64 g), an 85% reduction. Functional outcome scores (Quick Disabilities of Arm, Shoulder, and Hand, Patient-Rated Wrist Evaluation, visual analog scale) were similar between groups at all time points. CONCLUSIONS:Thermoplastic splinting resulted in greater compliance and fewer complications but generated substantially more waste than WC splinting. As both splint types yielded comparable functional outcomes, the choice of splinting material should account for therapist expertise and health care waste considerations. The findings support exploring alternative biodegradable splint materials that support waste management without compromising patient care.Randomized Controlled Trial: ClinicalTrials.gov ID: NCT06876350.
Background:Precision in glenoid baseplate placement is paramount to optimize fixation and longevity of reverse total shoulder arthroplasty (rTSA). Robotic assistance has recently been shown to improve mean accuracy in component positioning, but its most meaningful benefit may be the prevention of severe outliers-the "tail-risk" events that disproportionately compromise outcomes and inflate costs. This study sought to quantify and compare the frequency of outliers across 3 glenoid preparation techniques: manual, manual assisted with patient-specific instrumentation (PSI), and robotic arm-assisted preparation using the Mako System (Stryker, Kalamazoo, MI). Methods:Using data from a comparative study of bone matrix models, we performed Monte Carlo simulations of 100,000 glenoid baseplate implantations per technique (manual, PSI, robotic-assisted). Parameters compared across techniques included glenoid component version, inclination, anteroposterior translation, superoinferior translation, and depth of reaming. Outliers were prespecified as cases exceeding both >10° angulation and >5 mm translation deviations from the pre-operative plan. Results:The modeled error distributions narrowed progressively from manual to PSI to robotic techniques. Outlier frequencies were 24% for manual, 2% for PSI, and 0% for robotic assistance (95% confidence interval, 23.9%-24.5%; 1.85%-2.02%; 0.00%-0.0038%, respectively). Robotic assistance completely eliminated outlier malposition events. Conclusion:Mako robotic-assisted glenoid preparation in reverse total shoulder arthroplasty appears to virtually eliminate the occurrence of high-risk baseplate malposition outliers. When value is framed through tail-risk rather than mean accuracy, the principal contribution of robotic assistance in shoulder arthroplasty lies in risk containment, with potential, although unproven to date, clinical and economic implications. Further research linking its use to patient outcomes is warranted, as it may ultimately redefine the technology's value proposition.
OBJECTIVES:To describe the injury characteristics, treatment methods, and maternal and fetal perioperative outcomes among pregnant patients with pelvic ring and acetabular fractures. METHODS: DESIGN:Multisite retrospective cohort study. SETTING:Nine Level I trauma centers. PATIENT SELECTION CRITERIA:Adult pregnant patients who presented with pelvic ring or acetabular fractures (AO/OTA 61A-C and/or 62A-C) were included. Patients with trace amounts of human chorionic gonadotropin due to recent miscarriages or deliveries were excluded. OUTCOME MEASURES AND COMPARISONS:Demographics, concomitant injuries, treatment methods, and perioperative clinical outcomes for both mother and fetus were abstracted and described. Comparisons were made between patients who presented with intrauterine fetal demise (IUFD) and those who did not, as well as between patients treated operatively and nonoperatively. RESULTS:Seventy-eight female patients were identified, with 68% having pelvic ring fractures, 22% acetabular fractures, and 10% combined fractures. Median age was 25.4 years (range 18-40 years). The median Injury Severity Score (ISS) was 22. Patients' gravid status was evenly distributed by viability (51.3% viable). One-third of the patients arrived with IUFD (n = 25/78), and those with IUFD had higher ISS (median ISS 30.5 in IUFD group, 16.9 in non-IUFD group). Of the remaining 53 patients, 64% were indicated for surgery, and 36% were treated nonoperatively. Maternal complications occurred in 8% of patients (n = 1/19, 5.3% nonoperative; n = 2/19, 10.5% operative). Among patients who did not arrive with IUFD or deliver their baby before orthopaedic management, fetal complications (premature delivery, miscarriage, and neonatal death) occurred in 28.9% (n = 11/38). Fetal complications were lower in the group treated operatively (n = 4/19, 21.1%) as compared with the nonoperative group (n = 7/19, 36.8%). Miscarriages specifically were similar between these groups (n = 3, 15.8% nonoperative; n = 2, 10.5% operative). CONCLUSIONS:Fractures of the pelvic ring/acetabulum in pregnant patients frequently result in IUFD at presentation or during the hospital stay. Surgical management added minimal additional risk to the fetus. Miscarriage rates were similar among patients treated surgically and those managed nonoperatively. LEVEL OF EVIDENCE:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Importance:Oxycodone and hydrocodone are the most frequently prescribed opioids for postoperative joint arthroplasty pain, yet comparative effectiveness data remain limited. Objective:To compare postoperative pain outcomes and opioid consumption for hydrocodone vs oxycodone among patients undergoing elective joint arthroplasty. Design, Setting, and Participants:This cohort study was a preplanned secondary analysis of a randomized clinical trial conducted among cytochrome P450 2D6 (CYP2D6) normal metabolizers (NMs) who underwent elective joint arthroplasty in 5 US surgery clinical sites from March 2021 to September 2023 and received hydrocodone or oxycodone postoperatively. Follow-up concluded in March 2024. Data analysis was conducted from October 2024 to December 2025. Exposure:Postoperative analgesia with hydrocodone or oxycodone within a multimodal pain management approach (opioids and nonopioids). Main Outcomes and Measures:Coprimary outcomes were composite pain score at postoperative day 10 (sum of current, worst, and mean pain over 7 days; range 3-15) and cumulative morphine milligram equivalents (MMEs) over 10 days. Secondary outcomes included mobility scores at day 10 and Patient-Reported Outcomes Measurement Information System anxiety and depression scores at day 30. Multivariable regressions were adjusted for demographic and clinical covariates. Results:Among 663 participants (mean [SD] age, 66 [10.6] years; 384 [57.9%] female), 217 received oxycodone and 446 received hydrocodone. Hydrocodone was associated with significantly lower composite pain scores compared with oxycodone (mean [SD], 9.0 [2.0] vs 9.3 [2.2]; adjusted P = .001) and significantly lower cumulative MME (mean [SD], 93.5 [159.3] vs 154.5 [121.6]; adjusted P < .001). Secondary outcomes did not differ between groups (mobility score: mean [SD], 26.3 [10.4] vs 30.9 [14.7]; P = .29; anxiety score: mean [SD], 45.4 [8.3] vs 45.5 [8.7]; P = .31; depression score: mean [SD], 43.8 [7.8] vs 44.0 [7.9]; P = .97). Findings were consistent in sensitivity analyses, restricting to opioid and acetaminophen combinations, restricting to sites prescribing both opioids, and in subgroups of knee arthroplasty, but not consistent in hip arthroplasty. Conclusions and Relevance:In this cohort study of CYP2D6 NMs undergoing joint arthroplasty, within multimodal analgesia, hydrocodone provided comparable pain control to oxycodone with significantly lower opioid exposure, supporting its use as a viable and possibly preferable analgesic option.
