Objectives: To describe outcomes after distal humerus nonunion surgery and to identify risk factors for failure in the same population. METHODS: Design: Retrospective case series. Setting: Seven, academic, level I trauma centers. Patient selection criteria: Included were patients who underwent operative repair of a distal humerus (OTA/AO 13) nonunion and were ≥18 years old. Patients were excluded if they had clinical or serologic signs of infection prior to nonunion repair, or if their follow-up was less than 180 days and their surgery could not otherwise be classified as a success or failure. Outcome Measures and Comparisons: This study measured the rate of recalcitrant nonunion and complications following distal humerus nonunion surgery. It additionally evaluated associations between union rate and demographics, injury characteristics, and nonunion surgery characteristics. Results: Fifty-four patients with distal humerus nonunion were identified. Of the 30 included patients (mean age 47.5 (range 22-71), 18 (60%) male), 7 (23.3%) failed to unite after their index nonunion surgery at a study institution. Thirteen patients (43.3%) experienced one or more postoperative complications. While twenty-one of the 30 (70%) included patients initially sustained an open distal humerus fracture, all 7 patients (100%) who developed a recalcitrant nonunion initially sustained an open fracture. The use of bone graft or bone graft substitute relative to no graft, patient age, body mass index, smoking status, diabetes, and initial OTA/AO fracture classification were not associated with nonunion repair success rate (all p>0.05). Conclusion: This multicenter series challenged the concept that union rates are high, defined by the authors as >90%, following distal humerus nonunion surgery. Though limited by a small sample size that precluded multivariate regression, this study’s bivariate analysis suggests that an initially open distal humerus fracture may increase the risk of recalcitrant distal humerus nonunion. Modifiable risk factors were not associated with the success rate of nonunion surgery. These findings can be used to better inform patients’ expectations of results and complications following distal humerus nonunion surgery. Level of Evidence: Therapeutic level III
Objectives: To determine if porous threaded titanium implant (PTTI) screws placed in the posterior pelvic ring as iliosacral (IS) or transiliac-transsacral (transsacral) were associated with implant positional changes, alterations in postoperative weightbearing restrictions, or the necessity of revision surgery in operatively managed geriatric pelvic ring injuries, compared to standard stainless steel screws. Methods: Design: Retrospective cohort study. Setting: Academic Level I trauma center. Patient Selection Criteria: Patients with operatively managed pelvic ring injuries (AO/OTA61) from January 2017 to June 2025, aged ≥65 years with a minimum of 6-months of radiographic and clinical follow-up were included. Outcome Measures and Comparisons: The primary study outcome was the incidence of postoperative pelvic ring implant positional changes, ≥2mm from immediate postoperative radiographs compared among patients treated with PTTI versus standard stainless steel screws for IS and transsacral fixation. Secondary outcomes included subsequent revision surgery or alterations in postoperative weightbearing restrictions related to implant positional changes. A multivariable logistic regression was used to determine associations of demographic, injury, and treatment variables with implant positional changes, the necessity for revision surgery, or negative changes in postoperative weightbearing restrictions. Results: 271 patients were included; 215 (79.3%) were managed with standard screws, while PTTIs were used in 56 (20.7%). The standard screw cohort had a median follow-up of 8.9 months (interquartile range 6.2-11.3 months), while the PTTI cohort had a median follow-up of 9.1 months (interquartile range 6.3-10.9 months). Compared with the standard screw cohort, the PTTI cohort had a higher proportion of female sex (57.2% versus 73.2%, respectively; p=0.029) and a higher average age (74.0 years versus 78.6 years, respectively; p<0.001). Radiographic migration ≥2mm for posterior implants was observed in 18.1% of patients in the standard implant cohort versus 0.0% in the PTTI cohort (p<0.001). Implant migration >1cm was observed in 3.7% of patients in the standard implant cohort versus 0.0% in the PTTI group (p=0.231). The implant positional changes resulted in negative weightbearing restriction changes in 9 of 215 (4.2%) patients in the standard implant cohort compared with 0 of 56 in the PTTI cohort (p=0.120). Of the patients with standard implants, 9 (4.2%) underwent revision for posterior implant loosening, compared with 0 (0.0%) in the PTTI cohort. On multivariate analysis, posterior implant positional changes were associated with a protective effect from PTTI and anterior ring fixation (OR 0.1, 95% CI 0.0-0.7, p=0.023 and OR 0.2, 95% CI 0.1-0.4, p<0.001, respectively). The necessity for revision surgery or negative change in postoperative weightbearing restrictions was not significantly associated with PTTI use (OR 0.3, 95% CI 0.1-1.3, p=0.106). Conclusions: In geriatric pelvic ring injuries, PTTIs had no migration after placement and were associated with a lower incidence of any implant positional change and posterior implant positional changes. Level of Evidence: Prognostic Level III
Objectives: To compare the projected lifetime salary compensation of orthopaedic trauma surgeons in academic versus non-academic practice settings. Methods: This was a net present value (NPV) financial analysis and Monte Carlo simulation. Data were obtained for academic and non-academic orthopaedic trauma surgeons in the 2025 American Medical Group Association (AMGA) and Medical Group Management Association (MGMA) salary surveys. Lifetime salary compensation assuming different career lengths, discount rates, and career trajectories were compared between academic and non-academic practices. Results: Compensation per wRVU was consistently lower (range, 20.5%–23.5%) in academia across MGMA percentile benchmarks. With MGMA benchmarks, academic practice had lower lifetime salary compensation than non-academic practice for fixed salaries at the 25th percentile ($10.6 million vs $13.9 million, 23.7% lower), at the 50th percentile ($13.7 million vs $16.6 million, 17.5% lower), and at the 75th percentile ($18.4 million vs $19.7 million, 6.6% lower). Academic orthopaedic trauma surgeons required 4 to 24 additional years based on MGMA benchmarks and 5 to 8 additional years based on AMGA benchmarks to reach parity in lifetime salary compensation with non-academic orthopaedic trauma surgeons. Conclusions: Academic orthopaedic trauma practice was associated with lower lifetime salary compensation than non-academic practice. The gap was driven by lower compensation per wRVU and not by differences in clinical productivity.
OBJECTIVES: To characterize 30-year trends in the topics of abstracts presented at the Orthopaedic Trauma Association (OTA) Annual Meeting. METHODS: All OTA Annual Meeting abstracts from 1996 through 2025 were identified from the OTA online abstract archive. Two independent reviewers classified each abstract into 1 of 22 primary topic categories and recorded non-exclusive secondary research themes. Each category’s annual proportion of abstracts was compared across 3 eras (1996–2005, 2006–2013, and 2014–2025), and its temporal trend across calendar years was assessed. RESULTS: A total of 5,213 abstracts were included. From 1996–2005 to 2014–2025, the proportion of abstracts increased for hip and proximal femur trauma (7.7% to 14.4%; r = +0.79, P < 0.001), the most represented anatomic region in 2014–2025, and for health-systems research (12.6% to 19.1%; r = +0.64, P < 0.001). Geriatric (3.6% to 7.1%; r = +0.59, P < 0.001), arthroplasty for trauma (2.1% to 4.1%; r = +0.52, P = 0.003), and periprosthetic fracture (0.6% to 1.3%; r = +0.43, P = 0.018) themes also increased. Proportions declined for midfoot/hindfoot (6.3% to 1.8%; r = −0.75, P < 0.001), spine (3.3% to 0.7%; r = −0.74, P < 0.001), and pediatric trauma (5.4% to 1.9%; r = −0.66, P < 0.001). The proportion of randomized controlled trials did not change significantly (7.8%, 9.9%, and 5.4%; r = −0.21, P = 0.26). CONCLUSIONS: Over 30 years, the proportion of Orthopaedic Trauma Association Annual Meeting abstracts addressing hip and proximal femur trauma, health-systems research, geriatric care, arthroplasty for trauma, and periprosthetic fractures increased, whereas the proportions addressing spine, pediatric, and midfoot/hindfoot trauma declined. The hip and proximal femur trauma category became the most represented anatomic region by 2014-2025, and the proportion of randomized controlled trials did not change significantly over the study period.
OBJECTIVES: To determine the safety of early versus delayed weight bearing and effectiveness for improving return-to-work following ankle fracture repair. METHODS: Design : Prospective randomized study. Setting: 19 United States Trauma Centers Patient Selection Criteria: Adult patients (≥18 years) with ankle fracture (OTA/AO 44 A, B or C) undergoing surgical fixation were included. Open Gustilo-Anderson (G-A) Type IIIB, IIIC, syndesmotic injuries with fixation, and injuries with arterial impaction that surgeons felt unsafe to weight were excluded. Outcome Measures and Comparisons: The co-primary outcomes were (1) non-inferiority of early versus delayed weight bearing for reoperation for complications of hardware failure, non-union, loss of reduction, infection, or fusion; and (2) gated superiority of early versus delayed weight bearing for time to return-to-work, both within 365 days of randomization. Reoperation and time to return-to-work was compared between patients assigned to early (2 weeks post-operatively) versus delayed (6 weeks post-operatively) weight bearing. RESULTS: The modified intent to treat sample included 418 patients enrolled between January 2020 through October 2023; 214 early (mean age: 47; SD (15) range (18-84); 35% male); 204 delayed (mean age: 43; SD (15); 36% male). Reoperation for complication occurred in 5 early (2.3%, 95% Confidence Interval (CI): 0.3%, 4.4%), and 7 delayed patients (3.4%, 95% CI: 0.9%, 5.9%). Median time to return-to-work (95% CI) was 54 (42, 77) days and 69 (47, 89) days for the early and delayed groups, respectively. Early weight bearing was non-inferior to delayed weight bearing for reoperation (difference in complication free survival (early - delayed): 1.5 percentage points; 90% two sided CI: -1.7%, 4.8% which excluded the non-inferiority tolerance of -5.0%) and not superior for return-to-work (Hazard Ratio 1.1, 95% CI: 0.8, 1.6, p=0.475). CONCLUSIONS: Trial findings add to the growing evidence demonstrating the safety of early weight bearing after fixation of bimalleolar and trimalleolar ankle fracture without syndesmotic disruption, a key concern for both clinicians and patients. However, no statistically significant benefit of earlier return-to-work was found. LEVEL OF EVIDENCE: I
