The demographics and outcomes in patients with bilateral distal radius fractures.

Although distal radius fractures are quite common, bilateral distal radius fractures seldomly occur. Due to this, treatment is primarily based on surgeon experience with unilateral fractures, however bi- lateral fractures add a level of complexity : loss of functional independence. The purpose of this study was to examine a cohort of patients with bilateral distal radius fractures to identify differences in demographics, mechanism of injury, and outcomes to further our understanding of these rare injuries. 23 patients were identified retrospectively over a 5-year period that met inclusion criteria. The medical records were reviewed with multiple demographic and clinical parameters recorded and analyzed. Males were more likely to sustain high-energy mechanisms (80% vs. 53%). Patients(90% vs. 46%) and were more likely to be treated operatively (80% vs. 62%). The most commonly associated injury was a head injury (30%). All patients treated non-operatively reported minimal/no pain upon final follow-up where 57% of patients treated operatively noted regular pain. 75% of patients with medical comorbidities had minimal/no pain upon final follow- up. Conclusions : Patients with bilateral fractures were more likely to be younger males who suffered from higher energy mechanisms. Age was a critical factor in determining treatment strategy. Rates of associated head injuries were elevated, which is an important factor for the clinician to keep in mind when treating this population. As we further our understanding of this unique population, we can improve our treatment approaches and subsequently attain better outcomes

Does Use of Oral Anticoagulants at the Time of Admission Affect Outcomes Following Hip Fracture

Purpose: The purpose of this study was to compare hospital quality outcomes in patients over the age of 60 undergoing fixation of hip fracture based on their anticoagulation status. Materials and Methods: Patients aged 60 and older with isolated hip fracture injuries treated operatively at 1 academic medical center between October 2014 and September 2016 were analyzed. Patients on the following medications were included in the anticoagulation cohort: warfarin, clopidogrel, aspirin 325 mg, rivaroxaban, apixaban, dabigatran, and dipyridamole/aspirin. We compared outcome measures including time to surgery, length of stay (LOS), transfusion rate, blood loss, procedure time, complication rate, need for intensive care unit (ICU)/step-down unit (SDU) care, discharge disposition, and cost of admission. Outcomes were controlled for age, Charlson comorbidity index (CCI), and anesthesia type. Results: A total of 479 hip fracture patients met the inclusion criteria, with 367 (76.6%) patients in the nonanticoagulated cohort and 112 (23.4%) patients in the anticoagulated cohort. The mean LOS and time to surgery were longer in the anticoagulated cohort (8.3 vs 7.3 days, P = .033 and 1.9 vs 1.6 days, P = .010); however, after controlling for age, CCI, and anesthesia type, these differences were no longer significant. Surgical outcomes were equivalent with similar procedure times, blood loss, and need for transfusion. The mean number of complications developed and inpatient mortality rate in the 2 cohorts were similar; however, more patients in the anticoagulated cohort required ICU/SDU-level care (odds ratio = 2.364, P = .001, controlled for age, CCI, and anesthesia). There was increased utilization of post-acute care in the anticoagulated cohort, with only 10.7% of patients discharged home compared to 19.9% of the nonanticoagulated group ( P = .026). Lastly, there was no difference in cost of care. Conclusion: This study highlights that anticoagulation status alone does not independently put patients at increased risk with respect to LOS, surgical outcomes, and cost of hospitalization

The Proximal 5th Metatarsal Fracture: A Spectrum of Misunderstood Fractures

Category: Midfoot/Forefoot; Trauma Introduction/Purpose: Several different types of 5th metatarsal fractures exist and are treated with various methods of immobilization, weight bearing restrictions, and occasionally operative procedures. The purpose of this study was to evaluate the differences in clinical and radiographic outcomes between pseudo-Jones fractures (Zones 1 and 2 of the 5th MT base), True Jones fractures (Zone 3), and 5th MT shaft fractures. Methods: This was a retrospective cohort study of patients presenting to a single large, urban, academic medical center with any 5th MT fracture between 2012 and 2022. Inclusion criteria for this analysis included patient follow up until there was evidence of radiographic healing, clinical healing, or duration greater than one year following injury. Radiographs obtained at the initial presentation were reviewed and fracture patterns were categorized as either Zone 1, Zone 2, Zone 3, or Shaft. Linear regression models were used to evaluate the effect of fracture type on the duration of healing when controlling for age, sex, BMI, smoking status, and history of diabetes. 1,279 patients with 5th metatarsal fracture met the inclusion criteria and were included in the analysis (mean age 49.2 +/- 17.9 years). Overall, 5.2% were treated in a splint or cast, 67.5% in a CAM boot, 20.3% in a hard sole shoe, and 7.0% without immobilization. Results: 31.2% of patients were non-weight bearing, 8.1% partial weight bearing, and 60.7% weight bearing as tolerated. There was no difference in time to radiographic union (p=0.946) or time to clinical healing (p=0.520) between any of the fracture types. Similarly, there was no difference in the proportion of patients with incomplete radiographic healing at 6 months (p=0.310) and at 1 year after injury (p=0.552) based on the fracture type. Likewise, there was no difference in any clinical or radiographic healing parameter based on fracture type for patients treated operatively. Based on linear regression model, there was no difference in the time to clinical or radiographic healing when controlling for confounding factors. Conclusion: All commonly occurring 5th metatarsal fractures, including those of both the metatarsal base and the shaft, demonstrate similar times to clinical and radiographic healing

Operative Treatment of Jones Fractures (OTA Type 87,5.2A) is not Associated with Earlier Clinical or Radiographic Healing

Category: Midfoot/Forefoot; Trauma Introduction/Purpose: The purpose of this study was to compare the time to radiographic and clinical healing between patients with metadiaphyseal metatarsal fractures (True Jones) treated operatively and those treated nonoperatively. Methods: This was a retrospective cohort study of patients presenting to a single large, urban, academic hospital center with Jones fractures between December 2012 and April 2022. Jones fractures were defined as 5th metatarsal base fractures occurring in the proximal metadiaphyseal region, just distal to the articulation of the 4th and 5th metatarsals on the oblique radiographic view (Zone 3). Information regarding patient demographics, injury mechanism, clinical presentation, management, and time to healing was collected. A fracture was defined as clinically healed when the patient had returned to their baseline ambulatory status without pain and there was an absence of tenderness to palpation on physical examination. Radiographic healing was defined as the presence of complete osseous consolidation. A total of 2,466 patients presented with 5th metatarsal fractures during the study period. Results: Among all 5th metatarsal fractures, 170 patients (6.9%) were classified as “true Jones” fractures. The mean age of patients presenting with Jones fractures was 46.1 +/- 18.6 years, and 65.8% were female. 19.9% were treated operatively (92.9% with screw fixation and 7.1% with ORIF), and 80.1% were treated nonoperatively. 95.9% of patients with Jones fractures went on to heal with no difference in time to radiographic healing (p = 0.296) or clinical healing between both groups (p = 0.228). Furthermore, there was no difference between groups with respect to the proportion of patients who developed delayed radiographic union with incomplete osseous healing at 6 months post-injury (9.3% in the nonoperative group versus 10.7% in the operative group, p = 0.098). Conclusion: Contrary to popular opinion, operative treatment of true Jones fractures was not associated with faster or more reliable radiographic union or time to clinical healing compared to patients treated nonoperatively. The overall rate of nonunion in true Jones fractures was found to be lower than previously described, and there was no evidence of any difference in nonunion rate with operative treatment compared to nonoperative management