Gregory J. Della Rocca

Purpose: To compare reoperation rates and radiographic outcomes between parasymphyseal fracture location and those in extra-symphyseal zones for lateral compression (LC) pelvic ring injuries. Methods: This retrospective study included patients with acute, operatively treated LC injuries. Anterior ring fractures were classified based on a modified Nakatani classification as parasymphyseal (zone Ia), extra-symphyseal (zone Ib), zones II or III. Patient, fracture and implant characteristics were collected. The primary outcome was unplanned reoperation; secondary was radiographic loss of reduction. Comparisons were made across zones, with a sub-analysis restricted to LC1 injuries. Multivariable logistic regression was performed. Results: Among 275 LC injuries (mean age 59.8 ± 21.3 years; 56% [n = 155] female; reoperation rates were 6.5% (n = 18) overall and did not differ significantly across zones (Ia 12% [7/60], Ib 5.7% [3/53], II 6.8% [7/103], III 1.7% [1/59]; p = 0.2). Radiographic deformity differed significantly across zones (Ia 27% [16/60], Ib 23% [12/53], II 24% [25/103], III 3.4% [2/59]; p = 0.004), driven by the markedly lower rate in zone III. Multivariable regression confirmed deformity was associated with the low rate in zone III, while older age (OR 1.02 per year, 95% CI 1.00–1.04) and ramus comminution (OR 2.11, 95% CI 1.06–4.20) were independently associated with deformity. Reoperation did not differ by zone. When restricted to 183 LC1 injuries (mean age 64.1 ± 19.5 years; 61% [n = 112] female), findings were similar. Conclusion: Parasymphyseal fractures represent a challenging LC cohort. Loss of reduction is common but driven primarily by comminution and patient age rather than fracture location alone.

Objective: Surgical Site Infections (SSIs) are a serious complication in orthopedic surgery, While isotonic saline has long been considered the gold standard for wound irrigation, the current rate of SSIs and the recent saline shortage in 2024 have prompted consideration for using other types of wound irrigation. Vashe Wound Solution (Urgo Medical, Fort Worth, TX, USA) is a pure hypochlorous acid solution that kills bacteria and biofilms by disrupting cell membranes. However, Vashe, in its current commercial product, is not terminally sterilized and there is concern that there is an increased risk of infection. It was hypothesized that Vashe is not inferior to isotonic saline in orthopedic surgery. Methods: With institutional review board approval, a retrospective chart review was performed to include patients treated by our orthopedic trauma service. The final cohort included 100 patients in the Vashe group and 201 patients in the isotonic saline group. Data collected included patient demographics, type of injury, surgical procedure, the type and amount of solution used for irrigation and postoperative complications. Results: There were no statistically significant differences between the two groups regarding postoperative infection, adverse events or complications. Conclusion: The results of this study demonstrate that the use of Vashe for irrigation in orthopedic surgery is safe and is not inferior to isotonic saline.

Purpose This study evaluates the long-term outcomes following below-knee amputation (BKA), focusing on reoperations, readmissions, complications and mortality at 180 and 365 days. It aims to identify key risk factors and address the underreporting of long-term outcomes. Methods This retrospective study analyzed adult BKA patients (2005–2022) at a Level I trauma center, analyzing demographics, surgical details, and comorbidities to assess long-term outcomes using statistical analyses (p < 0.05). Results The study assessed 376 BKAs. Patients had a mean age of 51.4 years and body mass index (BMI) of 32.7 kg/m². Complications occurred in 62.5% of cases; 28.2% had direct surgical complications, and 25.8% required unplanned reoperations. Readmission rates were 10.1% by 30 days, 29.8% by 180 days, and 32.98% by 365 days. Diabetes mellitus (DM) (OR 1.98; p = 0.0115) and insurance status were associated with increased readmission. Younger age (OR 0.96; p = 0.001) and employment status were associated with higher odds of direct complications, while diabetes (OR 2.47; p < 0.001) and poor glycemic control (A1c > 5.83%) predicted indirect complications. Mortality increased from 2.7% by 30 days to 17.0% by 1 year and was independently associated with cancer (OR 4.37; p = 0.005), myocardial infarction (MI), chronic obstructive pulmonary disease (COPD), peripheral vascular disease (PVD), and prior vascular intervention (VI). Conclusion A substantial proportion of BKA complications and deaths occur beyond 30 days. Risk-tailored perioperative management and extended follow-up are essential to improving patient outcomes and reducing long-term healthcare burdens.

Category: Ankle; Trauma Introduction/Purpose: Existing literature has established that obese patients have nearly double the risk of sustaining an ankle fracture when compared to a non-obese population. However, few studies have investigated obesity’s effect on fracture complications and patient reported outcomes (PROs) when patients are stratified by fracture type. Furthermore, as the average body mass index (BMI) of our population steadily rises, it becomes prudent to investigate variations in complications rates and patient reported outcomes in various stages of obesity. The aim of this study is to identify trends in complication rates and patient reported outcome scores among patients of different BMI before and after dividing by fracture complexity. Methods: We retrospectively assessed clinical and surgical data from 595 patients who underwent ankle fracture surgery at a single institution between 2017 and 2021 for surgical related complications. All patients had a minimum of 18 months follow up (mean-42.2 [18.2-71.4] months). PROMIS Physical Health and Visual Analog Scale pain scores surveys were available only for patients receiving surgery after November 2019. We aggregated survey data for timepoints between three months and two years post-operatively to assess only patients with meaningful clinical data in regard to their recovery. Patients were divided based on BMI and fracture type. BMI subgroups were classified as: Non-obese (18.5-24.9 kg/m², n=88), Overweight/Obese I (25-34.9 kg/m², n=314), Obese II/III (≥35 kg/m², n=192). Fracture subgroups were divided into two groups: Simple (Unimalleolar types) and complex (Bimalleolar and Trimalleolar variants). Data analysis was performed using Chi-Square and T-Tests with statistical significance set at an alpha (α) of ≤ 0.05. Results: We observed a whole cohort complication rate of (15.3%, n=91/594). Complication rates when stratified by BMI were: Non-obese (12.3%, n=9), Overweight/Obese class I (19.4%, n=61), Obese class II/III (10.3%, n=20). Complication rates for Overweight/Obese I patients were significantly higher when compared to Non-obese patients (p=0.044, OR=2.11). However, there was no significant difference when comparing Non-obese to Class II/III (p=0.972). We observed no significant differences in complications when performing a sub analysis on specific fracture types, regardless of BMI group. Pain scores were significantly higher in both Overweight/Obese I and Obese II/III groups when compared to Non-Obese patients (p= < 0.001, p=0.015). Physical health scores were significantly lower only in the Obese II/III group when compared to Non-Obese patients (p=0.011). Conclusion: Our results indicate that patients who are Overweight/Obese I have a significantly higher risk of complication when compared to patients of normal BMI. Surprisingly, our cohort demonstrated nearly equivalent risk between Obese II/III and Non- obese patient groups. Patient reported outcome data shows different trends with worse pain scores and lower physical health outcomes in the Obese II/III group. These findings add to the growing debate surrounding obesity’s effect on ankle fracture complication rates as well as patient reported outcomes and suggest that increased BMI cannot be viewed purely as a one-to-one relationship with negative outcomes.