Ahmed Nageeb Mahmoud

Background/Objectives: Tree stand falls have become one of the leading causes of hunting-related injuries in the United States, surpassing firearm incidents. These injuries often result in significant morbidity, particularly musculoskeletal trauma, yet detailed anatomical stratification of fractures remains underreported. The purpose of this study is to classify and analyze the anatomical distribution of musculoskeletal injuries sustained from tree stand falls during deer hunting and to describe associated demographics, injury severity, and resource utilization in a rural health system. Methods: A retrospective review was conducted on patients aged ≥18 years who presented to a Level I or II trauma center in central Pennsylvania between 2005 and 2020 following a tree stand fall. Data were extracted from electronic medical records and trauma registry, including demographics, mechanism of injury, fracture location, Injury Severity Score (ISS), Intensive Care Unit (ICU) admission, and discharge disposition. Two orthopedic surgeons independently reviewed radiographs for accuracy. Results: A total of 144 patients were included (mean age was 53.0 ± 14.6 years; 143 of 144 were male). Falls had a median height of 15 ft (range, 2–45 ft), with harness use documented in only 2 patients. The mean ISS was 11.97 (range 2–36). Twenty patients required ICU admission (mean stay 4.8 days), and seven required mechanical ventilation. Most injuries occurred between October and December. Fractures most frequently involved the spine (36.3%), followed by the thorax (ribs and sternum; 36.1%), the hip and lower extremity (9.0%), the pelvis (9.0%), the shoulder and upper extremity (6.0%), and the skull and facial bones (3.5%). No fatalities were recorded. Conclusions: Tree stand falls during deer hunting result in complex, multi-system injuries with high resource utilization but low mortality. Spine and thorax fractures predominate, underscoring the need for trauma centers serving hunting communities to maintain subspecialty capabilities in orthopedic, spine, thoracic, and multidisciplinary trauma care. Preventive strategies, including targeted safety education during peak hunting months, may be implemented to potentially reduce injury burden.

The peroneus longus tendon has emerged as a viable autograft choice for single‐bundle anterior cruciate ligament reconstruction. However, ankle donor‐site morbidity remains a significant concern. More recently, the anterior half of the peroneus longus tendon has been suggested as an alternative graft to avoid possible ankle morbidity. However, when harvested through a retromalleolar incision, its usable length may be insufficient for preparing an anterior cruciate ligament graft with an adequate diameter. Our technique for inframalleolar harvest of a partial‐thickness peroneus longus tendon aims to provide a longer tendon length sufficient for preparing an anterior cruciate ligament graft of adequate diameter.

(1) Background: Neurological and cognitive disorders increase with age, raising risks of falls, poor bone health, and hip fractures. While previous studies found increased complications of hip arthroplasty in neurologic disorders in general, no studies have specifically focused on hip hemiarthroplasty (HA) for femoral neck fractures in patients with epilepsy. This retrospective study aimed to evaluate the outcomes of HA in hip fracture patients with epilepsy. (2) Methods: After IRB approval, all HA cases performed in our multi-hospital health system were reviewed. Included were patients who underwent HA for hip fracture and had a documented diagnosis of epilepsy. Cases with missing follow-up data or secondary epilepsy due to associated neurological conditions were excluded. A total of 69 cases (68 patients) were included. (3) Results: The cohort included 43 females and 25 males, with a mean age of 73.7 years. After a mean follow-up of 58.1 months, complications included prosthetic joint infections (8.7%), periprosthetic fractures (8.7%), acetabular erosion (1.45%), and dislocation (1.45%). Mortality rates were 4.4% at 3 months, 16.18% at 12 months, and 38.24% at 3 years. Given the retrospective, non-comparative design and small sample size, these findings are descriptive and do not establish causality between epilepsy and complication risk. (4) Conclusions: Periprosthetic fractures and prosthetic joint infections were the most common complications after HA in patients with epilepsy. Larger multicenter studies are recommended.

OBJECTIVES: To determine when patients with surgically treated right femoral fractures achieve objective criteria for driving readiness after surgery. METHODS: Design : Prospective cohort study. Setting: Single Level I trauma center. Patient Selection Criteria: Patients aged ≥18 years who are licensed drivers and sustained a surgically treated right femoral fracture (OTA/AO 31–33) at a single Level I trauma center were prospectively enrolled after surgery between 2020 and 2024 and underwent braking simulator testing during postoperative follow-up visits. Patients were weight-bearing as tolerated at the time of testing, and those with associated fractures or neurologic deficits were excluded. Outcome Measures and Comparisons: Brake reaction time (BRT) and maximum brake force (BF) were measured using a custom braking simulator during postoperative visits. Driving readiness was defined as BRT 350 N, consistent with conservative published thresholds. Patients were classified as meeting both thresholds (I), BRT only (II), BF only (III), or neither (IV), and category distributions were reported across four postoperative intervals: 1–25, 26–75, 76–125, and >125 days. RESULTS: Forty-five patients were included in this study. Patients were 23 females and 22 males, with a mean age of 58.9 years (range, 18-90). The number of simulator tests performed was 18 at 1–25 days, 33 at 26–75 days, 25 at 76–125 days, and 24 at >125 days. Within the first 25 postoperative days, one patient met both thresholds, while 50% were category III-IV. Mean brake reaction time was 0.87 ± 0.40 seconds at 26–75 days and 0.77 ± 0.22 seconds at 76–125 days, while mean maximum brake force was 333.1 ± 136.9 N and 352.6 ± 110.0 N, respectively. At >125 days postoperatively, a majority of testing observations met both thresholds, with 62.5%, 12.5%, 20.8%, and 4.2% falling into categories I, II, III, and IV, respectively. CONCLUSIONS: Patients with right femoral fractures generally did not meet the predefined simulator braking time thresholds in the first 25 days postoperatively, whereas a majority first met both thresholds after 125 days. Simulator-based assessment may help guide individualized postoperative counseling. LEVEL OF EVIDENCE: Level II

Antibiotic-loaded cement hip spacers are a cornerstone in the management of prosthetic and native hip infections before second-stage arthroplasty. However, complications such as spacer dislocation or acetabular erosion often stem from a size mismatch between the spacer and the patient’s unique anatomy. In this technical note, we describe a patient-adapted, hand-crafted technique for fabricating a well-fitting antibiotic cement hemi-articulating spacer for infection management. This approach aims at matching the individual’s acetabular anatomy, potentially reducing complications and improving outcomes.

Background: Fracture displacement and bony contact in proximal humeral fractures can affect healing and patient outcomes. The eccentric head index, currently used to measure displacement, is relatively complex and not ideal for all fracture types. Aim: This study proposes and evaluates the reproducibility of an exploratory measurement, the humeral shaft coverage, to quantify the degree of bony contact between fracture ends in surgical neck humeral fractures. Methods: All patients with surgical neck humeral fractures who had undergone closed reduction in our electronic medical records were identified using the diagnostic terms, and their full series of follow-up radiographs were reviewed for measurement by two observers. The estimated total humeral shaft coverage (THSC) was calculated by multiplying the proportion of metaphyseal width covered by the humeral head on both anteroposterior (AP) and scapular Y views. Total uncoverage was determined using the formula: 1 – THSC. Results: Two observers evaluated 22 shoulder AP and Y radiographs, resulting in 44 measurements, and each repeated their measurements to assess intra-observer reliability. The mean HSC values for observers 1 and 2 were 0.36 ± 0.32 and 0.44 ± 0.31, with no significant difference (p = 0.098). Inter-observer reliability was good to excellent (intraclass correlation coefficient [ICC] = 0.88, 95% confidence interval: 0.67–0.97). Intra-observer reliability was excellent for both observers (ICC = 0.99). Conclusion: Humeral shaft coverage is a consistent measurement that may help quantify fracture displacement in surgical neck humeral fractures. Relevance for patients: A simple method for quantifying fracture displacement may help predict prognosis and guide management of proximal humeral fractures.

An abstract is unavailable. This article is available as a PDF only.

BACKGROUND Several studies have questioned the efficacy of the standard perioperative low-molecular-weight heparin (LMWH) dose in preventing venous thromboembolic complications and have recommended dose escalation to a weight-based regimen. Other studies, however, have cautioned that higher anticoagulation regimens may be associated with an elevated risk of wound complications and periprosthetic joint infections. This dichotomy underscores the need for identifying the safety of the thromboprophylaxis approach in surgical settings. AIM To analyze the effect of LMWH regimen modification to weight-based with dose administration the morning of surgery on the incidence of early (within 3 months) postoperative prosthetic joint infection (PJI) in patients with hip hemiarthroplasty (HA). METHODS At our multi-hospital health system, LMWH dose escalation to the weight-based regimen without holding the morning dose on the day of surgery started in mid-June 2019. We have reviewed all cases of HA performed at our institution from 2007 to 2024 and divided them into two groups: Before and after the dose modification protocol. The number of early PJI cases has been studied in each group. RESULTS A total of 33 HA early PJI cases fit the study selection criteria and were included in this study. Of the 1517 cases performed before the new protocol, 19 cases (1.25%) had early infections, while within the modified protocol (weight-based with morning dose), 14 cases (1.49%) had infections out of a total of 937 cases. The difference between the two groups was found to be not statistically significant (z = -0.5, P = 0.6). CONCLUSION Our results indicate that LMWH dose escalation to a weight-based regimen without withholding the LMWH morning dose on the day of surgery did not lead to a significant change in the rate of early PJI in this study. A larger, multicenter study would be ideal for providing stronger evidence.

Aim: Pilon fractures, often resulting from high-energy trauma, are traditionally managed with staged fixation due to their known high risk of soft-tissue complications. This retrospective study evaluates the feasibility and outcomes of single-stage Open Reduction and Internal Fixation (ORIF) combined with immediate postoperative Vacuum-Assisted Closure (VAC) of the surgical wounds in selected patients with pilon fractures and favorable local soft-tissue conditions. Methods: Eleven selected patients with complex 3- or 4-part pilon fractures were included in this study. None of the cases received external fixation and the definitive ORIF was performed using plates and screws at a mean of 12 days post-injury (range, 3-20) after ensuring adequate soft tissue integrity (no or mild edema, positive ankle wrinkle sign, no bullae or soft tissue degloving). The cohort included nine males and two females, with a mean age of 43 years. One patient presented with an associated ipsilateral foot compartment syndrome in association with multiple metatarsal fractures and received foot fasciotomy and metatarsal ORIF with K-wires, two weeks before the pilon ORIF. All incisions received a VAC dressing within 8 hours of surgery, which was maintained until complete wound healing. Results: All cases achieved fracture union, as noticed radiographically at an average of 4.5 months postoperatively. At a mean follow-up of 17 months, only one patient (9.1%, the patient who presented with foot compartment syndrome and received foot fasciotomy) developed a deep wound infection and was successfully managed with three surgical debridement sessions, with maintenance of wound VAC, without hardware removal. No cases of hardware failure, nonunion or other cases of deep infection were observed. Conclusion: Single-stage ORIF combined with incisional wound VAC may represent an alternative to the staged fixation for high-energy pilon fractures when soft-tissue conditions are favorable. In cases associated with soft tissue compromise nearby, it may be advisable to utilize the gold standard staged fixation. The small sample size warrants larger comparative studies for generating stronger evidence.