Lisa K. Cannada

Objectives: To evaluate whether same-day discharge for aseptic lower extremity nonunions is associated with increased complication rates compared with patients admitted to the hospital, aiming to determine the safety and feasibility of same-day discharge in this patient population. Methods: A retrospective cohort study was conducted across 14 Level 1 trauma centers, including 981 adult patients who underwent surgical fixation of aseptic femur or tibia nonunions between 2007 and 2022. Patients were stratified by length of stay into same-day discharge and admission to the hospital (≥1 night). Primary outcomes were postoperative complications: infection, reoperation, and readmission rates. Multivariable logistic regression controlled for confounders including age, body mass index, comorbidities, ASA classification, insurance, and bone graft use. Results: Of 981 patients, 146 (14.9%) underwent same-day discharge and 835 (85.1%) were admitted to the hospital. Patients undergoing same-day discharge were younger, healthier, and had shorter operative times. Unadjusted complication rates were higher among patients admitted to the hospital; however, after adjustment, same-day discharge was not associated with increased odds of infection (odds ratio [OR] 0.75, P = 0.386), readmission (OR 0.76, P = 0.346), or reoperation (OR 0.92, P = 0.730). No significant differences in injury characteristics or procedure types were found between groups. Conclusions: Same-day discharge for aseptic lower extremity nonunion surgery was not associated with increased complication or readmission rates compared with admission to the hospital. With careful patient selection and perioperative management, same-day discharge pathways may be safely expanded for appropriately selected patients, supporting cost-effective care without compromising outcomes. Level of Evidence: III.

Background: This study compares orthopedic trauma case volumes at an urban hospital before and after ACS Level II Trauma designation. We hypothesized a significant increase in both volume & case complexity following this designation which impacts hospital operations and personnel needs. Methods: This retrospective study analyzed prospectively collected data on orthopedic trauma cases at an urban Level II center for the year before and after accreditation. Data collected included injury/surgery details, case urgency and surgery day/weekend timing. Data analysis was conducted using SPSS (IBM Corp., Armonk, NY) and Microsoft Excel. Independent t-tests assuming unequal variances were performed for comparison. A p-value of < 0.05 was considered statistically significant. Results: There was a significant increase in overall case volume (P < 0.001), including urgent (P < 0.001) & emergent cases (P = 0.002). Significant growth was observed in periarticular tibial plateau (P < 0.001) and femoral shaft fractures (P < 0.001). An increase in distal femur (P = 0.073), open tibial shaft (P = 0.189), closed tibial shaft (P = 0.05), and periarticular pilon fractures (P = 0.210) were also observed. Significant increases were noted in ballistic fractures (P < 0.001) and open fractures (P < 0.001). A notable rise in cases occurred on both weekends (P = 0.049) and weekdays (P < 0.001), demonstrating the impact of the accreditation. Conclusion: Our data demonstrates transition to an ACS Level II Trauma Center led to increases in caseload and complexity. This highlights the need for adjustments in operating room access, staffing and scheduling to accommodate these demands. This also represents an increase in opportunities for trainees, supporting the importance of trauma center access in education. Further studies into the impact of change in ACS designation level and how it affects case volume distribution across are warranted.

Objectives: The purpose was to report pre–COVID-19 and post–COVID-19 trends in training and job searches for recent orthopaedic trauma fellowship graduates. The pandemic occurred within the survey period, so the aim was to evaluate the pandemic's effects, particularly regarding training and jobs. It was hypothesized that the pandemic and other societal changes that occurred during the survey period had broad-reaching effects on graduate medical education and job selection for graduating traumatologists, including fewer surgical repetitions, strained interviews, and altered trends in job characteristic prioritization extending beyond the pandemic. Design: Cross-sectional survey. Setting: Orthopaedic Trauma Association (OTA/AO) surveys. Participants: Orthopaedic surgeons who graduated from United States (US) trauma fellowships from 2017 to 2023 were eligible. Main Outcome Measurement: A 56-question survey was emailed to recent trauma fellowship graduates assessing training, job searches, and job types selected. Results: In total, 240/600 (40%) orthopaedic surgeons who graduated from US trauma fellowships from 2017 to 2023 participated. Most (68%) trained at academic level 1 trauma fellowships. Of 2020–2023 graduates, 52% reported lighter caseloads, while 27% felt telehealth made their clinical experience less valuable. Many (42%) reported fewer jobs. Sought-after job characteristics included 51–70 work hours/wk (63%), 4–6 night-calls/month (36%), and 401–500 cases/year (27%). The most common salary was $501,000–$600,000/y (22%). Conclusion: For trauma fellows, COVID-19 resulted in training disadvantages, including fewer hands-on experiences, and job search obstacles, including less employment opportunities and compensation. Recognizing trends in recently graduated traumatologists will help maximize training and enhance professional satisfaction for young surgeons. Level of Evidence: V.

OBJECTIVES: To identify practices for treating interprosthetic femur fractures (IFFs) and determine factors that positively affect patient outcomes. METHODS: . Design: Retrospective cohort study. Setting: Fifteen trauma centers in the United States. Patient Selection Criteria: Patients aged 50–90 years who underwent operative fixation of an AO/OTA 32 A-B-C type IFF fracture from 2011 to 2021 were included. Patients who underwent revision arthroplasty at the time of fixation or were nonambulatory were excluded. Outcome Measures and Comparisons: The primary outcome was union rate. Secondary outcomes included postoperative complications, revision surgery, mortality, and change in ambulation status. Univariate analyses using chi-square tests, Fisher exact tests, and analysis of variance were performed to detect associations between demographic, injury, and surgical characteristics with postoperative outcomes. RESULTS: One hundred thirty-nine patients were included, with 110 (79%) women and median age 78 [range, 57–90]. Distal one-third fractures were most common, 68% (N = 95). One hundred eighteen (85%) patients were treated with a lateral plate, 8% (N = 11) were treated with nail–plate combination and 7% (N = 10) were treated with dual plates. The median time to full-weight bearing was 2.5 months. Dual plate combination was associated with the fastest time to full-weight bearing (P = 0.048) at 2 weeks. In total, 61% (n = 85) of patients returned to baseline ambulation status (100% [11] IMN–plate, 60% [71] lateral plate, and 25% [3] dual plate) with patients treated with nail–plate had higher rates of return to baseline function (P = 0.009). The overall mortality rate was 13% and associated with greater than 1 comorbidity (P = 0.022). CONCLUSIONS: A spanning lateral plate was the most common fixation of IFF. Patients with dual fixation were more likely to return to baseline ambulatory status, particularly those with intramedullary nail–plate combination. The mortality rate at 1 year was 11% and comorbidity burden was associated with higher risk of mortality. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.