Bryan Joost Marinus van de Wall

Introduction: The operative treatment of closed distal radius fractures has traditionally been managed through trauma waiting lists, resulting in the planning of add-on cases after urgent trauma or elective surgery. We investigated the feasibility of a once-weekly dedicated operating list for the treatment of semi-elective upper extremity fractures and assessed the effects on costs and operative time. Methods: A retrospective analysis was performed comparing consecutive periods before and after the introduction of a dedicated upper extremity trauma list at a Level I trauma center. The preimplementation period extended from January 2024 to August 2024, and the postimplementation period from September 2024 to March 2025. The dedicated operating list was run once-weekly and used to schedule the surgical treatment of isolated closed distal radius fractures and clavicle fractures. Closed distal radius fractures that required open reduction and internal fixation (ORIF) via volar plate osteosynthesis accounted for the highest caseload and were reviewed for the purpose of this study. Exclusion criteria were age 14 days after the date of injury. The operating list was established to facilitate a standardized workflow managed by a dedicated surgical team responsible for treating these fractures on a weekly basis. The consecutive patient cohort from the postimplementation period was compared with a consecutive cohort from the preimplementation period. The following data were collected from the health records: surgical and operating room time per case, procedure- and admission-related costs, time to treatment, hospital stay, and complications and reoperations at the 90-day mark. Results: The nondedicated cohort comprised a total of 143 patients that were treated during the preimplementation period. The dedicated cohort comprised 104 consecutive patients treated during the postimplementation period. After introduction of the dedicated upper extremity trauma list, the median surgical time per case was reduced by 51%, from 79 min (range 27–193) to 39 min (range 23–93) (p < 0.01). The quartile deviation of surgical time in the nondedicated and dedicated cohorts decreased from 23 to 7 min, respectively (p < 0.001). The median total cost per case decreased by 29% (p < 0.01). The median time to treatment increased from 2 days to 5 days after implementation of the dedicated list (p p = 0.82). The reoperation rates at 90 days were 4.3% and 1.9%, respectively (p = 0.47). Conclusion: A dedicated upper extremity trauma list, run once-weekly by a specialized team, significantly improves time and cost efficiency in volar locked plating of isolated, closed distal radius fractures. Summary: This retrospective study evaluated the feasibility and outcomes of introducing a dedicated weekly upper extremity trauma list at a Level I trauma center. A cohort of 143 consecutive patients who underwent volar locked plating of the distal radius in the preimplementation period was compared to a cohort of 104 patients in the postimplementation period. The median surgical time per case, operating room time and overall case time were significantly reduced by 51%, 49% and 38%, respectively, after implementation of the dedicated operating list. The median total cost per case was reduced by 29%. No statistically significant differences in complications and reoperations were observed between the dedicated and nondedicated cohorts at 90-day follow-up; however, noninferiority could not be established.

Background/Objectives: Mixing implant components from different manufacturers in primary total hip arthroplasty (THA) remains controversial because of concerns regarding implant compatibility and revision risk. This systematic review and meta-analysis aimed to compare revision outcomes between brand-mixed and brand-unmixed primary THA. Methods: A PRISMA-compliant systematic review of PubMed/MEDLINE and Embase identified studies comparing brand-mixed and brand-unmixed primary THA. Reported time-to-event estimates were pooled as hazard ratios (HRs), and revision-event counts as odds ratios (ORs), using random-effects models. Results: Six retrospective observational studies comprising 1,185,948 primary THAs were included. The time-to-event analysis did not identify a statistically significant difference in all-cause revision between brand-mixed and brand-unmixed THA (HR 1.03; 95% CI 0.97–1.08; I² = 0%). The complementary crude revision-event analysis likewise did not identify a statistically significant difference (OR 1.01; 95% CI 0.83–1.24), although substantial heterogeneity was present (I² = 93%). A post hoc exploratory sensitivity analysis excluding metal-on-metal and ceramic-on-metal bearings and brand-mixed stem–head constructs was based on two studies and yielded an OR of 0.97 (95% CI 0.79–1.20; I² = 95%). Certainty of evidence was low for the time-to-event analysis and very low for the event-based analyses. Conclusions: Available observational evidence did not identify a statistically significant association between brand mixing and all-cause revision following primary THA. However, these findings do not establish equivalence, universal component compatibility, or the safety of specific brand-mixed combinations and should be interpreted in light of the observational study designs, residual confounding, and heterogeneity in implant constructs.

Background/Objectives: The rising fracture burden has strained healthcare systems, prompting a reassessment of standard practices. One of such practices—the six-week postoperative outpatient visit and X-ray for lower extremity fractures—remains standard, though its value in modern care is increasingly uncertain. Methods: This retrospective study examined patients with the most common lower extremity fractures (including proximal femur, femoral and tibia shaft and bi-/tri-/malleolar fractures) treated surgically at a Level 1 trauma center between January 2020 and March 2024. It focused on two outcomes on the six-week postoperative visit: Firstly, the incidence of radiographic abnormalities on X-rays taken—defined as discrepancies compared to intra- or immediate postoperative images—and their clinical relevance. Secondly, the incidence of deviations from local standard postoperative treatment and follow-up protocols. Abnormalities and deviations were classified as necessitating additional diagnostic tests, further therapeutic interventions, modifications to the standard postoperative regimen—including immobilization, weightbearing status, and permitted range of motion (ROM). Results: A total of 275 patients were included. Deviations from standard care, based on the outpatient visit as a whole, occurred in 9%, rarely requiring reinterventions. Six-week X-rays abnormalities were found in 6%. Of all X-rays, only 2% had a clinical consequence; of those, one patient was asymptomatic. Conclusions: These findings suggest that routine six-week follow-up visits and radiographs after surgical treatment of common lower limb fractures seldom result in changes in clinical management. While the 6-week visit may provide additional value through assessment of functional recovery, rehabilitation guidance, reassurance, and addressing practical concerns, these benefits need to be balanced against the limited clinical yield of routine hospital-based follow-up. These findings therefore raise the question of whether a routine 6-week hospital visit and radiograph are warranted for every patient, and whether alternative models of follow-up, including physiotherapist-led assessment with selective referral to the treating hospital, could provide a more targeted approach.

Background/Objectives: Minimal invasive temporary spanning plate (SP) fixation has been established as a valuable treatment for complex distal radius fractures; while short-term outcomes are promising, long-term data remains limited. This study conducts a long-term outcome analysis of patients treated with SP fixation to address this gap within the current literature. Methods: We conducted a retrospective single-center study of patients treated with a spanning plate for distal radius fractures at a level I trauma center between 2018 and 2025. Indications for spanning plate fixation included distal radius fractures with severe metaphyseal comminution, radiocarpal fracture dislocations and very distal intra-articular fractures where standard osteosynthesis was not feasible. The inclusion criteria required a minimum follow-up of one year. Hospital records were screened for healing data and adverse events. Included patients were contacted for assessment of functional scores using the Patient-Rated Wrist Evaluation (PRWE) and a Visual Analogue Scale (VAS) for pain, as well as a 5-point Likert scale for satisfaction. Results: A total of 35 patients (mean age 57; 89% AO type C) were included. The SP was removed on average 3.8 months postoperatively. Radiological union was achieved at a mean of 8.6 weeks, with one non-union requiring reoperation. Complications included one implant failure and two Extensor Pollicis Longus (EPL) ruptures. Three other reoperations occurred: two for DRUJ instability and one wrist denervation due to osteoarthritis. Twenty-six patients responded to functional questionnaires at a mean follow-up of 58.3 months. They reported a mean satisfaction score of 4.1, mean resting VAS pain of 1.7, and a mean PRWE score of 16.7. Conclusions: Radiological, functional, and patient-rated outcomes demonstrate that excellent short-term results are successfully maintained over a 4.5-year period. The spanning plate technique proves to be a reliable and durable treatment option for complex distal radius fractures with a low long-term complication rate.

Purpose Implant related irritation and subsequent removal are one of the main disadvantages of clavicle plate osteosynthesis. 2.7 mm VA-LCP clavicle plates with a lower profile were introduced in recent years, with the aim to improve fit and reduce plate prominence. This study aims to investigate whether this leads to a lower implant removal rate compared to the older 3.5 mm LCP clavicle plates. Methods All patients that underwent single-plate osteosynthesis for midshaft clavicle fractures between 2019 and 2024 in a Swiss level I trauma-center were included. Patients were categorized into two treatment groups: DePuy Synthes 3.5 mm LCP clavicle plates or DePuy Synthes 2.7 mm VA-LCP clavicle plates. Treatment groups were compared regarding healing, complications, and removal rate. Results 101 patients were included, 54 with a 2.7 mm VA-LCP plate, and 47 with a 3.5 mm LCP plate. There were no significant differences in implant removal due to hardware irritation (44% versus 49%), overall reintervention rate (46.3% versus 53.2%, p = 0.49), infection (0% versus 4.3% p = 0.21), and refractures (1.9% versus 6.4%, p=0.34). All fractures healed in both groups. Conclusion Newer 2.7 mm VA-LCP clavicle single plating shows similar results in terms of complication and healing rates compared to older 3.5 mm LCP plating. Despite the design aiming for reduced plate-prominence, it does not demonstrate a significant reduction in removal rates in this study. Further studies are needed to ascertain the generalizability of results.