Harlene Kaur

Introduction Low-energy hip fractures (HFs) and distal radius fractures (DRFs) are common orthopedic injuries. Although winter increases same-level, low-energy fall rates, the role of specific weather variables, and whether these effects differ by age or fracture type, remains unclear. Objective To evaluate weekly association between weather conditions and HF and DRF incidence over eight-years using age-stratified statistical models. Methods Retrospective review of 1882 HF and 444 DRF patients presenting to a single Level 1 trauma center from January 2017-March 2025. Daily local weather data were merged with injury dates and aggregated into weekly counts. Separate negative binomial regression models were run by fracture type and age group to evaluate associations between weekly mean temperature, relative humidity, rainy days, snow days, and near-freezing days and fracture incidence. Results Weather-fracture relationships varied by age and fracture type. For HFs, rain days correlated with higher incidence in older and geriatric adults, while snow days were strongest in younger adults. For DRFs, rain and snow days increased incidence in both age groups, especially < 65 years. Higher relative humidity was protective in the oldest DRF cohort. Temperature showed a weak association with increased DRF incidence in younger adults and decreased HF incidence in younger adults. Conclusion Specific meteorologic conditions, not just seasons, were meaningfully associated with fracture incidence, with effects differing by age and fracture type. Age-stratified weather models may improve orthopedic preparedness, resource allocation, and fall-prevention strategies. As climate change increases precipitation variability and freeze-thaw cycles, weather-fracture associations become important for planning and prevention.

Immune checkpoint inhibitors (ICIs) and vascular endothelial growth factor (VEGF) pathway inhibitors are increasingly used in bone and soft tissue sarcomas. Risks associated with combination therapy, such as venous thromboembolism (VTE), carry significant consequences but remain poorly characterized. This study evaluated whether adding a VEGF pathway inhibitor to ICI therapy increases VTE risk in sarcoma patients. Using the TriNetX U.S. Collaborative Network, we identified patients with bone or soft tissue sarcoma [International Classification of Diseases (ICD)-10 C40, C41, C47, C49] who received either combination therapy (ICI plus VEGF pathway inhibitor within ±30 days of ICI initiation) or ICI monotherapy. Propensity score matching (1:1) balanced cohorts for age, sex, race, hypertension, diabetes, obesity, and smoking history. The primary outcome was 1-year VTE incidence (pulmonary embolism or venous thrombosis). Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional hazards models. After matching, 834 patients remained in each cohort (mean age 63 years; hypertension prevalence 60%). At 1 year, VTE occurred in 14.0% of the combination cohort and 12.4% of the monotherapy cohort (HR 1.23; 95% CI: 0.91-1.66; P=0.07), corresponding to an absolute risk difference of 1.6 percentage points (95% CI: -2.1 to 5.2). Musculoskeletal toxicity did not differ between groups (5.5% vs. 6.4%; HR 0.93; 95% CI: 0.61-1.41; P=0.82). Sarcoma patients receiving ICI-based therapy experienced a high 1-year VTE burden. Although we did not detect a statistically significant increase in VTE with the addition of a VEGF pathway inhibitor, the point estimates were compatible with a modestly higher risk; however, the CIs were wide and included no difference between groups. These findings support clinical vigilance and risk assessment and motivate prospective studies of risk-adapted thromboprophylaxis in this population.