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  • British Editorial Society of Bone & Joint Surgery  (7)
  • 1
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    The effect of time to irrigation and debridement on the rate of reoperation in open fractures : a propensity score-based analysis of the Fluid Lavage of Open Wounds (FLOW) study
    British Editorial Society of Bone & Joint Surgery ; 2021
    In:  The Bone & Joint Journal Vol. 103-B, No. 6 ( 2021-06-01), p. 1055-1062
    Details
    In: The Bone & Joint Journal, British Editorial Society of Bone & Joint Surgery, Vol. 103-B, No. 6 ( 2021-06-01), p. 1055-1062
    Abstract: Despite long-standing dogma, a clear relationship between the timing of surgical irrigation and debridement (I & D) and the development of subsequent deep infection has not been established in the literature. Traditionally, I & D of an open fracture has been recommended within six hours of injury based on animal studies from the 1970s, however the clinical basis for this remains unclear. Using data from a multicentre randomized controlled trial of 2,447 open fracture patients, the primary objective of this secondary analysis is to determine if a relationship exists between timing of wound I & D (within six hours of injury vs beyond six hours) and subsequent reoperation rate for infection or healing complications within one year for patients with open limb fractures requiring surgical treatment. Methods To adjust for the influence of patient and injury characteristics on the timing of I & D, a propensity score was developed from the dataset. Propensity-adjusted regression allowed for a matched cohort analysis within the study population to determine if early irrigation put patients independently at risk for reoperation, while controlling for confounding factors. Results were reported as odds ratios (ORs), 95% confidence intervals (CIs), and p-values. All analyses were conducted using STATA 14. Results In total, 2,286 of 2,447 patients randomized to the trial from 41 orthopaedic trauma centres across five countries had complete data regarding time to I & D. Prior to matching, the patients managed with early I & D had a higher proportion requiring reoperation for infection or healing complications (17% vs 13%; p = 0.019), however this does not account for selection bias of more severe injuries preferentially being treated earlier. When accounting for propensity matching, early irrigation was not associated with reoperation (OR 0.71 (95% CI 0.47 to 1.07); p = 0.73). Conclusion When accounting for other variables, late irrigation does not independently increase risk of reoperation. Cite this article: Bone Joint J 2021;103-B(6):1055–1062.
    Type of Medium: Online Resource
    ISSN: 2049-4394 , 2049-4408
    URL: Article
    DOI: 10.1302/0301-620X.103B6.BJJ-2020-2289.R1
    Language: English
    Publisher: British Editorial Society of Bone & Joint Surgery
    Publication Date: 2021
    detail.hit.zdb_id: 2697480-0
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  • 2
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    Does negative pressure wound therapy reduce the odds of infection and improve health-related quality of life in patients with open fractures?
    British Editorial Society of Bone & Joint Surgery ; 2022
    In:  Bone & Joint Open Vol. 3, No. 3 ( 2022-03-01), p. 189-195
    Details
    In: Bone & Joint Open, British Editorial Society of Bone & Joint Surgery, Vol. 3, No. 3 ( 2022-03-01), p. 189-195
    Abstract: To evaluate the impact of negative pressure wound therapy (NPWT) on the odds of having deep infections and health-related quality of life (HRQoL) following open fractures. Methods Patients from the Fluid Lavage in Open Fracture Wounds (FLOW) trial with Gustilo-Anderson grade II or III open fractures within the lower limb were included in this secondary analysis. Using mixed effects logistic regression, we assessed the impact of NPWT on deep wound infection requiring surgical intervention within 12 months post-injury. Using multilevel model analyses, we evaluated the impact of NPWT on the Physical Component Summary (PCS) of the 12-Item Short-Form Health Survey (SF-12) at 12 months post-injury. Results After applying inverse probability treatment weighting to adjust for the influence of injury characteristics on type of dressing used, 1,322 participants were assessed. The odds of developing a deep infection requiring operative management within 12 months of initial surgery was 4.52-times higher in patients who received NPWT compared to those who received a standard wound dressing (95% confidence interval (CI) 1.84 to 11.12; p = 0.001). Overall, 1,040 participants were included in our HRQoL analysis, and those treated with NPWT had statistically significantly lower mean SF-12 PCS post-fracture (p 〈 0.001). These differences did not reach the minimally important difference for the SF-12 PCS. Conclusion Our analysis found that patients treated with NPWT had higher odds of developing a deep infection requiring operative management within 12 months post-fracture. Due to possible residual confounding with the worst cases being treated with NPWT, we are unable to determine if NPWT has a negative effect or is simply a marker of worse injuries or poor access to early soft-tissue coverage. Regardless, our results suggest that the use of this treatment requires further evaluation. Cite this article: Bone Jt Open 2022;3(3):189–195.
    Type of Medium: Online Resource
    ISSN: 2633-1462
    URL: Article
    DOI: 10.1302/2633-1462.33.BJO-2021-0199.R1
    Language: English
    Publisher: British Editorial Society of Bone & Joint Surgery
    Publication Date: 2022
    detail.hit.zdb_id: 3016366-3
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  • 3
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    Development of machine-learning algorithms for 90-day and one-year mortality prediction in the elderly with femoral neck fractures based on the HEALTH and FAITH trials
    British Editorial Society of Bone & Joint Surgery ; 2023
    In:  Bone & Joint Open Vol. 4, No. 3 ( 2023-3-14), p. 168-181
    Details
    In: Bone & Joint Open, British Editorial Society of Bone & Joint Surgery, Vol. 4, No. 3 ( 2023-3-14), p. 168-181
    Abstract: To develop prediction models using machine-learning (ML) algorithms for 90-day and one-year mortality prediction in femoral neck fracture (FNF) patients aged 50 years or older based on the Hip fracture Evaluation with Alternatives of Total Hip arthroplasty versus Hemiarthroplasty (HEALTH) and Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trials. Methods This study included 2,388 patients from the HEALTH and FAITH trials, with 90-day and one-year mortality proportions of 3.0% (71/2,388) and 6.4% (153/2,388), respectively. The mean age was 75.9 years (SD 10.8) and 65.9% of patients (1,574/2,388) were female. The algorithms included patient and injury characteristics. Six algorithms were developed, internally validated and evaluated across discrimination (c-statistic; discriminative ability between those with risk of mortality and those without), calibration (observed outcome compared to the predicted probability), and the Brier score (composite of discrimination and calibration). Results The developed algorithms distinguished between patients at high and low risk for 90-day and one-year mortality. The penalized logistic regression algorithm had the best performance metrics for both 90-day (c-statistic 0.80, calibration slope 0.95, calibration intercept -0.06, and Brier score 0.039) and one-year (c-statistic 0.76, calibration slope 0.86, calibration intercept -0.20, and Brier score 0.074) mortality prediction in the hold-out set. Conclusion Using high-quality data, the ML-based prediction models accurately predicted 90-day and one-year mortality in patients aged 50 years or older with a FNF. The final models must be externally validated to assess generalizability to other populations, and prospectively evaluated in the process of shared decision-making. Cite this article: Bone Jt Open  2023;4(3):168–181.
    Type of Medium: Online Resource
    ISSN: 2633-1462
    URL: Article
    DOI: 10.1302/2633-1462.43.BJO-2022-0162.R1
    Language: English
    Publisher: British Editorial Society of Bone & Joint Surgery
    Publication Date: 2023
    detail.hit.zdb_id: 3016366-3
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  • 4
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    Who, if anyone, may benefit from a total hip arthroplasty after a displaced femoral neck fracture? : a post hoc subgroup analysis of the HEALTH trial
    British Editorial Society of Bone & Joint Surgery ; 2022
    In:  Bone & Joint Open Vol. 3, No. 8 ( 2022-08-01), p. 611-617
    Details
    In: Bone & Joint Open, British Editorial Society of Bone & Joint Surgery, Vol. 3, No. 8 ( 2022-08-01), p. 611-617
    Abstract: The aim of this study was to explore the functional results in a fitter subgroup of participants in the Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty versus Hemiarthroplasty (HEALTH) trial to determine whether there was an advantage of total hip arthroplasty (THA) versus hemiarthroplasty (HA) in this population. Methods We performed a post hoc exploratory analysis of a fitter cohort of patients from the HEALTH trial. Participants were aged over 50 years and had sustained a low-energy displaced femoral neck fracture (FNF). The fittest participant cohort was defined as participants aged 70 years or younger, classified as American Society of Anesthesiologists grade I or II, independent walkers prior to fracture, and living at home prior to fracture. Multilevel models were used to estimate the effect of THA versus HA on functional outcomes. In addition, a sensitivity analysis of the definition of the fittest participant cohort was performed. Results There were 143 patients included in the fittest cohort. Mean age was 66 years (SD 4.5) and 103 were female (72%). No clinically relevant differences were found between the treatment groups in the primary and sensitivity analyses. Conclusion This analysis found no differences in functional outcomes between HA and THA within two years of displaced low-energy FNF in a subgroup analysis of the fittest HEALTH patients. These findings suggest that very few patients above 50 years of age benefit in a clinically meaningful way from a THA versus a HA early after injury. Cite this article: Bone Jt Open 2022;3(8):611–617.
    Type of Medium: Online Resource
    ISSN: 2633-1462
    URL: Article
    DOI: 10.1302/2633-1462.38.BJO-2022-0074.R1
    Language: English
    Publisher: British Editorial Society of Bone & Joint Surgery
    Publication Date: 2022
    detail.hit.zdb_id: 3016366-3
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  • 5
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    Bone turnover markers as surrogates of fracture healing after intramedullary fixation of tibia and femur fractures
    British Editorial Society of Bone & Joint Surgery ; 2022
    In:  Bone & Joint Research Vol. 11, No. 4 ( 2022-04-01), p. 239-250
    Details
    In: Bone & Joint Research, British Editorial Society of Bone & Joint Surgery, Vol. 11, No. 4 ( 2022-04-01), p. 239-250
    Abstract: Bone turnover markers (BTMs) follow distinct trends after fractures and limited evidence suggests differential levels in BTMs in patients with delayed healing. The effect of vitamin D, and other factors that influence BTMs and fracture healing, is important to elucidate the use of BTMs as surrogates of fracture healing. We sought to determine whether BTMs can be used as early markers of delayed fracture healing, and the effect of vitamin D on BTM response after fracture. Methods A total of 102 participants aged 18 to 50 years (median 28 years (interquartile range 23 to 35)), receiving an intramedullary nail for a tibial or femoral shaft fracture, were enrolled in a randomized controlled trial comparing vitamin D 3 supplementation to placebo. Serum C-terminal telopeptide of type I collagen (CTX; bone resorption marker) and N-terminal propeptide of type I procollagen (P1NP; bone formation marker) were measured at baseline, six weeks, and 12 weeks post-injury. Clinical and radiological fracture healing was assessed at three months. Results CTX and P1NP concentrations peaked at six weeks in all groups. Elevated six-week CTX and P1NP were associated with radiological healing at 12 weeks post-injury (odds ratio (OR) 10.5; 95% confidence interval 2.71 to 53.5, p = 0.002). We found no association between CTX or P1NP and functional healing. Baseline serum 25(OH)D showed a weak inverse relationship with P1NP (p = 0.036) and CTX (p = 0.221) at 12 weeks, but we observed no association between vitamin D supplementation and either BTM. Conclusion Given the association between six-week BTM concentrations and three-month radiological fracture healing, CTX and P1NP appear to be potential surrogate markers of fracture healing. Cite this article: Bone Joint Res 2022;11(4):239–250.
    Type of Medium: Online Resource
    ISSN: 2046-3758
    URL: Article
    DOI: 10.1302/2046-3758.114.BJR-2021-0226.R1
    Language: English
    Publisher: British Editorial Society of Bone & Joint Surgery
    Publication Date: 2022
    detail.hit.zdb_id: 2669244-2
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  • 6
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    Prognostic factors for predicting health-related quality of life after intramedullary nailing of tibial fractures: a randomized controlled trial
    British Editorial Society of Bone & Joint Surgery ; 2021
    In:  Bone & Joint Open Vol. 2, No. 1 ( 2021-01-01), p. 22-32
    Details
    In: Bone & Joint Open, British Editorial Society of Bone & Joint Surgery, Vol. 2, No. 1 ( 2021-01-01), p. 22-32
    Abstract: Using tibial shaft fracture participants from a large, multicentre randomized controlled trial, we investigated if patient and surgical factors were associated with health-related quality of life (HRQoL) at one year post-surgery. Methods The Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT) trial examined adults with an open or closed tibial shaft fracture who were treated with either reamed or unreamed intramedullary nails. HRQoL was assessed at hospital discharge (for pre-injury level) and at 12 months post-fracture using the Short Musculoskeletal Functional Assessment (SMFA) Dysfunction, SMFA Bother, 36-Item Short Form 36 (SF-36) Physical, and SF-36 Mental Component scores. We used multiple linear regression analysis to determine if baseline and surgical factors, as well as post-intervention procedures within one year of fracture, were associated with these HRQoL outcomes. Significance was set at p 〈 0.01. We hypothesize that, irrespective of the four measures used, prognosis is guided by both modifiable and non-modifiable factors and that patients do not return to their pre-injury level of function, nor HRQoL. Results For patient and surgical factors, only pre-injury quality of life and isolated fracture showed a statistical effect on all four HRQoL outcomes, while high-energy injury mechanism, smoking, and race or ethnicity, demonstrated statistical significance for three of the four HRQoL outcomes. Patients who did not require reoperation in response to infection, the need for bone grafts, and/or the need for implant exchanges had statistically superior HRQoL outcomes than those who did require intervention within one year after initial tibial fracture nailing. Conclusion We identified several baseline patient factors, surgical factors, and post-intervention procedures within one year after intramedullary nailing of a tibial shaft fracture that may influence a patient’s HRQoL. Cite this article: Bone Jt Open 2021;2(1):22–32.
    Type of Medium: Online Resource
    ISSN: 2633-1462
    URL: Article
    DOI: 10.1302/2633-1462.21.BJO-2020-0150.R1
    Language: English
    Publisher: British Editorial Society of Bone & Joint Surgery
    Publication Date: 2021
    detail.hit.zdb_id: 3016366-3
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  • 7
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    Is the use of bipolar hemiarthroplasty over monopolar hemiarthroplasty justified? A propensity score-weighted analysis of a multicentre randomized controlled trial
    British Editorial Society of Bone & Joint Surgery ; 2023
    In:  Bone & Joint Open Vol. 4, No. 5 ( 2023-5-19), p. 370-377
    Details
    In: Bone & Joint Open, British Editorial Society of Bone & Joint Surgery, Vol. 4, No. 5 ( 2023-5-19), p. 370-377
    Abstract: Using data from the Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty versus Hemiarthroplasty (HEALTH) trial, we sought to determine if a difference in functional outcomes exists between monopolar and bipolar hemiarthroplasty (HA). Methods This study is a secondary analysis of patients aged 50 years or older with a displaced femoral neck fracture who were enrolled in the HEALTH trial and underwent monopolar and bipolar HA. Scores from the Western Ontario and McMaster University Arthritis Index (WOMAC) and 12-Item Short Form Health Survey (SF-12) Physical Component Summary (PCS) and (MCS) were compared between the two HA groups using a propensity score-weighted analysis. Results Of 746 HAs performed in the HEALTH trial, 404 were bipolar prostheses and 342 were unipolar. After propensity score weighting, adequate balance between the bipolar and unipolar groups was obtained as shown by standardized mean differences less than 0.1 for each covariable. A total of 24 months after HA, the total WOMAC score and its subcomponents showed no statistically significant difference between the unipolar and bipolar groups. Similarly, no statistically significant difference was found in the PCS and MCS scores of the SF-12 questionnaire. In participants aged 70 years and younger, no difference was found in any of the functional outcomes. Conclusion From the results of this study, the use of bipolar HA over unipolar design does not provide superior functional outcomes at 24 months postoperatively. The theoretical advantage of reduced acetabular wear with bipolar designs does not appear to influence functional outcomes in the first two years postoperatively. Cite this article: Bone Jt Open  2023;4(5):370–377.
    Type of Medium: Online Resource
    ISSN: 2633-1462
    URL: Article
    DOI: 10.1302/2633-1462.45.BJO-2023-0026.R1
    Language: English
    Publisher: British Editorial Society of Bone & Joint Surgery
    Publication Date: 2023
    detail.hit.zdb_id: 3016366-3
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