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Patients living with substance use disorder (SUD) have complex pain management needs, which may be mismanaged during hospital admission. Ineffectively managed pain following orthopaedic trauma, influenced by clinician biases related to race or SUD diagnosis, may subject patients to worse pain outcomes and subsequent emergency department (ED) encounters. This study examined ED encounters and opioid prescribing for pain-related complaints following orthopaedic trauma, among patients with SUD who identify as Black or African American relative to White patients. This retrospective analysis included 1089 patients with a SUD diagnosis discharged from a Level I trauma center, following hospitalization for orthopaedic injuries, between 2016 and 2021. Multivariable regressions assessed the associations among race, opioid prescribing, and ED encounters within 90 days for pain-related care. Among the 1089 patients included in the sample, the proportion of individuals with an ED encounter within 90 days for pain-related care was 12.4 % and 4.5 % for Black and White patients, respectively (odds ratio [OR] = 3.0, p <.001). When adjusting for injury severity and demographics, the difference in ED encounters between Black and White patients remained significant (OR = 2.8, p =.002). Opioid prescription doses did not statistically differ by race. The difference in ED encounters between Black and White patients with SUDs following orthopaedic trauma may indicate a need to optimize pain management prior to initial discharge and improve post-injury care. • Black patients living with SUD face increased risk for subsequent ED encounters for pain management after orthopedic trauma. • Black patients received lower doses during hospitalization, but this difference was not statistically significant in the adjusted model. • ED encounters for Black patients with SUD following orthopedic trauma may indicate racial disparities in pain management. [ABSTRACT FROM AUTHOR]

This pilot study assessed the feasibility and impact of integrating a Life Care Specialist (LCS) into orthopaedic trauma care. This was a prospective feasibility single group pilot study at a level 1 trauma center. The LCS is a paraprofessional behavior-based "pain coach" and delivered patient-centered opioid safety education, trained participants on nonpharmacologic pain management approaches, conducted opioid risk assessments, and coordinated care. Numeric Rating Scale pain scores were assessed on admission, at discharge, and at 2-week follow-up. Daily morphine milligram equivalents (MME) during hospitalization, opioid medication use at 2-weeks, and patient satisfaction were recorded. T test compared mean morphine milligram equivalents (MME) to historical orthopaedic trauma patient population's mean dosage at discharge from the study site. Generalized linear models assessed pain scores over time. Twenty-two percent of 121 total participants met criteria for moderate to severe risk of opioid misuse at initial hospitalization. On average, 2.8 LCS pain management interventions were utilized, most frequently progressive muscle relaxation (80%) and sound therapy (48%). Mean inpatient MME/day was 40.5, which was significantly lower than mean historical MME/day of 49.7 (p <.001). Pain scores improved over time from admission to 2-weeks postoperatively (p <.001). Nearly all participants agreed that the LCS was helpful in managing pain (99%). The findings indicate feasibility to integrate LCS into orthopaedic trauma care, evident by participant engagement and satisfaction, and that LCS serve as valuable resources to assist with pain management and opioid education. [ABSTRACT FROM AUTHOR]

• Mean patient-reported adherence was 64.5 % (SD 35.5). • Seventeen (34 %) patients reported once-daily rather than twice-daily use. • Six themes of patient-reported barriers for adherence were identified: Inconvenience, Pain, Fear, Acquisition, Bruising, and mechanism. • Overall, 40 (80 %) of patients endorsed at least one barrier to adherence. • Changes in prescribing patterns and patient engagement techniques may improve post-operative thromboembolic outcomes. Venous thromboembolism following orthopedic trauma surgery remains prevalent despite prophylaxis being a standard of care. Enoxaparin injection is a commonly utilized prophylaxis regimen among high-risk patients. Patient-reported rates of nonadherence and barriers to enoxaparin use are not described in the literature. A better understanding of these barriers and their impact on adherence to post-discharge prophylaxis regimens may shed light on persistent outcomes gaps. Semi-structured interviews were administered to adult patients prescribed prophylactic enoxaparin and presenting to orthopedic surgery outpatient clinic at an urban level 1 trauma center for a post-operative appointment following traumatic injury from April to July 2023. Patients self-reported their age, gender, race, and mobility. Inductive thematic analysis with three-reviewer consensus identified common barriers among responses. Adherence rates were calculated by dividing patients' estimated number of missed doses over total prescribed doses at the point of inquiry. We identified 154 eligible patients through chart review, and 50 enrolled and interviewed. Participants had a mean age of 37 years. Of 50 participants, 20 identified as female; 25 identified as Black or African American, 16 as White, 5 as Hispanic, 2 as Asian, and 2 as multiracial. Twenty-one participants were non-ambulatory at time of interview. Mean and median patient-reported adherence were 64.5 % (SD 35.5) and 70.5 % (IQR 33–100) respectively. Five patients reported complete nonadherence, while 17 patients reported perfect adherence. Every participant reporting complete nonadherence identified as Black or African American, as compared to 8 out of 17 reporting perfect adherence. Despite acknowledging a twice-daily prescription, 17 patients reported once-daily rather than twice-daily use. Inductive thematic analysis revealed the following six barriers to prophylaxis adherence (number of participants reporting): Inconvenience (18 patients), Pain (16), Fear (12), Acquisition (7), Bruising (7), and Mechanism (7). Altogether, 40 patients endorsed at least one barrier to adherence. Most patients face barriers to adherence with post-discharge prophylactic enoxaparin, and the resultant rates of adherence are low. This may contribute to persistent outcomes gaps in the orthopedic trauma population despite prophylaxis standards. Changes in prescribing patterns and patient engagement techniques may improve post-operative thromboembolic outcomes. [ABSTRACT FROM AUTHOR]

Malnutrition is known to negatively affect outcomes after arthroplasty, hip fracture, and spine surgery. Although distal radius fracture surgery may be considered in a similar patient cohort, the effect of malnutrition in this scenario is unknown. We hypothesized that admission serum albumin level, as a marker for malnutrition, would correlate with the rate of postoperative complications following surgery for distal radius fracture. We performed a retrospective cohort study of the American College of Surgeons National Surgery Quality Improvement database. Patients undergoing open reduction and internal fixation of a distal radius fracture were identified using Current Procedural Terminology codes. We excluded patients who were septic at presentation, were multiply injured, or had open fractures. We collected patient demographics, length of stay, 30-day complications, reoperation, and readmission rates. We performed multivariable linear regression analysis controlling for age, sex, body mass index, operative time, discharge destination, and modified Frailty Index score. We identified 1,989 patients (mean age, 56 years; range, 18–90 years) with available albumin levels, and 14.7% had hypoalbuminemia (albumin, < 3.5 g/dL). Multivariable regression revealed that malnourished patients had higher rates of postoperative complications (6.5% vs 1.3%; odds ratio [OR] 4.88; 95% confidence interval [95% CI], 2.47–9.66). Specifically, these patients had increased rates of Clavien-Dindo IV (life-threatening) complications (2.4% vs 0%), readmission (7.2% vs 2%; OR, 3.37; 95% CI, 1.88–6.03), and mortality (1.7% vs 0.1%; OR, 9.23; 95% CI, 1.55–54.87). Malnourished patients had significantly longer length of stay (3.55 vs 0.73 days). Albumin concentration was inversely associated with risk of death (OR, 0.12; 95% CI, 0.03–0.52). Malnutrition, indicated by albumin less than 3.5 g/dL, is a powerful predictor of uncommon, but important, postoperative complications, including mortality, following surgery for distal radius fracture. Evaluation of preoperative albumin level may, therefore, help surgeons provide individualized counseling and more accurately stratify the risk of patients. Prognostic II. [ABSTRACT FROM AUTHOR]

Purpose Compared with cast treatment, surgery may expose patients with distal radius fractures to undue risk. Surgical intervention in this cohort may offer less benefit than previously thought and appropriate patient selection is imperative. The modified Frailty Index (mFI) predicts complications after other orthopedic surgeries. We hypothesized that this index would predict, and might ultimately prevent, complications in patients older than 50 years with distal radius fractures. Methods We retrospectively reviewed the American College of Surgeons—National Surgery Quality Improvement Program (ACS-NSQIP) database, including patients older than 50 years who underwent open reduction and internal fixation of a distal radius fracture. A 5-item mFI score was then calculated for each patient. Postoperative complications, readmission and reoperation rates, as well as length of stay (LOS) were recorded. Bivariate and multivariable statistical analysis was then performed. Results We identified 6,494 patients (mean age, 65 years). Compared with patients with mFI of 0, patients with mFI of 2 or greater were nearly 2.5 times as likely to incur a postoperative complication (1.7% vs 7.4%). Specifically, the rates of Clavien-Dindo IV, wound, cardiac, and renal complications were increased significantly in patients with mFI of 2 or greater. In addition, as mFI increased from 0 to 2 or greater, 30-day reoperation rate increased from 0.8% to 2.4%, 30-day readmission from 0.8% to 4.6%, and LOS from 0.5 days to 1.44 days. Frailty was associated with increased complications as well as rates of readmission and reoperation even when controlling for demographic data, LOS, and operative time. Age alone was not significantly associated with postoperative complications, readmission, reoperation, or LOS. Conclusions A state of frailty is highly predictive of postoperative complications, readmission, reoperation, and increased LOS following open reduction and internal fixation of distal radius fractures. Our data suggest that a simple frailty evaluation can help inform surgical decision making in patients older than 50 years with distal radius fractures. Type of study/level of evidence Prognostic II. [ABSTRACT FROM AUTHOR]

Background: Frailty is described as decreased physiological reserve and typically increasing with age. Hospitals are being penalized for reoperations and readmissions, which can affect reimbursement. The purpose of this study was to determine if the modified frailty index (MFI) could be used as a risk assessment tool for preoperative counseling and to make an objective decision on whether to perform total hip arthroplasty (THA) on a frail patient.Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried by Current Procedural Terminology code for primary THA (27130) from 2005 to 2014. MFI was calculated using 11 variables extracted from the medical record. Bivariate analysis was performed for outcomes and complications, and the multiple logistic regression model was used to compare MFI with other predictors of readmission, any complication, and reoperation.Results: A total of 51,582 patients underwent primary THA during the study period. MFI was a significant and stronger predictor than the American Society of Anesthesiologists class and age for readmission (odds ratio [OR], 14.72; 95% confidence interval [CI], 6.95-31.18; P < .001), any complication (OR, 3.63; 95% CI, 1.64-8.05; P = .002), and reoperation (OR, 8.78; 95% CI, 3.67-20.98; P < .001). As MFI increased, adverse discharge, any complication, readmission, reoperation, and mortality significantly increased (P < .001). Rates of systemic complications and length of stay significantly increased with increasing MFI.Conclusion: MFI is a simple and effective risk assessment tool to preoperatively counsel and make an objective decision on whether to perform THA on a frail patient. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine the relationship between the size of cam lesions and the presence of cartilage damage, labral damage, or changes in range of motion in the hips with signs and symptoms of femoroacetabular impingement (FAI). Methods: Cross-table lateral radiographs were available for 102 consecutive patients presenting with signs and symptoms of FAI. Radiographs with excessive external rotation, dysplasia, severe arthritis, avascular necrosis, or Legg-Calvé-Perthes syndrome were excluded, leaving 82 patients available for analysis (47 men, 35 women; average age, 25 yr [range, 12 to 55 yr]). Offset angle alpha was measured from the films with a digital goniometer. Patients subsequently underwent hip arthroscopy and the surgical findings and hip range of motion were prospectively recorded. Results: Higher offset angle alpha was associated with the presence of acetabular rim chondral defects (P = .044) and full-thickness delamination of the acetabular cartilage (P = .034). Patients with detachment of the base of the labrum had a higher offset angle alpha (P = .016). Higher offset angle alpha was related to male sex (P = .001) and decreased range of motion (P < .05), but not to age. Conclusions: Cam-type FAI, as measured by an increased offset angle alpha, was correlated with increased chondral damage, labral injury, and decreased range of motion. Level of Evidence: Level II, development of diagnostic criteria on basis of consecutive patients with universally applied gold standard. [Copyright &y& Elsevier]

Purpose: The purpose of this study was to investigate percent fill and repair grade of microfractured lesions of the acetabulum. Methods: Nine patients underwent revision hip arthroscopy for a variety of procedures after undergoing microfracture for treatment of a full-thickness chondral defect of the acetabulum at primary arthroscopy. The size of the chondral defect was measured during primary arthroscopy, and the percent fill of the defect and repair grade were noted at revision hip arthroscopy. Results: Mean time from primary arthroscopy to revision was 20 months (range, 10 to 36 months). The average percent fill of the acetabular chondral lesions at second-look was 91% (range, 25% to 100%). Eight of the patients had grade 1 or 2 repair product at second-look. The 1 patient with 25% fill and grade 4 repair product had diffuse osteoarthritis on the femur and acetabulum at primary microfracture. One patient required total hip arthroplasty 66 months after the index microfracture. Conclusions: In this study, 8 of 9 patients had 95% to 100% coverage of an isolated acetabular chondral lesion or acetabular lesion associated with a femoral head lesion, with grade 1 or 2 appearance of the repair product at an average of 20 months follow-up. One patient who had diffuse osteoarthritis failed, with only 25% coverage with a grade IV appearance of the repair product 10 months after index arthroscopy. Level of Evidence: Level IV, therapeutic case series. [Copyright &y& Elsevier]

The article discusses the application of arthroscopy for the clinical management of femoroacetabular impingement (FAI) in athletes. According to the author, FAI is a common cause of hip pain among athletes. It is also associated with reduced range of motion and decreased performance. The clinical manifestations of FAI are described. The article also explains the surgical techniques for FAI management, along with postoperative management.

The article proposes a method for acetabular rim trimming and detached labral repair. Defining the borders of a tear is the first step in addressing labral tears. One bioabsorbale suture is needed in repairing detached labrum to be able to stabilize fibrocartilage to the acetabular rim. The procedures included in the proposed method are explained.

The article discusses the neuromuscular hip biomechanics and pathology in athletes. It describes the osseous and ligamentous structures contributing to hip stabilization. It discusses the neuromechanical mechanisms that affect hip joint mechanics. It also explains the functional analysis of hip biomechanics and electromyography of hip muscles.

Abstract: Hip pain can be caused by multiple pathologies. Injuries to the acetabular labrum are the most common pathologic findings identified at the time of hip arthroscopy. Five causes of labral tears have been identified; these include trauma, femoroacetabular impingement, capsular laxity, dysplasia, and degeneration. Studies have shown the function and the importance of the labrum. To restore function of the labrum, new surgical techniques, such as suture anchor repair, have been described. The goal of arthroscopic treatment of a torn labrum is to relieve pain by eliminating the unstable flap tear that causes hip discomfort. The goals of these treatments are to maintain the function of the hip joint and decrease the development of premature arthrosis. [Copyright &y& Elsevier]

Intra-articular hip injuries are becoming increasingly recognized as a significant cause of pain and decreased performance in the athlete. The introduction of arthroscopic techniques for the treatment of athletic hip injuries, including capsular laxity, has allowed many athletes to return to their high levels of performance. The mechanisms of intra-articular athletic hip injuries, however, have not been well defined. As a result, the establishment of optimal post-arthroscopic rehabilitation protocols and return-to-play guidelines has been difficult. However, based on extensive clinical observation, certain hip injury patterns have been documented for sports in which intra-articular hip pathology are common findings. [Copyright &y& Elsevier]

Background: "Frailty" is a marker of physiological decline of multiple organ systems, and the frailty index identifies patients who are more susceptible to postoperative complications. The purpose of this study is to validate the modified frailty index (MFI) as a predictor of postoperative complications, reoperations, and readmissions in patients who underwent primary total knee arthroplasty (TKA).Methods: The American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2014 was queried by the Current Procedural Terminology code for primary TKA (27447). A previously described MFI was used to summate 11 variables in 5 organ systems. Bivariate analysis was performed for postoperative complications. A multiple logistic regression model was used to determine the relationship between MFI, American Society of Anesthesiologists score, and 30-day reoperation, controlling for age, gender, and body mass index.Results: A total of 90,260 patients underwent primary TKA during the study period. As MFI score increased, 30-day mortality significantly increased (P < .001). In addition, significantly higher rates of postoperative complications (all P < .001) were observed with increasing MFI: infection, wound, cardiac, pulmonary, and renal complications; and any occurrence. More frail patients also had increasing odds of adverse hospital discharge disposition, reoperation, and readmission (all P < .001). Length of hospital stay increased from 3.10 to 5.16 days (P < .001), while length of intensive care unit stay increased from 3.47 to 5.07 days (P < .001) between MFI score 0 and ≥0.36. MFI predicts 30-day reoperation with an adjusted odds ratio of 3.32 (95% confidence interval, 1.36-8.11; P < .001). Comparatively, MFI was a stronger predictor of reoperation compared with American Society of Anesthesiologists score and age with adjustment for gender and body mass index.Conclusion: Utilization of the MFI is a valid method in predicting postoperative complications, reoperations, and readmissions in patients undergoing primary TKA and can provide an effective and robust risk assessment tool to appropriately counsel patients and aid in preoperative optimization. [ABSTRACT FROM AUTHOR]

Background: There is a select number of massive-volume, high-acuity trauma centers (HACs) in the United States. Expertise in polytrauma care has been associated with improved mortality in general surgery trauma, though has not been investigated in orthopaedic trauma. With complex polytrauma proficiency comes the inherent risk of intensive care, complications, and prolonged inpatient stays, without a commensurate increase in allocated resources. The purpose of this study was to compare mortality, complications, and length of stay in polytraumatized orthopaedic patients treated at HACs vs. low-acuity trauma centers (LACs).Methods: The National Trauma Data Bank was queried for orthopaedic injuries with injury severity score (ISS)>15 and mortality, complications, hospital length of stay, ICU length of stay, ventilation duration, and demographics. Hospitals where at least 13% (median percentage of patients with ISS > 15 admitted to all hospitals) of total admissions had an ISS>15 were classified as HAC; all others were LACs.Results: HACs admitted 86.8% of 28,314 patients with ISS>15. On univariate analysis, patients at HACs have 16% decreased odds of in-hospital mortality vs. LACs (p=0.005); the effect increased to 27% (p=0.002) on multivariate analysis. Patients at HACs have 63% greater odds of ICU admission (p<0.001), 48% higher odds of ventilatory support (p=<0.001), 38% increased odds of unplanned reoperation (p=0.007), and 37% increased odds of medical complications (p<0.001). On multivariate analysis, secondary outcome measures showed no significant difference between HACs and LACs. Patients at HACs had 2.8 days longer length-of-stay (p<0.001).Conclusion: Severely injured orthopaedic trauma patients have decreased mortality at HACs, despite having a higher average ISS and a higher prevalence of obesity and active smoking. While there is a higher incidence of ICU admission, mechanical ventilation, complications, and unplanned reoperation on univariate analysis, correction for ISS and patient factors enhances the effect of HACs on mortality, but removes the effect on secondary measures. Thus, HACs are life-saving institutions for polytraumatized orthopaedic patients, and the known resource demand of these hospitals is supported by their favorable outcome profile.Level Of Evidence: IV. [ABSTRACT FROM AUTHOR]

Background: Metabolic syndrome (MetS) increases cardiovascular risk and is associated with poor patient outcomes. We hypothesized that MetS confers an increased risk of morbidity and mortality in severely injured trauma patients.Study Design: We performed a retrospective review of trauma patients from 2014 through 2018, excluding patients younger than 16 years, with Injury Severity Score <16, and with incomplete height and/or weight documentation. Metabolic syndrome was defined as the presence of diabetes, hypertension, and BMI ≥30 kg/m2. Outcomes included length of stay (LOS), complications, discharge location, and mortality.Results: There were 4,489 patients meeting criteria, of which 100 (2.2%) had MetS. Patients with MetS were older (64.0 vs 38.6 years; p < 0.0001), but with similar Injury Severity Scores (22 vs 22; p = 0.7). Hospital LOS was significantly longer with MetS (16.5 vs 11 days; p < 0.0001), as was ICU LOS (9 vs 5 days; p = 0.0002). MetS correlated with higher rates of acute kidney injury (19% vs 3.6%; p < 0.0001), ARDS (11.0% vs 4.6%; p = 0.01), cardiac arrest (10.0% vs 4.0%; p = 0.01), MI (2.0% vs 0.3%; p = 0.05), severe sepsis (8.0% vs 3.3%; p = 0.03), unplanned intubation (11.0% vs 5.0%; p = 0.02), unplanned ICU admission (13.0% vs 6.1%; p = 0.02), and non-home discharge (51.0% vs 30.2%; p = 0.0007). After controlling for age, Glasgow Coma Scale, Injury Severity Score, sex, and mechanism, MetS remained an independent predictor of mortality (odds ratio 2.5; 95% CI 1.33 to 4.7; p = 0.004).Conclusions: MetS occurs infrequently in our severely injured trauma population, but is strongly associated with increasing LOS, as well as cardiac, pulmonary, infectious, and renal complications. MetS also significantly and independently predicts death and should be identified early to facilitate prompt multidisciplinary treatment. [ABSTRACT FROM AUTHOR]

Objectives: To describe differences in follow-up compliance and emergency department (ED) visits between ballistic and non-ballistic operative lower extremity fracture patients.Design: Retrospective study.Setting: Urban level 1 trauma center.Patients/participants: Patients age ≥18 years with ≥1 tibia or femur fractures treated with ORIF or intramedullary nailing (IMN) between September 1, 2013 and August 31, 2015.Main Outcome Measure: A compliance fraction calculated as ([number of attended follow-up visits] / [number of attended follow-up visits + number of missed follow-up visits]) and ED visits in the post-operative period.Results: 612 patients were studied. Patients with ballistic lower extremity fractures had a younger mean age (30.8 years v. 41.6 years; p < 0.0001); a shorter length of stay (5.00 days v. 8.00 days; p < 0.0001); and were more likely to be male (92.6% v. 68%; p < 0.0001) and African-American (90.1% v. 63.1%; p < 0.0001) when compared to non-ballistic long bone injuries. Increased follow-up compliance (defined as a compliance fraction ≥0.75) was associated with having a non-ballistic fracture (OR 1.73, 1.13-2.64; p = 0.01), not having an ED visit (OR 2.08, 1.30-3.33; p = 0.002), and being female (OR 1.82, 1.27-2.61; p = 0.001). Increased ED utilization (≥ 1 ED visit) was associated with ballistic mechanism (OR 1.95, 1.20-3.16; p = 0.006), a low follow-up compliance fraction (OR 2.08, 1.30-3.33; p = 0.0019), homelessness (OR 3.91, 1.53-9.98; p = 0.006), and African-American race (OR 2.26, 1.26-4.05; p = 0.05). Scheduling a specific follow-up visit on the discharge summary did not predict higher compliance (OR 1.51, 0.98-2.33; p = 0.06). Conversely, the lack of a specific follow-up visit scheduled on the discharge summary did not predict ED utilization (OR 0.63, 0.34-1.17; p = 0.14).Conclusion: The results of this study demonstrate that increased utilization of the ED was associated with ballistic fractures, homelessness, decreased clinic compliance, and African American race. Furthermore, patients with non-ballistic injuries, women, and those without any ED visit were more likely to have higher outpatient clinic compliance. [ABSTRACT FROM AUTHOR]

Background: As morbidity and mortality from traumatic orthopaedic injuries continues to rise, increased research is being conducted on how to best predict complications in at risk patients. Recently, frailty indices have been validated in a variety of surgical subspecialties as predictors of morbidity and mortality. However, the vast majority of research has been conducted on geriatric patient populations, with little evidence on patients who are chronologically young. The purpose of this study was to evaluate the role of a modified frailty index (mFI) in predicting mortality and complications after pelvis, acetabulum, and lower extremity trauma in patients of all ages.Methods: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was queried from 2005 to 2014 for all patients who underwent surgery for pelvis, acetabulum, and lower extremity trauma. The sample size was divided into geriatric (age ≥ 60) and young (age < 60) cohorts. The mFI score was calculated for each patient. Bivariate analysis was performed using logistic regression and a chi-square test to determine the relationship between mFI and both primary and secondary outcomes while adjusting for age. Univariate analysis and multivariate analyses were performed. All analyses were done using SAS 9.4 (Cary, NC) and a p < 0.05 was considered significant.Results: 56,241 patients were identified to have undergone surgery for pelvis, acetabulum, or lower extremity trauma. 28% of patients were identified under the age of 60. In the young cohort, mFI was a strong predictor of thirty-day mortality (OR 11.02, 95% CI 6.26-19.39, p < 0.001). With regards to Clavien-Dindo grade IV complications, MFI is also a strong predictor in the young cohort (OR 28.82, 95% CI 16.05-51.77, p < 0.001).Conclusion and Relevance: The mFI score was a significant predictor of morbidity and mortality in chronologically young orthopaedic trauma patients. The use of the mFI score can provide an individualized risk assessment to interdisciplinary teams for perioperative counseling and to improve outcomes. [ABSTRACT FROM AUTHOR]

Objective: The burgeoning elderly population calls for a robust tool to identify patients with increased risk of mortality and morbidity. This paper investigates the utility of the MFI as a predictor of morbidity and mortality in orthopaedic trauma patients.Design: Retrospective review of the NSQIP database to identify patients age 60 and above who underwent surgery for pelvis and lower extremity fractures between 2005 and 2014.Main Outcomes and Measures: For each patient, an MFI score was calculated using NSQIP variables. The relationship between the MFI score and 30-day mortality and morbidity was determined using chi-square analysis. MFI was compared to age, American Society of Anesthesiologists physical status classification, and wound classifications in multiple logistic regression.Results: Study sample consisted of 36,424 patients with 27.8% male with an average age of 79.5 years (SD 9.3). MFI ranged from 0 to 0.82 with mean MFI of 0.12 (SD 0.09). Mortality increased from 2.7% to 13.2% and readmission increased from 5.5% to 18.8% with increasing MFI score. The rate of any complication increased from 30.1% to 38.6%. Length of hospital stay increased from 5.3days (±5.5days) to 9.1days (±7.2days) between MFI score 0 and 0.45+. There was a stronger association between 30-day mortality and MFI (aOR for MFI 0.45+: 2.6, 95% CI: 1.7-3.9) compared to age (aOR for age: 1.1, 95% CI: 1.1-1.1) and ASA (aOR 2.5, 95% CI: 2.3-2.7).Conclusions and Relevance: MFI was a significant predictor of morbidity and mortality in orthopaedic trauma patients. The use of MFI can provide an individualized risk assessment tool that can be used by an interdisciplinary team for perioperative counseling and to improve outcomes. [ABSTRACT FROM AUTHOR]

Orthopedic biomaterial-associated infections remain a major clinical challenge, with Staphylococcus aureus being the most common pathogen. S. aureus biofilm formation enhances immune evasion and antibiotic resistance, resulting in a local, indolent infection that can persist long-term without symptoms before eventual hardware failure, bone non-union, or sepsis. Immune modulation is an emerging strategy to combat host immune evasion by S. aureus. However, most immune modulation strategies are focused on local immune responses at the site of infection, with little emphasis on understanding the infection-induced and orthopedic-related systemic immune responses of the host, and their role in local infection clearance and tissue regeneration. This study utilized a rat bone defect model to investigate how implant-associated infection affects the systemic immune response. Long-term systemic immune dysregulation was observed with a significant systemic decrease in T cells and a concomitant increase in immunosuppressive myeloid-derived suppressor cells (MDSCs) compared to non-infected controls. Further, the control group exhibited a regulated and coordinated systemic cytokine response, which was absent in the infection group. Multivariate analysis revealed high levels of MDSCs to be most correlated with the infection group, while high levels of T cells were most correlated with the control group. Locally, the infection group had attenuated macrophage infiltration and increased levels of MDSCs in the local soft tissue compared to non-infected controls. These data reveal the widespread impacts of an orthopedic infection on both the local and the systemic immune responses, uncovering promising targets for diagnostics and immunotherapies that could optimize treatment strategies and ultimately improve patient outcomes. [ABSTRACT FROM AUTHOR]