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Article ; Online: Letter to the editor on: Treatment Failure in Femoral Neck Fractures in Adults Younger than 50 Years: Analysis of 492 Patients Treated at 26 North American Trauma Centers.

Patterson, Joseph T / Morshed, Saam

2022 Volume 37, Issue 3, Page(s) e139–e140

MeSH term(s)	Humans ; Adult ; Trauma Centers ; Femoral Neck Fractures/surgery ; Fracture Fixation, Internal ; Treatment Failure ; North America ; Retrospective Studies
Language	English
Publishing date	2022-12-13
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	639099-7
ISSN	1531-2291 ; 0890-5339
ISSN (online)	1531-2291
ISSN	0890-5339
DOI	10.1097/BOT.0000000000002540
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Article ; Online: Letters to the Editor.

Patterson, Joseph T / Morshed, Saam

Journal of orthopaedic trauma

2021 Volume 34, Issue 11, Page(s) e434–e436

MeSH term(s)	Bibliometrics ; Femoral Neck Fractures ; Fracture Fixation, Internal ; Humans ; Open Fracture Reduction ; Reoperation
Language	English
Publishing date	2021-01-27
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	639099-7
ISSN	1531-2291 ; 0890-5339
ISSN (online)	1531-2291
ISSN	0890-5339
DOI	10.1097/BOT.0000000000001919
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Article ; Online: Deciphering data: How should clinical trials change your clinical practice?

O'Marr, Jamieson M / Miclau, Theodore / Morshed, Saam

Injury

2023 Volume 54 Suppl 5, Page(s) 110928

Abstract: Introduction: The careful consideration of how to apply findings from the scientific literature is important to every physician's clinical practice. This can pose a difficult task, particularly with the increasing speed of technological advances and ... ...

Abstract	Introduction: The careful consideration of how to apply findings from the scientific literature is important to every physician's clinical practice. This can pose a difficult task, particularly with the increasing speed of technological advances and complexity involved in modern clinical trials. This review introduces a new method, the WHOM criteria (Who, How, Outcomes, Minimizing bias), from which orthopedic surgeons and other physicians can efficiently evaluate novel medical literature for inclusion into their clinical practice. Whom criteria: The WHOM framework consists of four steps. The first step, Who, involves confirming whether a sample population studied is similar to one's patient under treatment, in order to ensure the results can be reasonably applied. Second, the How, comprises evaluating the intervention performed and ensuring that it could be reasonably replicated. The third step requires thoroughly evaluating the outcomes used in the study so as to ensure they are clinically meaningful to both the treating physician and the patient. Finally, there must be a careful evaluation of potential sources of bias and the ways in which errors and bias were minimized in all phases of the study. Conclusion: Evidence-based practice should drive clinical decision making whenever the necessary literature is available. This requires the careful evaluation of new literature on a regular basis so that physicians can render safe and effective health care in partnership with their patients. The WHOM criteria are described in order to aid clinicians in navigating published research and change practice when appropriate.
MeSH term(s)	Humans ; Delivery of Health Care ; Clinical Trials as Topic
Language	English
Publishing date	2023-07-07
Publishing country	Netherlands
Document type	Review ; Journal Article
ZDB-ID	218778-4
ISSN	1879-0267 ; 0020-1383
ISSN (online)	1879-0267
ISSN	0020-1383
DOI	10.1016/j.injury.2023.110928
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Zs.A 778: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Estimating the economic impact of complications after open tibial fracture: A secondary analysis of the pilot Gentamicin Open Tibia trial (pGO-Tibia).

Flores, Michael J / Brown, Kelsey E / Haonga, Billy / Morshed, Saam / Shearer, David W

OTA international : the open access journal of orthopaedic trauma

2024 Volume 7, Issue 1, Page(s) e290

Abstract: Objectives: To estimate the indirect economic impact of tibial fractures and their associated adverse events (AEs) in Tanzania.: Design: A secondary analysis of the pilot Gentamicin Open (pGO)-Tibia randomized control trial estimating the indirect ... ...

Abstract	Objectives: To estimate the indirect economic impact of tibial fractures and their associated adverse events (AEs) in Tanzania. Design: A secondary analysis of the pilot Gentamicin Open (pGO)-Tibia randomized control trial estimating the indirect economic impact of suffering an AE, defined as a fracture-related infection (FRI) and/or nonunion, after an open tibial fracture in Tanzania. Setting: The pGO-Tibia trial was conducted from November 2019 to August 2021 at the Muhimbili Orthopaedic Institute in Dar es Salaam, Tanzania. Patients/participants: One hundred adults with open tibial shaft fractures participated in this study. Intervention: Work hours were compared between AE groups. Cost data were analyzed using a weighted-average hourly wage and converted into purchasing power parity-adjusted USD. Main outcome measurements: Indirect economic impact was analyzed from the perspective of return to work (RTW), lost productivity, and other indirect economic and household costs. RTW was analyzed using a survival analysis. Results: Half of patients returned to work at 1-year follow-up, with those experiencing an AE having a significantly lower rate of RTW. Lost productivity was nearly double for those experiencing an AE. There was a significant difference in the mean outside health care costs between groups. The total mean indirect cost was $2385 with an AE, representing 92% of mean annual income and an increase of $1195 compared with no AE. There were significantly more patients with an AE who endorsed difficulty affording household expenses postinjury and who borrowed money to pay for their medical expenses. Conclusions: This study identified serious economic burden after tibial fractures, with significant differences in total indirect cost between those with and without an AE. Level of evidence: II.
Language	English
Publishing date	2024-01-19
Publishing country	United States
Document type	Journal Article
ISSN	2574-2167
ISSN (online)	2574-2167
DOI	10.1097/OI9.0000000000000290
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Article: Retrospective cohort study analyzing outcomes of the SIGN Fin Nail in adult femoral fractures using the retrograde approach.

Subramanian, Aditya / Adejuyigbe, Babapelumi / Niknam, Kian / Gomez-Alvarado, Francisco / Morshed, Saam / Shearer, David

Journal of orthopaedics

2024 Volume 54, Page(s) 103–107

Abstract: Purpose: There is high burden of long bone fractures in low- and middle-income countries (LMICs). Given a limited availability of fluoroscopy in LMICs, the Surgical Implant Generation Network (SIGN) developed two types of intramedullary nails: the SIGN ... ...

Abstract	Purpose: There is high burden of long bone fractures in low- and middle-income countries (LMICs). Given a limited availability of fluoroscopy in LMICs, the Surgical Implant Generation Network (SIGN) developed two types of intramedullary nails: the SIGN standard nail and the SIGN Fin Nail. A limited number of studies have analyzed healing outcomes with the SIGN Fin Nail and the current study is the largest one to date. The purpose of this study is to compare outcomes between the SIGN standard nail and SIGN Fin Nails in adult femoral shaft fractures treated with a retrograde approach. Method: A retrospective cohort study of adults with femoral shaft fractures was performed using the Sign Online Surgical Database (SOSD). The primary outcome was achieving full painless weight bearing and the secondary outcomes assessed were radiographic healing and infection. A propensity-score adjustment was performed for potential confounders and effect modification due to fracture location was tested using a Mantel-Haenszel test for heterogeneity. Results: Of 19,928 adults with femoral shaft fractures, 2,912 (14.7%) had the required 6-month follow-up to be included. The overall propensity score weighted relative risk between the Fin and Standard Nail for achieving painless weight-bearing was 0.99, 95% CI [0.96-1.03] and for radiographical healing was 0.99, 95%CI [0.97-1.02]. The propensity score weighted relative risk for infection was 1.30, 95% [0.85-1.97]. Use of the Fin nail was also significantly associated with shorter surgery times (p < 0.005, effect size = 24 min). Sub-group analysis based on fracture location and injury cause demonstrated no change in relative risk. Conclusion: The Fin nail showed no change in relative risk in terms of achieving full painless weightbearing or radiographic healing compared to the standard nail for retrograde nailing of femoral shaft fractures in adults. The heterogeneous nature of the cohort and large sample size allow for generalizability and add to a growing base of literature supporting use of the Fin Nail for retrograde femoral nailing. However, there are limitations as we could not correct for comminution at the fracture site or measure radiographic alignment or shortening.
Language	English
Publishing date	2024-03-13
Publishing country	India
Document type	Journal Article
ZDB-ID	2240839-3
ISSN	0972-978X
ISSN	0972-978X
DOI	10.1016/j.jor.2024.03.020
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Article ; Online: Management of aseptic nonunions and severe bone defects: let us get this thing healed!

Nauth, Aaron / Crist, Brett D / Morshed, Saam / Watson, J Tracy / Pape, Hans-Christoph

OTA international : the open access journal of orthopaedic trauma

2023 Volume 6, Issue 3 Suppl, Page(s) e258

Abstract: Effective nonunion and bone defect management requires consideration of multiple potential contributing factors including biomechanics, biology, metabolic, and patient factors. This article reviews these factors as well as several potential nonunion or ... ...

Abstract	Effective nonunion and bone defect management requires consideration of multiple potential contributing factors including biomechanics, biology, metabolic, and patient factors. This article reviews these factors as well as several potential nonunion or bone defect treatments including bone grafts, bone graft substitutes, the induced membrane technique, and distraction osteogenesis. A summary of these concepts and guidelines for an overall approach to management are also provided.
Language	English
Publishing date	2023-06-16
Publishing country	United States
Document type	Journal Article ; Review
ISSN	2574-2167
ISSN (online)	2574-2167
DOI	10.1097/OI9.0000000000000258
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Article ; Online: Low Surgeon and Hospital Volume Increase Risk of Early Conversion to Total Knee Arthroplasty After Tibial Plateau Fixation.

Brodke, Dane J / Morshed, Saam

The Journal of the American Academy of Orthopaedic Surgeons

2020 Volume 29, Issue 1, Page(s) 25–34

Abstract: Background: Some orthopaedic procedures exhibit volume-outcome relationships that suggest benefits associated with a triage and treatment by higher volume surgeons and hospitals. The purpose of this study was to determine whether this association is ... ...

Abstract	Background: Some orthopaedic procedures exhibit volume-outcome relationships that suggest benefits associated with a triage and treatment by higher volume surgeons and hospitals. The purpose of this study was to determine whether this association is present for open reduction internal fixation (ORIF) of tibial plateau fractures regarding the outcome of conversion to total knee arthroplasty (TKA). Methods: The Florida State Inpatient Database was queried to identify patients who underwent ORIF of a tibial plateau fracture between 2006 and 2009. The annual volumes of surgeons and hospitals were determined. The outcome of interest was any subsequent hospitalization for TKA within 5 years. Comparing the rates of this outcome, cut points were established to define high and low volume. Survival analysis, including Cox proportional hazards modeling, was used to estimate the effect of volume on rates of TKA while controlling for patient factors and injury characteristics. Results: In this cohort of 3,921 patients, 172 patients (4.4%) underwent TKA within 5 years of ORIF of the tibial plateau. This included 5.0% of patients treated by low-volume surgeons versus 2.1% treated by high-volume surgeons and 4.8% treated at low-volume hospitals versus 2.0% treated at high-volume hospitals. High-volume surgeons and hospitals were defined by annual volumes greater than or equal to 7 and 29, respectively. After adjustment, treatment at a low-volume hospital was associated with a larger hazard of conversion to TKA (hazard ratio = 2.05; 95% confidence interval = 1.11 to 3.80). Treatment by a low-volume surgeon was also associated with a larger hazard of conversion to TKA (hazard ratio = 2.17; 95% confidence interval = 1.31 to 3.59). Discussion: High-volume treatment of tibial plateau fractures is associated with a lower rate of conversion to TKA, suggesting that the regionalization of care for these injuries may improve outcomes. Level of evidence: Level III.
MeSH term(s)	Arthroplasty, Replacement, Knee/adverse effects ; Florida ; Fracture Fixation, Internal ; Hospitals, High-Volume ; Humans ; Retrospective Studies ; Surgeons ; Tibial Fractures/surgery ; Treatment Outcome
Language	English
Publishing date	2020-04-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	1200524-1
ISSN	1940-5480 ; 1067-151X
ISSN (online)	1940-5480
ISSN	1067-151X
DOI	10.5435/JAAOS-D-19-00403
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Zs.A 4048: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article: Evidence for Local Antibiotics in the Prevention of Infection in Orthopaedic Trauma.

Flores, Michael J / Brown, Kelsey E / Morshed, Saam / Shearer, David W

Journal of clinical medicine

2022 Volume 11, Issue 24

Abstract: Prevention of fracture-related infection (FRI) remains a substantial challenge in orthopaedic trauma care. There is evolving evidence to support the use of local antibiotics for both the prevention and treatment of musculoskeletal infection. Local ... ...

Abstract	Prevention of fracture-related infection (FRI) remains a substantial challenge in orthopaedic trauma care. There is evolving evidence to support the use of local antibiotics for both the prevention and treatment of musculoskeletal infection. Local antibiotics can achieve higher local tissue concentrations with a lower risk of systemic complications compared to intravenously administered antibiotics. These antibiotics may be administered in powder or liquid form without carrier, or if sustained release is desired, using a carrier. Polymethylmethacrylate (PMMA), ceramics, and hydrogels are examples of antibiotic carriers. Unlike PMMA, ceramics and hydrogels have the advantage of not requiring a second surgery for removal. The VANCO trial supported the use of powdered vancomycin in high-risk fracture cases for the reduction of Gram-positive infections; although, data is limited. Future studies will evaluate the use of aminoglycoside antibiotics to address Gram-negative infection prevention. While theoretical concerns exist with the use of local antibiotics, available studies suggest local antibiotics are safe with a low-risk of adverse effects.
Language	English
Publishing date	2022-12-16
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm11247461
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Article ; Online: Preclinical models of orthopaedic trauma: Orthopaedic Research Society (ORS) and Orthopaedic Trauma Association (OTA) symposium 2022.

Wise, Patrick M / Saiz, Augustine M / Haller, Justin / Wenke, Joseph C / Schaer, Thomas / Schneider, Prism / Morshed, Saam / Bahney, Chelsea S

OTA international : the open access journal of orthopaedic trauma

2024 Volume 7, Issue 2 Suppl, Page(s) e303

Abstract: Orthopaedic trauma remains a leading cause of patient morbidity, mortality, and global health care burden. Although significant advances have been made in the diagnosis, treatment, and rehabilitation of these injuries, complications such as malunion, ... ...

Abstract	Orthopaedic trauma remains a leading cause of patient morbidity, mortality, and global health care burden. Although significant advances have been made in the diagnosis, treatment, and rehabilitation of these injuries, complications such as malunion, nonunion, infection, disuse muscle atrophy and osteopenia, and incomplete return to baseline function still occur. The significant inherent clinical variability in fracture care such as differing patient demographics, injury patterns, and treatment protocols make standardized and replicable study, especially of cellular and molecular based mechanisms, nearly impossible. Hence, the scientists dedicated to improving therapy and treatments for patients with orthopaedic trauma rely on preclinical models. Preclinical models have proven to be invaluable in understanding the timing between implant insertion and bacterial inoculation on the bioburden of infection. Posttraumatic arthritis (PTOA) can take years to develop clinically, but with a porcine pilon fracture model, posttraumatic arthritis can be reliably induced, so different surgical and therapeutic strategies can be tested in prevention. Conversely, the racehorse presents a well-accepted model of naturally occurring PTOA. With preclinical polytrauma models focusing on chest injury, abdominal injury, multiple fractures, and/or head injury, one can study how various injury patterns affect fracture healing can be systemically studied. Finally, these preclinical models serve as a translational bridge to for clinical application in human patients. With selection of the right preclinical model, studies can build a platform to decrease the risk of emerging technologies and provide foundational support for therapeutic clinical trials. In summary, orthopaedic trauma preclinical models allow scientists to simplify a complex clinical challenge, to understand the basic pathways starting with lower vertebrate models. Then, R&D efforts progress to higher vertebrate models to build in more complexity for translation of findings to the clinical practice.
Language	English
Publishing date	2024-03-11
Publishing country	United States
Document type	Journal Article
ISSN	2574-2167
ISSN (online)	2574-2167
DOI	10.1097/OI9.0000000000000303
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Article ; Online: Complex Orthopaedic Trauma Is Shifting Away From Level I to Non-Level I Trauma Centers: An Analysis of the National Trauma Data Bank.

Marmor, Meir T / Coufal, Sarah / Parel, Philip M / Rezaei, Arash / Morshed, Saam

Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews

2023 Volume 7, Issue 2

Abstract: Introduction: An increasing number of fellowship-trained orthopaedic trauma surgeons are working in non-Level I centers. This study aimed to examine trends of management of complex orthopaedic trauma in Level I centers versus non-Level I centers and its ...

Abstract	Introduction: An increasing number of fellowship-trained orthopaedic trauma surgeons are working in non-Level I centers. This study aimed to examine trends of management of complex orthopaedic trauma in Level I centers versus non-Level I centers and its potential effect on patient outcomes. Methods: Data from the National Trauma Data Bank from 2008 to 2017 were analyzed. Non-Level I to Level I center ratios for complex fractures and complication rates, median hours to procedure for time-sensitive fractures, and uninsured/underinsured rates of Level I and non-Level I centers were recorded. Results: Three hundred one thousand patients were included. A statistically significant downward trend was identified in the percent of all complex orthopaedic trauma at Level I centers and per-hospital likelihood of seeing a complex orthopaedic fracture in a Level I versus non-Level I hospital. Per-hospital complication rates were consistently lower in non-Level I hospitals after controlling for injury severity and payer mix. Time-sensitive fractures were treated earlier in non-Level I centers. Discussion: This study demonstrates a reduction of complex trauma treatment in Level I centers that did not translate to adverse effects on patient outcomes. Policymakers should notice this trend to ensure the continued quality of orthopaedic trauma training and maintenance of expertise in complex fracture management.
MeSH term(s)	Humans ; Orthopedics/education ; Trauma Centers ; Fractures, Bone ; Surgeons ; Orthopedic Surgeons ; Skull Fracture, Basilar
Language	English
Publishing date	2023-02-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	2898328-2
ISSN	2474-7661 ; 1067-151X
ISSN (online)	2474-7661
ISSN	1067-151X
DOI	10.5435/JAAOSGlobal-D-22-00288
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