Search

Abstract Background Diaphyseal radius and ulna fractures require surgical fixation in adults. Open reduction and internal fixation (ORIF) have been considered the gold standard of treatment. The recent development of an interlocking intramedullary nail (IMN) has provided an alternative treatment method for these fractures. The objective of this meta-analysis is to compare the outcomes and complications of IMN versus ORIF for diaphyseal forearm fractures in adults. Methods MEDLINE and Embase were searched from January 1, 2000, through January 7, 2024. All English-language studies were included comparing radiographic and functional outcomes for interlocking IMN fixation and ORIF of diaphyseal forearm fractures in adults (age ≥ 18 years). Study demographics, fracture data, functional outcomes, radiographic outcomes, and complications were extracted. Study quality was determined using the ROBINS-I criteria for cohort studies and the Cochrane risk of bias 2.0 (RoB 2) tool for randomized controlled trials. Meta-analysis of included studies used odds ratios and standardized mean difference when appropriate. Data was analyzed using subgroups of all diaphyseal fractures (including isolated radius or ulna fractures) and those with BBFFs. Results Nine studies were included for analysis. There were 42 isolated radius, 80 isolated ulna, and 116 both-bone fractures (BBFF) treated with IMN and 36 radius, 81 ulna, and 116 both-bone fractures treated with ORIF. Compared to ORIF, IMN of diaphyseal forearm fractures appeared to be associated with shorter operative times and a lower overall complication rate. Time-to-union and the rate of nonunion following IMN were similar to ORIF. According to the Grace–Eversmann score, functional outcomes tended to be better following IMN, but DASH scores were similar between fixation strategies. Conclusions Our findings suggest that interlocking IMN can be a safe and effective treatment option for simple and complex diaphyseal forearm fractures in adults. Further high-quality studies are needed to define indications for treating diaphyseal fractures with an interlocking IMN. Level of Evidence Therapeutic Level IV.

Objective: This observational study examines the associated risk for concussion following ‘lowering the helmet to initiate contact’ penalties in the National Football League. Methods: Using officially published injury data on the National Football League (NFL) website, the authors reviewed NFL Players diagnosed with a concussion from 2015 to 2022 and who received a ‘lowering the helmet to initiate contact’ penalty from 2018 to 2020. Reported concussions were evaluated for association with ‘lowering the helmet to initiate contact’ penalties. The Friedman test assessed overall differences between the years. Pairwise comparisons were performed using the Wilcoxon signed-rank test with a Bonferroni correction to adjust for multiple comparisons. Results: The average incidence of all concussions per play was 0.45% for regular-season games. From 2018 to 2020, 86 lowering the helmet to initiate contact penalties were called. Three of 86 penalties resulted in concussions, with a 3.5% incidence. The Friedman test indicated significant differences in concussion trends across the years (χ2 = 16.0, p = 0.0003). Pairwise analysis with the Wilcoxon signed-rank test and adjusted for multiple comparisons with a Bonferroni correction (α = 0.05/28 = 0.0018) showed no statistically significant differences between years. There was a significant negative correlation of overall concussion incidence per year. Conclusions: The incidence of concussion with players penalized for lowering the helmet to initiate contact is greater than the overall incidence of concussions in all plays. While there is no difference in total concussions that occur, the concussion rate has a significant negative trend between 2015 and 2022. However, it is difficult to analyze the nonimmediate effects of this penalty on players’ intended play and practice, which may further decrease concussions.

The National Resident Matching Program (NRMP) offers a Couples Match (CM) option to aid applicants with a significant other in medical school. The CM process can be confusing to all involved and is further complicated when both students apply to the same specialty, even more so when it is a competitive specialty such as orthopaedic surgery. There is a lack of guidance and information for applicants CM into orthopaedic surgery. We (two orthopaedic surgery applicants), who successfully CM, aim to explain the nuances of the CM in orthopaedic surgery, describe our experience, and give advice to future applicants.