Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for Type 2 diabetes and obesity due to their cardiometabolic benefits. However, their effects on fracture healing remain controversial. This study investigates perioperative GLP-1 RA use and outcomes following surgical treatment of lower extremity (LE) fractures. A retrospective analysis utilizing a large multicenter database compared patients on GLP-1 RAs within one year prior to and after lower extremity index surgery (+GLP) with those not on GLP-1 RAs (-GLP). Propensity score matching was performed on 275,970 included patients, matching 1:1 on age, sex, tobacco use, diabetes mellitus, primary hypertension, hyperlipidemia, chronic ischemic heart disease, chronic lower respiratory disease, and body mass index (BMI), resulting in 6125 "best-matched" patients per group. This was conducted utilizing multivariate logistic regression with a 0.1 caliper. Outcomes were assessed at 1 month, 3 months, and 1 year. At 1-year follow-up, GLP-1 RA users demonstrated a significantly higher rate of nonunion compared to matched controls (5.4% vs 4.4%, Risk Ratio 1.2, 95% CI 1.0-1.4, P < 0.05) when assessing patients who also continued GLP-1 RAs postoperatively. There were no significant differences in wound dehiscence, deep or superficial surgical site infections, or hematoma. Importantly, the +GLP group experienced significantly lower rates of cardiac arrest (0.8% vs 1.6%, RR 0.5, 95% CI 0.3-0.7, P < 0.01) and all-cause mortality (4.4% vs 8.0%, RR 0.5, 95% CI 0.4-0.6, P < 0.01). Perioperative GLP-1 RA use was associated with a higher risk of nonunion following lower extremity fracture surgery, though without increased wound complication rates. Importantly, GLP-1 RA use was linked to reduced cardiac arrest and mortality within one year. These findings suggest that while the increased rate of nonunion is statistically significant, its clinically significance is limited. Thus, the mortality reduction may be more clinically meaningful for patient counseling and perioperative management. Further study is required to clarify the balance between systemic benefits and surgical outcomes of GLP-1 RAs in orthopedic trauma.

Background: Nonunion is a rare yet serious complication in pediatric fracture healing that can lead to patient morbidity and economic burden. The administration of nonsteroidal anti-inflammatory drugs (NSAIDs) has been associated with an increased risk of fracture nonunion in adults, but data are lacking in the pediatric population. This study examines the relationship between postoperative ketorolac administration and nonunion in operatively managed pediatric long-bone fractures. Methods: A retrospective cohort study was conducted with use of TriNetX, a research network that encompasses data from the United States, Canada, and Western Europe. A total of 462,260 patients from 52 health-care organizations met the inclusion criteria. Patients <18 years old with operatively managed upper or lower-extremity long-bone fractures were included. The exposure of interest was ketorolac administration within 30 days postoperatively between 2003 and 2023. Nonunion was identified and verified with use of the pertinent medical codes. Absolute risks and hazard ratios (HRs) were calculated for both study groups. Significance was set at p < 0.05. Results: After propensity score matching, 48,778 patients were identified per group. The incidence of nonunion was 2.19% in the ketorolac group and 0.93% in the non-ketorolac group (HR, 2.71; 95% confidence interval [CI]: 2.46, 3.21; p < 0.0001). Subgroup analyses demonstrated a higher risk of nonunion in patients with lower-extremity fractures (HR, 3.45; 95% CI: 3.14, 3.75; p < 0.0001) than in those with upper-extremity fractures (HR, 2.11; 95% CI: 1.84, 2.32; p < 0.0001). Among the fracture location subgroups, the greatest HR for nonunion was observed in patients with femoral fractures, followed sequentially by those with tibial and/or fibular fractures, humeral fractures, and radial and/or ulnar fractures. Conclusions: To our knowledge, this is the largest study to date to explore postoperative ketorolac use and nonunion in the setting of operatively managed pediatric long-bone fractures. Nonunion in children was rare, occurring in <1% of all included patients. Ketorolac administration was associated with a 2 to 3-fold increase in nonunion risks, with pronounced implications for patients with lower-extremity fractures, particularly those with femoral fractures. Clinicians should weigh the therapeutic advantages of non-opiate analgesia with ketorolac against the risk of nonunion in order to optimize postoperative pain management and recovery. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Background: The literature is inconclusive regarding the potential complications of tranexamic acid (TXA), an antifibrinolytic drug, for total hip arthroplasty (THA). The purpose of this study is to compare complication rates and patient outcomes between THA patients administered TXA vs. THA patients not administered TXA. Methods: The TriNetX Research network was utilized to generate a cohort of adult patients who underwent THA between 2003 and 2024. These patients were categorized into two subgroups for the retrospective analysis: (1) patients who received TXA 24 h prior to THA (TXA), and (2) patients who did not receive TXA 24 h prior to total hip arthroplasty (no-TXA). The follow-up period was 30 and 90 days. Results: At 30 days following THA, the TXA patients had a reduced risk of transfusion (risk ratio (RR): 0.412; 95% confidence intervals (CI): 0.374, 0.453), reduced risk of DVT (RR: 0.856; CI: 0.768, 0.953), reduced risk of joint infection (RR: 0.808; CI: 0.710, 0.920), but a higher rate of periprosthetic fracture (RR: 1.234; CI: 1.065, 1.429) compared to patients who did not receive TXA. At 90 days following THA, TXA patients had a reduced risk of transfusion (RR: 0.446; CI: 0.408, 0.487), DVT (RR: 0.847; CI: 0.776, 0.924), and periprosthetic joint infection (RR: 0.894; CI: 0.815, 0.982) compared to patients who did not receive TXA. Patients who received TXA had higher rates of periprosthetic fracture (RR: 1.219; CI: 1.088, 1.365), acute postoperative anemia (RR: 1.222; CI: 1.171, 1.276), deep surgical site infection (SSI) (RR: 1.706; CI: 1.117, 2.605), and superficial SSI (RR: 1.950; CI: 1.567, 2.428) compared to patients who did not receive TXA. Conclusions: Patients receiving TXA prior to THA exhibited significantly reduced the prevalence of blood transfusions, DVT, and periprosthetic joint infection following THA. However, superficial SSI and periprosthetic fracture were seen with higher rates in the TXA cohort than in the no-TXA cohort.

Background/Objectives: While methicillin-resistant Staphylococcus aureus (MRSA) colonization is a known risk factor for surgical site infections, no definitive recommendations exist regarding preoperative S. aureus screening and decolonization protocols due to inconclusive evidence in Orthopedic Surgery. This study aimed to examine the correlation between preoperative MRSA colonization and postoperative infections in Total Knee Arthroplasty (TKA) patients. Methods: Data from 2005 to 2023 were collected from TriNetX, a global health research network, reviewing 237,360 unique patients. TKA patients were assigned under Current Procedural Terminology, while International Statistical Classification of Diseases Codes were used to identify preoperative comorbidities and postoperative complications. Demographic and analytical statistics were compared between MRSA-positive and control groups before and after propensity matching. Results: The MRSA-positive group had a significantly (p < 0.001) higher proportion of patients over 65 years (47.17% vs. 38.46%), obesity (41.76% vs. 34.67%), smoking disorders (33.36% vs. 19.73%), and diabetes (25.06% vs. 19.85%) compared to the control group. Postoperative complications were significantly (p < 0.001) more frequent in the MRSA-positive group, specifically periprosthetic joint infection (PJI) (4.11% vs. 0.79%, OR = 5.40), deep (0.12% vs. 0.01%, OR = 11.15) and superficial (0.37% vs. 0.09%, OR = 4.17) surgical site infections, and wound dehiscence (1.11% vs. 0.52%, OR = 2.13). The matched analysis confirmed significantly (p < 0.001) higher rates of PJI (4.39% vs. 1.18%, OR = 3.59). Conclusions: Our results illustrated preoperative colonization of MRSA as associated with an increased risk of wound-related complications. Surgeons and patients must consider preoperative MRSA colonization status when deciding if TKA is an optimal treatment option.

Background: After a unilateral slipped capital femoral epiphysis (SCFE), the contralateral hip is at risk for a subsequent SCFE. However, further information with regard to risk factors involved in the development of contralateral SCFE must be investigated. The purpose of this study was to report the rate and risk factors for subsequent contralateral SCFE in adolescents treated for unilateral SCFE by exploring a mix of known and potential risk factors. Methods: A case-control study utilizing aggregated multi-institutional electronic medical record data between January 2003 and March 2023 was conducted. Patients <18 years of age diagnosed with SCFE who underwent surgical management were included. Variables associated with contralateral SCFE were identified using multivariable logistic regression models that adjusted for patient characteristics and time of the surgical procedure, providing adjusted odds ratios (ORs). The false discovery rate was accounted for via the Benjamini-Hochberg method. Results: In this study, 15.3% of patients developed contralateral SCFE at a mean (and standard error) of 296.53 ± 17.23 days and a median of 190 days following the initial SCFE. Increased thyrotropin (OR, 1.43 [95% confidence interval (CI), 1.04 to 1.97]; p = 0.022), diabetes mellitus (OR, 1.67 [95% CI, 1.22 to 2.49]; p = 0.005), severe obesity (OR, 1.81 [95% CI, 1.56 to 2.57]; p < 0.001), history of human growth hormone use (OR, 1.85 [95% CI, 1.10 to 3.38]; p = 0.032), low vitamin D (OR, 5.75 [95% CI, 2.23 to 13.83]; p < 0.001), younger age in boys (under 12 years of age: OR, 1.85 [95% CI, 1.37 to 2.43]; p < 0.001) and in girls (under 11 years of age: OR, 1.47 [95% CI, 1.05 to 2.02]; p = 0.026), and tobacco exposure (OR, 2.43 [95% CI, 1.49 to 3.87]; p < 0.001) were significantly associated with increased odds of developing contralateral SCFE. Conclusions: In the largest study on this topic, we identified the rate, odds, and risk factors associated with development of contralateral SCFE. We found younger age, hypothyroidism, severe obesity, low vitamin D, diabetes mellitus, and a history of human growth hormone use to be independent risk factors. Our findings can aid clinical decision-making in at-risk patients. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.