Hip fracture is a cause for concern in the geriatric population. It is one of the leading causes of traumatic injury in this demographic and correlates to a higher risk of all-cause morbidity and mortality. The Garden classification of femoral neck fractures (FNF) dictates treatment via internal fixation or hip replacement, including hemiarthroplasty or total hip arthroplasty. This review summarizes existing literature that has explored the difference in outcomes between internal fixation, hemiarthroplasty, and total hip arthroplasty for nondisplaced and displaced FNF in the geriatric population, and more specifically highlights the risks and benefits of a cemented vs. uncemented approach to hemiarthroplasty.

Introduction: Scholarly impact has been used to measure faculty productivity and academic contribution throughout academia. Traditionally, the number of articles authored has been the primary metric for scholarly impact regarding academic promotion and reputation. We hypothesize that over time, the nature of authorship has evolved to include more authors per research article throughout the history of orthopaedic literature. Methods: Bibliometric data for all original research article abstracts were extracted from PubMED for the 10 highest rated H5-index orthopaedic clinical journals (“American Journal of Sports Medicine,” “Journal of Bone and Joint Surgery American Volume,” “Clinical Orthopaedics and Related Research “Spine,” “Knee Surgery, Sports Traumatology, Arthroscopy,” “Journal of Arthroplasty,” “Arthroscopy,” “The Spine Journal,” “European Spine Journal,” and “Journal of Bone and Joint Surgery British Volume/Bone & Joint Journal”). The number of authors per article was then analyzed over time using the Cochran-Armitage trend test. Results: A total of 106,529 original articles were analyzed over a 70-year period. The number of authors increased significantly over time from a mean of 1.4 authors (SD: 0.62) in 1946 to 5.7 authors (SD: 3.1) in 2019, representing an average relative increase of 4.3% per year (P < 0.05). The three oldest journals had the lowest average authors (Journal of Bone and Joint Surgery Am Volume: 1946, mean 3.7 authors [SD: eight]; Journal of Bone and Joint Surgery Br Volume/Bone & Joint Journal: 1948, mean: 3.6 authors [SD: 7.5]; Clinical Orthopaedics and Related Research: 1963, mean 3.3 authors [SD: 2.9]). The three newest journals had the highest average authors (European Spine Journal: 1992, mean 5.3 authors [SD: 3.3]; Knee Surgery, Sports Traumatology, Arthroscopy: 1993, mean 5.5 authors [SD: 6.7 authors; The Spine Journal: 2003, mean 5.2 authors [SD: 3.6]). Discussion: Original research articles published in orthopaedic academic journals have experienced an increase in authorship over time. Although our data cannot explain what has driven this change, increasing cooperation between collaborators may represent less contribution per author over time.

Revision quadriceps tendon repair is a challenging problem. In this four-case series, novel quadriceps tendon revision resulted in improved range of motion and durable repair for patients with recurrent rupture. Our technique includes a combination of a running locked #5 FiberWire or 2 mm SutureTape suture placed through parallel medial, lateral, and central drill holes in the patella with running Krackow-type quadriceps tendon repair medially and laterally resulting in four strands, delivering the vastus medialis and medial quadriceps tendon to an anatomic repair at the superior pole of the patella, with 2 sutures passed centrally and 1 each passed medially and laterally and then tied. Reinforcement is performed using a tibialis anterior tendon allograft with placement at the inferior pole of the patella starting superolaterally coursing lateral to medial through infrapatellar tendon. It is then threaded medially into the centrally repaired portion of the quadriceps tendon, and then back down to the lateral suprapatellar and lateral patellar retinaculum, giving three crossing strands. This is repaired with multiple interrupted 0 Vicryl mattress sutures. Immobilization postoperatively was dictated by patient's body habitus. Patient 1 was a 79-year-old obese man treated after two prior revision periprosthetic quadriceps repair procedures. He was immobilized in a knee immobilizer for 8 weeks postoperatively. He was revised for TKA instability at 6 months postoperatively, and one month later returned to the operating room for persistent hematoma; repair was noted to be intact. Patient 2 was a 39-year-old morbidly obese man who was revised after failure of one revision quadriceps repair. He was protected with an external fixator for 6 weeks. Patient 3 was a 49-year-old obese man who was treated with four revision quadriceps repair procedures over the course of 15 years. Postoperatively he was treated with a knee immobilizer. Patient 4 was a 71-year-old obese man who was treated after failure of one prior revision quadriceps repair procedure. He was casted postoperatively for one month. On final follow up, all patients were able to maintain straight leg raise, with functional range of motion and ambulation. Revision quadriceps tendon repair using an anterior tibialis tendon allograft is a viable solution for obese patients with recurrent quadriceps tendon ruptures.

Open fractures represent a commonly encountered traumatic injury with complex challenges, the most notorious being infection. Antibiotic prophylaxis demonstrates a critical first line of defense; however, there exists some disagreement in the literature related to the efficacy of the timing of antibiotic administration in the setting of open fracture. This study aimed to determine if antibiotic prophylaxis administered within one hour exhibited an effect on the rate of deep infection across all open long bone fractures, as well as to investigate the role of antibiotic administration (≤ 1 h vs. > 1 h) on superficial and deep infection in upper vs. lower extremity and severity of open fracture based on G-A classification. Retrospective review was performed at one Level 1 trauma center including patients ≥ 18 years old identified through query of the trauma quality improvement program (TQIP) database, directly admitted with open long bone fractures from blunt injury between January 1, 2019 to March 31, 2023. Fisher exact test and chi squared test were performed for categorical variables. Non-parametric Mann Whitney U-test was used for continuous variable analysis. Non-normally distributed variables were reported as median (95% CI). P-value < 0.5 determined significance. Of 477 patients, 270 received antibiotics ≤ 1 h from arrival (EAbx, mean time to antibiotics 0.58 ± 0.26 h) and 207 > 1 h from arrival (DAbx, 2.35 ± 2.45 h). There were 34 (12.6%) deep infections in EAbx and 29 (14.1%) in DAbx (p = 0.651). Lower extremity injuries demonstrated increased deep (16.6% vs. 5.6%, p = 0.001) and superficial (21% vs. 13.2%, p = 0.044) infections compared to upper extremity injuries. G-A type III injuries demonstrated the highest combined infection rates at 39.9% vs. 12.3% and 24.5% (p < 0.001) for type I and II, respectively. This analysis reaffirms elevated risk in lower extremity and G-A Type III fractures. Patient-specific and injury-specific risk factors may outweigh accepted recommendations for time thresholds, warranting further investigation. Average time to antibiotics in the DAbx group was 2.35 h which may account for lack of significant findings. However, our recommendation remains to administer antibiotics as soon as possible. Level III, Therapeutic/Care Management.