Background/Objectives: Tranexamic acid (TXA) is widely used to reduce bleeding in orthopedic surgery, but its safety and impact on outcomes in arthroscopic rotator cuff repair (ARCR) remain unclear. The purpose of this study was to evaluate the safety and effects of injectable TXA on short- and long-term postoperative outcomes and opioid use following ARCR. Methods: The TriNetX Research Network, an insurance claims-based database, was utilized to conduct this retrospective, propensity-matched cohort study. Patients aged ≥18 years undergoing ARCR were identified and divided into TXA (n = 5855) and non-TXA (n = 5855) groups after propensity score matching. Outcomes assessed included 30-day hospital utilization, complications (infection, thromboembolism, hemarthrosis, blood transfusion), one-year revision and shoulder surgery rates, and early, prolonged, and chronic postoperative opioid use. Results: No significant differences were observed between groups in 30-day emergency department visits (2.0% vs. 1.8%, p = 0.502), readmissions, infections, wound dehiscence, blood transfusions, hemarthrosis, or one-year revision and shoulder surgery rates. TXA use was associated with significantly lower rates of early (24.8% vs. 26.8%, p = 0.011), prolonged (9.5% vs. 12.8%, p < 0.001), and chronic opioid use (6.6% vs. 9.6%, p < 0.001). Conclusions: Injectable TXA is safe in ARCR, with no increase in postoperative complications or hospital utilization. Furthermore, TXA use is linked to reduced postoperative opioid consumption, suggesting benefits in pain management and recovery. Prospective studies are warranted to further explore these findings.

Trimalleolar ankle fractures are complex injuries associated with high complication rates and poorer outcomes, particularly in elderly and medically comorbid patients. While open reduction and internal fixation (ORIF) remains the standard treatment, alternative strategies such as tibiotalocalcaneal arthrodesis (TTCA) have been increasingly explored for high-risk populations. A retrospective cohort study was performed using the TriNetX Research Network. Adult patients undergoing operative treatment for trimalleolar fractures were identified and stratified by procedure (TTCA versus ORIF). Propensity score matching (1:1) was performed to balance demographics and comorbidities, including age, sex, obesity, tobacco use, osteoporosis, diabetes, dementia, and peripheral vascular disease. Outcomes were assessed at 90 days, 1 year, and 2 years. Primary outcomes included secondary surgery (revision procedures, irrigation and debridement, hardware removal, and below-knee amputation). Secondary outcomes included 90-day infection and wound dehiscence. Risk ratios with 95% confidence intervals were calculated, with p < 0.05 considered significant. After matching, 210 patients were included in each group. At 90 days, infection and wound complication rates were similar between TTCA and ORIF cohorts. TTCA was associated with significantly higher rates of secondary surgery at 1 year (28.1% vs 17.1%; RR 1.64, p = 0.007) and 2 years (31.4% vs 21.0%; RR 1.50, p = 0.015). Irrigation and debridement was also more frequent in the TTCA cohort at 1 year (RR 2.25, p = 0.012) and 2 years (RR 2.23, p = 0.009). In sensitivity analysis of closed fractures, findings remained consistent, with higher secondary surgery rates in the TTCA group. In this large propensity-matched study, TTCA may be associated with a higher incidence of secondary surgery-particularly irrigation and debridement-compared with ORIF at one and two years postoperatively, while early wound complication rates were similar. These findings may be influenced by residual confounding despite propensity matching.

Objectives: To compare the Trauma-Specific Frailty Index (TSFI) with an institutional Perioperative Geriatric Score (PGS) for predicting postoperative level of care, discharge disposition, and length of stay in older adults undergoing operative fixation of lower-extremity fractures. Methods: Design: Retrospective cohort study. Setting: Two hospitals within a single academic health system: an urban level I and a suburban level III trauma center. Patient Selection Criteria: Patients aged ≥65 years who underwent operative fixation of lower-extremity fractures between January 1 and June 30, 2025; nonoperative fractures and encounters lacking primary outcome data were excluded. Frailty was measured with the TSFI (0–1 deficit-accumulation index). Perioperative risk was measured with an institutional PGS combining vasopressor use, blood loss, cardiac comorbidity, case duration, and delay to surgery. Outcome Measures and Comparisons: Primary outcomes were postoperative level of care, discharge disposition, and hospital length of stay; 90-day readmission and mortality were secondary. Multivariable regression adjusted for age, sex, body mass index, and fracture type. Results: Among 248 patients (median age, 78 years; 64.1% female), higher TSFI values were associated with stepdown admission (odds ratio [OR] 2.43; 95% confidence interval [CI], 1.13–5.21), intensive care unit admission (OR 2.79; 95% CI, 1.16–6.70), discharge to a skilled nursing facility (OR 1.96; 95% CI, 1.11–3.47), and longer length of stay (OR 1.61; 95% CI, 1.19–2.17). The PGS showed weaker associations, reaching significance only for intensive care unit admission (OR 1.16; 95% CI, 1.07–1.26). Ninety-day readmission and mortality were too infrequent for reliable estimates. Conclusions: The TSFI outperformed an institutional perioperative geriatric triage score in predicting postoperative care escalation and discharge disposition in lower-extremity fracture patients. Incorporation of frailty assessment into orthopaedic trauma workflows may improve risk stratification, counseling, and resource planning.

Background: Accepted venous thromboembolism (VTE) prophylaxis after orthopedic trauma includes anticoagulants and aspirin, with selection varying by patient and injury factors. This study evaluates a single institution’s outcomes after transitioning from low–molecular-weight heparin to aspirin for postdischarge prophylaxis. Methods: This retrospective cohort study of adult patients (≥18 years) with lower extremity or pelvic orthopedic injuries who underwent operative treatment between 2020 and 2024 was identified from the trauma registry of a Level-1 trauma center. Patients were included if they underwent operative fixation during the index hospitalization. Exclusion criteria included a documented VTE or receipt of therapeutic anticoagulation/antiplatelet therapy within six months before admission. The primary outcome was 90-day postdischarge VTE, defined as deep vein thrombosis or pulmonary embolism. Secondary outcomes included 90-day readmission and mortality. Inverse probability of treatment weighting and doubly robust logistic regression were used to compare discharge chemoprophylaxis regimens (aspirin vs. enoxaparin), controlling for age, sex, body mass index, injury severity score, length of stay, comorbidities, and fracture location. Results: A total of 982 patients met inclusion criteria, including 456 (46.4%) patients discharged on aspirin and 526 (53.6%) patients discharged on enoxaparin. Among orthopedic trauma patients, discharge aspirin was associated with significantly higher odds of 90-day postdischarge VTE compared with low–molecular-weight heparin (OR, 4.704; 95% CI, 1.332–16.612; p = 0.016). No significant differences were observed between discharge chemoprophylaxis groups with respect to 90-day readmission or mortality. Conclusions: Low-molecular-weight heparin was associated with lower odds of postdischarge VTE compared with aspirin in this retrospective cohort of orthopedic trauma patients. Further investigation is needed to better define the optimal postdischarge prophylaxis strategy based on individual patient comorbidities and injury patterns. ( J Trauma Acute Care Surg 2026;00:000–000. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved.) Level of Evidence: Retrospective, Therapeutic/Care Management; Level 3.

Purpose: Gabapentinoids are increasingly incorporated into multimodal analgesia after orthopaedic surgery, yet their impact on outcomes following fracture fixation remains unclear. This study evaluated the association between early postoperative gabapentinoid–opioid co-prescription and clinical outcomes after operative fixation of closed long bone fractures.Methods: Using the TriNetX Research Network, we identified opioid-naïve and gabapentinoid-naïve adults undergoing intramedullary or plate-and-screw fixation of isolated closed diaphyseal tibia, humerus, or femur fractures. Patients prescribed both gabapentin or pregabalin and opioids within three days after surgery were compared with patients receiving opioids alone. Propensity score matching (1:1) was used to control for demographics, medical comorbidities, fracture location, fixation method, mental health disorders, and substance use disorders. Primary outcomes were prolonged (30–90 days) and chronic (90–180 days) postoperative opioid use. Secondary outcomes included 30-day emergency department (ED) visits and readmissions, and 1-year nonunion and reoperation.Results: After matching, each cohort consisted of approximately 2,000 patients (range, 1,946-2,012). Gabapentinoid–opioid therapy was associated with higher rates of prolonged (21.0% vs 16.1%; RR 1.31; p<0.001) and chronic (9.8% vs 7.4%; RR 1.33; p=0.007) postoperative opioid use. Patients receiving gabapentinoid–opioid therapy had fewer 30-day ED visits (25.1% vs 42.5%; RR 0.59; p<0.001), while 30-day readmission rates were similar between groups (p=0.174). One-year rates of nonunion (4.3% vs 1.9%; RR 2.21; p<0.001) and reoperation (7.1% vs 4.2%; RR 1.68; p<0.001) were significantly higher among patients receiving gabapentinoid–opioid therapy.Conclusion: Early postoperative gabapentinoid–opioid therapy after long bone fracture fixation was associated with fewer ED visits but substantially higher risks of prolonged and chronic opioid use, nonunion, and the need for reoperation. These findings suggest that potential short-term analgesic benefits may be offset by adverse long-term outcomes, warranting caution and future study in the use of gabapentinoid prescribing to manage acute perioperative fracture pain.

Rotator cuff tears are common, and although surgical repair is frequently performed, re-tear and complication rates remain substantial. The impact of selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs) on postoperative outcomes after rotator cuff repair is not well understood. Using the TriNetX Research Network, adult patients undergoing arthroscopic rotator cuff repair were identified and stratified into SSRI/SNRI users (at least one prescription within 3 months preoperatively and continued use within 2 years postoperatively) and non-users. Propensity score matching was performed for demographic and medical comorbidities, yielding 2457 patients in each cohort. At 1-year follow-up, SSRI/SNRI users demonstrated lower rates of adhesive capsulitis compared with controls (3.1% vs. 5.8%; RR 0.53; 95% CI 0.41–0.70; p < 0.001), with similar revision rotator cuff repair rates. This pattern persisted at 2 years (3.6% vs. 6.1%; RR 0.58; 95% CI 0.45–0.75; p < 0.001), with comparable revision rates between groups. There were no differences in 30-day emergency department visits, readmissions, or 90-day postoperative infections. SSRI/SNRI users had lower early opioid use (21.0% vs. 29.5%; RR 0.71; p < 0.001) but higher prolonged (17.2% vs. 14.1%; RR 1.22; p = 0.003) and chronic opioid use (16.7% vs. 9.1%; RR 1.84; p < 0.001). In this large national cohort, SSRI/SNRI use was associated with lower rates of adhesive capsulitis and differences in postoperative opioid utilization, without differences in revision rotator cuff repair or short-term complications. These findings reflect associations rather than causation and highlight the need for further studies to clarify underlying mechanisms and clinical implications.