Dahiya, Rockey

Objectives: Despite advantages of titanium mesh, hardware exposure affects up to 25% of cases reported in the literature. We aim to identify risk factors associated with titanium mesh exposure following cranioplasty and characterize early wound changes that may signal impending hardware exposure. Methods: A review of 34 patients who underwent titanium mesh cranioplasty between 2015 and 2025 was performed. Seventeen patients with hardware exposure were matched 1:1 with 17 controls. Data on demographics, comorbidities, operative details, and postoperative complications were collected. Statistical analysis included Fisher exact test and t tests, with significance set at P <0.05. Results: Significant risk factors for titanium hardware exposure included a history of metal allergy and reconstruction with advancement flaps. Significant protective factors included patients undergoing postoperative radiation therapy and reconstruction with rotational flaps. Conclusions: Titanium mesh exposure risk increases with metal allergy history, postoperative radiotherapy, and use of advancement flaps for reconstruction. Recognition of early wound changes is crucial for timely intervention. These findings support individualized surgical planning and highlight the need for close postoperative monitoring to reduce complications and improve reconstructive outcomes.

Background Level I trauma centers employ various orthopaedic call strategies based on resources and surgeon subspeciality availability. Objective We hypothesize when surgeons fellowship trained in trauma are solely on call that patient outcomes will be improved compared to a combined plan. Methods Retrospective cohort study from two 24-month time periods at an academic level one trauma center. The first cohort consisted of only trauma surgeons taking call. The second cohort consisted of a combination of trauma and other subspecialities taking call. The primary outcome analyzed was time from admission to operating room for hip, femoral shaft, distal femur, tibia shaft, pelvic ring and acetabulum fractures. Secondary outcomes analyzed included length of stay, 90 day incidence of reoperation, mortality, VTE and readmission. Results Eight hundred and fifty seven patients in the trauma cohort and 992 patients in the combined cohort met the inclusion criteria. The time from admission to index surgical procedure was significantly shorter in the trauma cohort (1.7 vs 2.4). Length of stay (8.95 vs 11 days) and 90 day mortality (1.8% vs 3.8%) was improved in the trauma cohort. There was no difference in 90 day rate of VTE, readmission or reoperation. Length of stay and time to OR in pelvic ring injuries and acetabulum fractures were doubled compared to the hybrid group. Conclusions Our findings suggest that when trauma fellowship trained surgeons are the only ones taking call patients have a shorter time from admission to index surgical procedure, length of stay and lower mortality rate.