Frank Liporace - Academia.edu (original) (raw)

Papers by Frank Liporace

Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, Jan 12, 2018

Insertion of bone graft to fill metaphyseal defects and supply subchondral support when fixing Sc... more Insertion of bone graft to fill metaphyseal defects and supply subchondral support when fixing Schatzker type II and III tibial plateau fractures can be difficult and tedious. Accurately directing the placement of bone graft through a small entry portal and against gravity can be challenging. Using a modified 3-mL syringe and bone tamps with application of the Seldinger technique can make this tedious task simple and more accurate. Level of evidence V.

The Journal of bone and joint surgery. American volume, Jan 19, 2014

Today's increasingly complex health-care landscape requires that physicians take an active ro... more Today's increasingly complex health-care landscape requires that physicians take an active role in minimizing health-care costs and expenditures. Judicious choice of implants, a fracture-driven treatment algorithm, capitation models, use of generic fracture implants, and reuse of external fixation constructs all represent mechanisms that can result in substantial savings. In some health-care environments, these cost savings programs may be directly linked to physician reimbursement in the form of gainsharing plans. Evidence-based critical evaluations of implant usage patterns are necessary to help control implant-related health-care spending but are lacking in the current literature. Physicians need to acknowledge their influence and responsibility in this realm and assume an active role to help reduce costs.

Data Revues 10837515 V11i4 S1083751506000532, Aug 17, 2011

Journal of orthopaedic trauma, Jan 22, 2015

Dead space is defined as the residual tissue void after tissue loss. This may occur due to tissue... more Dead space is defined as the residual tissue void after tissue loss. This may occur due to tissue necrosis following high-energy trauma, infection or surgical debridement of non-viable tissue. This review provides an update on the state of the art and recent advances in management of osseous and soft tissue defects. Specifically, our focus will be on the initial dead space assessment, provisional management of osseous and soft tissue defects, techniques for definitive reconstruction, as well as dead space management in the setting of infection. Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.

The Journal of Bone and Joint Surgery

Patient safety in surgery, 2015

Iatrogenic injury during the posterior approach to the humerus during operative fixation is not a... more Iatrogenic injury during the posterior approach to the humerus during operative fixation is not an uncommon occurrence. A comprehensive understanding of the normal anatomy and its variants is of paramount importance in order to avoid such injury. Typically, the inferior lateral cutaneous branch of the radial nerve originates towards the distal end of the humerus at the inferior portion of the spiral groove. Here, we report an important variant of this nerve, which originated significantly more proximal than expected, further emphasizing the importance of identification, dissection and protection of the radial nerve and its major branches.

European Journal of Orthopaedic Surgery & Traumatology, 2015

To review the results of plating of various fracture patterns of proximal ulna fractures includin... more To review the results of plating of various fracture patterns of proximal ulna fractures including isolated olecranon fractures, olecranon fractures combined with a coronoid fracture, and olecranon fractures combined with a coronoid and radial head fracture. The study included 38 patients with either an isolated olecranon fracture or combined injuries, all treated with open reduction and internal fixation of the olecranon. Other procedures were performed as needed, including radial head fixation or arthroplasty, fixation of the coronoid, and repair of the lateral collateral ligament complex. There were 27 men and 11 women with an average age of 49 years. Clinical and radiographic assessment was obtained at an average follow-up time of 15 and 8.4 months, respectively. All fractures healed within 5 months. The average arc of ulnohumeral motion was 91° (range 0°-140°); average pronation-supination arc was 128° (range 0°-180°). Subgroup analysis showed a statistically significant lower rotational motion arc in patients with associated radial head (73°) or coronoid fractures (68°) compared to isolated olecranon fractures. All other parameters including ulnohumeral motion, complication rate, and revision rate were similar among the groups. A stable, functional elbow can be restored in most patients with proximal ulna fractures treated with open reduction and internal fixation. Loss of full flexion is likely with high-energy trauma, complex fracture patterns, and concomitant injuries. Fracture patterns involving the coronoid and/or the radial head are associated with restricted forearm rotation. III.

Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology, Jan 25, 2014

Recombinant human bone morphogenetic protein-2 (rhBMP-2) is particularly effective in improving o... more Recombinant human bone morphogenetic protein-2 (rhBMP-2) is particularly effective in improving osteogenesis in patients with diminished bone healing capabilities, such as individuals with type 1 diabetes mellitus (T1DM) who have impaired bone healing capabilities and increased risk of developing osteoporosis. This study measured the effects of rhBMP-2 treatment on osteogenesis by observing the dose-dependent effect of localized delivery of rhBMP-2 on biomechanical parameters of bone using a hydroxyapatite/tri-calcium phosphate (HA/TCP) carrier in a T1DM-related osteoporosis animal model. Two different doses of rhBMP-2 (LD low dose, HD high dose) with a HA/TCP carrier were injected into the femoral intramedullary canal of rats with T1DM-related osteoporosis. Two more diabetic rat groups were injected with saline alone and with HA/TCP carrier alone. Radiographs and micro-computed tomography were utilized for qualitative assessment of bone mineral density (BMD). Biomechanical testing ...

The Journal of bone and joint surgery. American volume, 2003

Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology, 2014

Originally described by Monteggia and later classified by Bado, elbow dislocations with concurren... more Originally described by Monteggia and later classified by Bado, elbow dislocations with concurrent radial and ulnar shaft fractures with distal radioulnar joint (DRUJ) disruption are considered operative cases with high-energy injurious etiologies. Here, we present an unclassifiable Monteggia variant fracture suffered through a high axial load mechanism in a 47-year-old female. The fracture pattern initially exhibited included a divergent elbow dislocation, a radial shaft fracture, plastic deformation of the distal ulna, and DRUJ instability. Here we describe the pattern in detail, along with definitive treatment and clinical outcome at 1 year follow-up.

Journal of orthopaedic trauma, 2012

Periprosthetic fracture and infection are dreaded complications after total hip arthroplasty. We ... more Periprosthetic fracture and infection are dreaded complications after total hip arthroplasty. We present the case of a 50-year-old man who suffered an early postoperative Vancouver B1 periprosthetic fracture, which was further complicated by concurrent infection after open reduction and internal fixation. We report the novel use of an antibiotic-impregnated cement coated locking plate during the staged treatment of concomitant periprosthetic fracture and chronic total hip arthroplasty infection. At 1-year follow-up, the patient is pain free and ambulating independently with full range of motion.

American journal of orthopedics (Belle Mead, N.J.), 2009

Acute bilateral radial shaft fractures are an unusual entity that has not been previously reporte... more Acute bilateral radial shaft fractures are an unusual entity that has not been previously reported in the literature. Given its bilaterality, this rare clinical entity is best treated with stable internal fixation. Here we report the case of an 18-year- old right-hand-dominant man who sustained a low-caliber gunshot injury. He had been driving with both hands on the steering wheel when he was struck by a single bullet. The bullet caused displaced fractures of the left proximal radial shaft and the right distal radial shaft. Each fracture had extension outside the mid-diaphysis. The patient underwent operative fixation with plating of the right upper extremity and intramedullary nailing on the left side. Both fractures healed, and range of motion was functional.

American journal of orthopedics (Belle Mead, N.J.), 2005

Hip fractures have been among the most studied injury patterns in adults. The number of hip fract... more Hip fractures have been among the most studied injury patterns in adults. The number of hip fractures is increasing exponentially, and their treatment costs place great economic strain on society. Recently developed hip fracture treatments, emphasizing cost containment, deformity prevention, and evidence-based medicine, are attempts to optimize patient outcomes. In this article, we outline some of these developments with respect to femoral neck and intertrochanteric fractures.

Foot and Ankle Clinics, 2007

Many reconstructive options exist for symptomatic hindfoot and ankle problems. Hindfoot and tibio... more Many reconstructive options exist for symptomatic hindfoot and ankle problems. Hindfoot and tibiotalar fusions are reliable procedures with consistent results. Unfortunately, many potential complications have been cited throughout the literature. Although the most important aspect in any fusion surgery is meticulous technique, advances in technology, including PRP, bone stimulators, and BMPs seem to be useful additions in the quest to achieve solid fusions with decreased complications.

Orthopedics, 2012

Computed tomography (CT) has been deemed a necessary part of management for Tillaux and triplane ... more Computed tomography (CT) has been deemed a necessary part of management for Tillaux and triplane pediatric ankle fractures. However, no previously published study has attempted to quantify its usefulness in changing management. Six third-party, blinded orthopedic surgeons (F.A.L., E.N.K., D.M.P., K.J.K., D.S.F., K.A.E.) were randomly assigned to evaluate 24 pediatric Tillaux or triplane fractures with plain radiographs; after 6 months, they were again randomly assigned to evaluate the 24 radiographs plus CT scans, totaling 144 third-party, blinded evaluations. Intra- and interobserver agreements were assessed via correlation coefficient analysis. Evaluation of CT scans changed the original diagnosis of fracture type from Tillaux to triplane fracture in 7 (4.9%) of 144 evaluations. Inter- and intraobserver agreements regarding primary treatment plans did not significantly differ between radiographs and radiographs plus CT scans (0.5 vs 0.4, respectively; P>.05). The addition of CT did not significantly change the impression of the amount of displacement per case. By adding CT, more patients who were assigned nonoperative management were reassigned to operative treatment (P=.033). Adding CT, although it may influence the decision to operate on Tillaux and triplane fractures, may not be as useful as previously thought.

Journal of Orthopaedic Trauma, 2015

Identification of Gerdy's tubercle is the... more Identification of Gerdy's tubercle is the mainstay to any approach to the knee. Most surgical approaches to the proximal tibia and distal femur reference Gerdy's tubercle as a critical landmark. Its identification is therefore paramount. Unfortunately, the bony landmark can be skewed by soft tissue swelling, morbid obesity, or disruption from bony injury. The objective of this study was to determine a reliable way of identifying the normal anatomic location of Gerdy's tubercle using surrounding structures during any surgical approach to the knee. Anatomic cadaver study. Academic laboratory center. Twenty-four adult human cadaver lower extremities as 12 matched pairs were used. Systematic identification and measurement from the point of intersection of a line drawn between 2 corners of a box created using the tibial tubercle, inferior pole of the patella, and the fibula head were performed and recorded. Mean distance from cutaneous point of intersection to Gerdy's tubercle upon dissection. The mean distance from the point of intersection to Gerdy's tubercle was 2.58 ± 2.01 mm with a range from 0 to 8. The mean distances for the right and left lower extremities were 2.67 ± 2.02 and 2.5 ± 2.11 mm, respectively. Statistical analysis using 2-tailed independent t test with a significance set at P <0.05 revealed no significant differences with P = 0.84. Our group has identified the point of intersection among 3 landmarks forming a point of intersection. This point is the intersection of a line drawn between 2 corners of a box created using the tibial tubercle, inferior pole of the patella, and the fibula head. This serves as a reliable and reproducible method to identify Gerdy's tubercle.

Current Orthopaedic Practice, 2013

Current Orthopaedic Practice, 2011

Foot and Ankle Clinics, 2006

Journal of Orthopaedic Trauma, 2014

The aim of this study was to investigate the rate, longitudinal improvement, and risk factors of ... more The aim of this study was to investigate the rate, longitudinal improvement, and risk factors of sleep disturbance after 4 common orthopaedic traumatic conditions. The functional status of 1095 patients was prospectively assessed using validated questionnaires for patients with acute proximal humerus (n = 111), distal radius (n = 440), tibial plateau (n = 109), and ankle fractures (n = 435). Patient reported sleep difficulty was compared with the overall functional and emotional status of each patient at 3, 6, and 12 months after treatment. Sleep difficulty at 3-month follow-up was reported in 41% of patients with proximal humerus fracture, 25% of patients with distal radius fracture, 36% of patients with tibial plateau, and 19% of patients with ankle fracture. By 12-month follow-up, less than 20% of patients with all fracture types reported sleep difficulty. At 12-month follow-up, the SF-36 Mental Health category for patients with distal radius fractures (P = 0.001) and the Short Musculoskeletal Function Assessment Emotional category for patients with tibial plateau fractures (P = 0.024) and ankle fractures (P ≤ 0.001) were independent predictors of poor sleep, whereas the respective functional status categories were not. At 12-month follow-up, poor sleep was independently associated with poor emotional status but not associated with poor functional status. The mental health status of patients with sleep difficulty in the latter stages of fracture healing should be carefully assessed to provide the highest level of care. The results of this study should allow orthopaedic trauma surgeons to counsel patients regarding expectations of difficulty sleeping after acute fractures. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, Jan 12, 2018

Insertion of bone graft to fill metaphyseal defects and supply subchondral support when fixing Sc... more Insertion of bone graft to fill metaphyseal defects and supply subchondral support when fixing Schatzker type II and III tibial plateau fractures can be difficult and tedious. Accurately directing the placement of bone graft through a small entry portal and against gravity can be challenging. Using a modified 3-mL syringe and bone tamps with application of the Seldinger technique can make this tedious task simple and more accurate. Level of evidence V.

The Journal of bone and joint surgery. American volume, Jan 19, 2014

Today's increasingly complex health-care landscape requires that physicians take an active ro... more Today's increasingly complex health-care landscape requires that physicians take an active role in minimizing health-care costs and expenditures. Judicious choice of implants, a fracture-driven treatment algorithm, capitation models, use of generic fracture implants, and reuse of external fixation constructs all represent mechanisms that can result in substantial savings. In some health-care environments, these cost savings programs may be directly linked to physician reimbursement in the form of gainsharing plans. Evidence-based critical evaluations of implant usage patterns are necessary to help control implant-related health-care spending but are lacking in the current literature. Physicians need to acknowledge their influence and responsibility in this realm and assume an active role to help reduce costs.

Data Revues 10837515 V11i4 S1083751506000532, Aug 17, 2011

Journal of orthopaedic trauma, Jan 22, 2015

Dead space is defined as the residual tissue void after tissue loss. This may occur due to tissue... more Dead space is defined as the residual tissue void after tissue loss. This may occur due to tissue necrosis following high-energy trauma, infection or surgical debridement of non-viable tissue. This review provides an update on the state of the art and recent advances in management of osseous and soft tissue defects. Specifically, our focus will be on the initial dead space assessment, provisional management of osseous and soft tissue defects, techniques for definitive reconstruction, as well as dead space management in the setting of infection. Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.

The Journal of Bone and Joint Surgery

Patient safety in surgery, 2015

Iatrogenic injury during the posterior approach to the humerus during operative fixation is not a... more Iatrogenic injury during the posterior approach to the humerus during operative fixation is not an uncommon occurrence. A comprehensive understanding of the normal anatomy and its variants is of paramount importance in order to avoid such injury. Typically, the inferior lateral cutaneous branch of the radial nerve originates towards the distal end of the humerus at the inferior portion of the spiral groove. Here, we report an important variant of this nerve, which originated significantly more proximal than expected, further emphasizing the importance of identification, dissection and protection of the radial nerve and its major branches.

European Journal of Orthopaedic Surgery & Traumatology, 2015

To review the results of plating of various fracture patterns of proximal ulna fractures includin... more To review the results of plating of various fracture patterns of proximal ulna fractures including isolated olecranon fractures, olecranon fractures combined with a coronoid fracture, and olecranon fractures combined with a coronoid and radial head fracture. The study included 38 patients with either an isolated olecranon fracture or combined injuries, all treated with open reduction and internal fixation of the olecranon. Other procedures were performed as needed, including radial head fixation or arthroplasty, fixation of the coronoid, and repair of the lateral collateral ligament complex. There were 27 men and 11 women with an average age of 49 years. Clinical and radiographic assessment was obtained at an average follow-up time of 15 and 8.4 months, respectively. All fractures healed within 5 months. The average arc of ulnohumeral motion was 91° (range 0°-140°); average pronation-supination arc was 128° (range 0°-180°). Subgroup analysis showed a statistically significant lower rotational motion arc in patients with associated radial head (73°) or coronoid fractures (68°) compared to isolated olecranon fractures. All other parameters including ulnohumeral motion, complication rate, and revision rate were similar among the groups. A stable, functional elbow can be restored in most patients with proximal ulna fractures treated with open reduction and internal fixation. Loss of full flexion is likely with high-energy trauma, complex fracture patterns, and concomitant injuries. Fracture patterns involving the coronoid and/or the radial head are associated with restricted forearm rotation. III.

Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology, Jan 25, 2014

Recombinant human bone morphogenetic protein-2 (rhBMP-2) is particularly effective in improving o... more Recombinant human bone morphogenetic protein-2 (rhBMP-2) is particularly effective in improving osteogenesis in patients with diminished bone healing capabilities, such as individuals with type 1 diabetes mellitus (T1DM) who have impaired bone healing capabilities and increased risk of developing osteoporosis. This study measured the effects of rhBMP-2 treatment on osteogenesis by observing the dose-dependent effect of localized delivery of rhBMP-2 on biomechanical parameters of bone using a hydroxyapatite/tri-calcium phosphate (HA/TCP) carrier in a T1DM-related osteoporosis animal model. Two different doses of rhBMP-2 (LD low dose, HD high dose) with a HA/TCP carrier were injected into the femoral intramedullary canal of rats with T1DM-related osteoporosis. Two more diabetic rat groups were injected with saline alone and with HA/TCP carrier alone. Radiographs and micro-computed tomography were utilized for qualitative assessment of bone mineral density (BMD). Biomechanical testing ...

The Journal of bone and joint surgery. American volume, 2003

Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology, 2014

Originally described by Monteggia and later classified by Bado, elbow dislocations with concurren... more Originally described by Monteggia and later classified by Bado, elbow dislocations with concurrent radial and ulnar shaft fractures with distal radioulnar joint (DRUJ) disruption are considered operative cases with high-energy injurious etiologies. Here, we present an unclassifiable Monteggia variant fracture suffered through a high axial load mechanism in a 47-year-old female. The fracture pattern initially exhibited included a divergent elbow dislocation, a radial shaft fracture, plastic deformation of the distal ulna, and DRUJ instability. Here we describe the pattern in detail, along with definitive treatment and clinical outcome at 1 year follow-up.

Journal of orthopaedic trauma, 2012

Periprosthetic fracture and infection are dreaded complications after total hip arthroplasty. We ... more Periprosthetic fracture and infection are dreaded complications after total hip arthroplasty. We present the case of a 50-year-old man who suffered an early postoperative Vancouver B1 periprosthetic fracture, which was further complicated by concurrent infection after open reduction and internal fixation. We report the novel use of an antibiotic-impregnated cement coated locking plate during the staged treatment of concomitant periprosthetic fracture and chronic total hip arthroplasty infection. At 1-year follow-up, the patient is pain free and ambulating independently with full range of motion.

American journal of orthopedics (Belle Mead, N.J.), 2009

Acute bilateral radial shaft fractures are an unusual entity that has not been previously reporte... more Acute bilateral radial shaft fractures are an unusual entity that has not been previously reported in the literature. Given its bilaterality, this rare clinical entity is best treated with stable internal fixation. Here we report the case of an 18-year- old right-hand-dominant man who sustained a low-caliber gunshot injury. He had been driving with both hands on the steering wheel when he was struck by a single bullet. The bullet caused displaced fractures of the left proximal radial shaft and the right distal radial shaft. Each fracture had extension outside the mid-diaphysis. The patient underwent operative fixation with plating of the right upper extremity and intramedullary nailing on the left side. Both fractures healed, and range of motion was functional.

American journal of orthopedics (Belle Mead, N.J.), 2005

Hip fractures have been among the most studied injury patterns in adults. The number of hip fract... more Hip fractures have been among the most studied injury patterns in adults. The number of hip fractures is increasing exponentially, and their treatment costs place great economic strain on society. Recently developed hip fracture treatments, emphasizing cost containment, deformity prevention, and evidence-based medicine, are attempts to optimize patient outcomes. In this article, we outline some of these developments with respect to femoral neck and intertrochanteric fractures.

Foot and Ankle Clinics, 2007

Many reconstructive options exist for symptomatic hindfoot and ankle problems. Hindfoot and tibio... more Many reconstructive options exist for symptomatic hindfoot and ankle problems. Hindfoot and tibiotalar fusions are reliable procedures with consistent results. Unfortunately, many potential complications have been cited throughout the literature. Although the most important aspect in any fusion surgery is meticulous technique, advances in technology, including PRP, bone stimulators, and BMPs seem to be useful additions in the quest to achieve solid fusions with decreased complications.

Orthopedics, 2012

Computed tomography (CT) has been deemed a necessary part of management for Tillaux and triplane ... more Computed tomography (CT) has been deemed a necessary part of management for Tillaux and triplane pediatric ankle fractures. However, no previously published study has attempted to quantify its usefulness in changing management. Six third-party, blinded orthopedic surgeons (F.A.L., E.N.K., D.M.P., K.J.K., D.S.F., K.A.E.) were randomly assigned to evaluate 24 pediatric Tillaux or triplane fractures with plain radiographs; after 6 months, they were again randomly assigned to evaluate the 24 radiographs plus CT scans, totaling 144 third-party, blinded evaluations. Intra- and interobserver agreements were assessed via correlation coefficient analysis. Evaluation of CT scans changed the original diagnosis of fracture type from Tillaux to triplane fracture in 7 (4.9%) of 144 evaluations. Inter- and intraobserver agreements regarding primary treatment plans did not significantly differ between radiographs and radiographs plus CT scans (0.5 vs 0.4, respectively; P>.05). The addition of CT did not significantly change the impression of the amount of displacement per case. By adding CT, more patients who were assigned nonoperative management were reassigned to operative treatment (P=.033). Adding CT, although it may influence the decision to operate on Tillaux and triplane fractures, may not be as useful as previously thought.

Journal of Orthopaedic Trauma, 2015

Identification of Gerdy's tubercle is the... more Identification of Gerdy's tubercle is the mainstay to any approach to the knee. Most surgical approaches to the proximal tibia and distal femur reference Gerdy's tubercle as a critical landmark. Its identification is therefore paramount. Unfortunately, the bony landmark can be skewed by soft tissue swelling, morbid obesity, or disruption from bony injury. The objective of this study was to determine a reliable way of identifying the normal anatomic location of Gerdy's tubercle using surrounding structures during any surgical approach to the knee. Anatomic cadaver study. Academic laboratory center. Twenty-four adult human cadaver lower extremities as 12 matched pairs were used. Systematic identification and measurement from the point of intersection of a line drawn between 2 corners of a box created using the tibial tubercle, inferior pole of the patella, and the fibula head were performed and recorded. Mean distance from cutaneous point of intersection to Gerdy's tubercle upon dissection. The mean distance from the point of intersection to Gerdy's tubercle was 2.58 ± 2.01 mm with a range from 0 to 8. The mean distances for the right and left lower extremities were 2.67 ± 2.02 and 2.5 ± 2.11 mm, respectively. Statistical analysis using 2-tailed independent t test with a significance set at P <0.05 revealed no significant differences with P = 0.84. Our group has identified the point of intersection among 3 landmarks forming a point of intersection. This point is the intersection of a line drawn between 2 corners of a box created using the tibial tubercle, inferior pole of the patella, and the fibula head. This serves as a reliable and reproducible method to identify Gerdy's tubercle.

Current Orthopaedic Practice, 2013

Current Orthopaedic Practice, 2011

Foot and Ankle Clinics, 2006

Journal of Orthopaedic Trauma, 2014

The aim of this study was to investigate the rate, longitudinal improvement, and risk factors of ... more The aim of this study was to investigate the rate, longitudinal improvement, and risk factors of sleep disturbance after 4 common orthopaedic traumatic conditions. The functional status of 1095 patients was prospectively assessed using validated questionnaires for patients with acute proximal humerus (n = 111), distal radius (n = 440), tibial plateau (n = 109), and ankle fractures (n = 435). Patient reported sleep difficulty was compared with the overall functional and emotional status of each patient at 3, 6, and 12 months after treatment. Sleep difficulty at 3-month follow-up was reported in 41% of patients with proximal humerus fracture, 25% of patients with distal radius fracture, 36% of patients with tibial plateau, and 19% of patients with ankle fracture. By 12-month follow-up, less than 20% of patients with all fracture types reported sleep difficulty. At 12-month follow-up, the SF-36 Mental Health category for patients with distal radius fractures (P = 0.001) and the Short Musculoskeletal Function Assessment Emotional category for patients with tibial plateau fractures (P = 0.024) and ankle fractures (P ≤ 0.001) were independent predictors of poor sleep, whereas the respective functional status categories were not. At 12-month follow-up, poor sleep was independently associated with poor emotional status but not associated with poor functional status. The mental health status of patients with sleep difficulty in the latter stages of fracture healing should be carefully assessed to provide the highest level of care. The results of this study should allow orthopaedic trauma surgeons to counsel patients regarding expectations of difficulty sleeping after acute fractures. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.