Defining length stability in paediatric femoral shaft fractures treated with titanium elastic nails.

Introduction: Optimal paediatric femoral shaft fracture patterns or lengths amenable to titanium elastic nail stabilization have not been well defined. The purpose of this study is to identify radiographic parameters predictive of treatment failure with flexible intramedullary nails based upon fracture morphology.

Methods: A retrospective review was performed of all femoral shaft fractures treated with flexible intramedullary nails over a five-year period.

Modified Lumbopelvic Technique Using S1 Pedicle Screws for Spinopelvic Dissociation U-Type and H-Type Sacral Fractures With Kyphotic Deformity.

Spinopelvic dissociation injuries are complex injuries defined as discontinuity between the appendicular and axial skeleton. Fracture patterns are variable, but U-type and H-type fractures are common and often present with kyphotic deformity along with translational displacement and impaction. The ideal method of fixation has not been established for these injuries.

Sciatic Nerve Entrapment and Transection in a Combined Pelvic Ring-Acetabular Fracture: A Case Report.

Case: A traumatic sciatic nerve entrapment and transection because of a combined pelvic ring injury and acetabular fracture has never previously been described. We report such a case of a 32-year-old man who was found intraoperatively to have entrapment and transection of the sciatic nerve within the acetabular fracture.

Conclusion: Consideration for urgent intervention should be given to patients who present with a sciatic nerve palsy in the setting of certain acetabular fracture patterns with residual posterior column displacement.

National Metrics Improved Timeliness of Antibiotic Administration for Open Extremity Fractures.

Introduction: Antibiotics have been shown to be an essential component in the treatment of open extremity fractures. The American College of Surgeons' Trauma Quality Improvement Program, based on a committee of physician leaders including orthopaedic trauma surgeons, publishes best-practice guidelines for the management of open fractures. Accordingly, it established the tracking of antibiotic timing as a metric with a plan to use that metric before trauma center site reviews.

A Biomechanical Comparison of Trochanteric Versus Piriformis Reconstruction Nails for Femoral Neck Fracture Prophylaxis.

Objectives: To compare piriformis fossa to greater trochanteric entry cephalomedullary implants in an evaluation of femoral neck load to failure when the device is used for femoral shaft fractures with prophylaxis of an associated femoral neck fracture.

Methods: Thirty fourth-generation synthetic femur models were separated into 5 groups: intact femora, entry sites alone at the piriformis fossa or greater trochanter, and piriformis fossa and greater trochanteric entry sites after the insertion of a cephalomedullary nail. Each model was mechanically loaded with a flat plate against the superior femoral head along the mechanical axis and load to failure was recorded.

Spontaneous pubic symphysis disruption and concomitant bladder rupture during competitive squatting: A case report.

Pubic symphysis disruption is typically secondary to external blunt force trauma. This report presents a case of concomitant bladder wall rupture and pubic symphysis diastasis during competitive squatting. This required open bladder repair, small artery embolization, and internal fixation of the pubic symphysis.

External iliac vein compression secondary to osteolysis-induced hematoma in total hip arthroplasty.

A 62-year-old man with a history of right total hip arthroplasty, who was managed conservatively for moderate osteolysis, presented with acute-onset, painless, significant, and diffuse right lower extremity edema. Initial laboratory markers were negative for infection. Advanced imaging demonstrated a complex extrapelvic fluid mass along the psoas sheath causing compression of the external iliac vein.

Are piriformis reconstruction implants ideal for prophylactic femoral neck fixation?

Objectives: Prophylactic femoral neck fixation may be performed in the setting of geriatric diaphyseal femur fracture, pathologic or impending atypical femur fractures. Fixation constructs often utilize cephalomedullary implants with one or two proximal interlocking screws into the femoral head/neck. Variations in proximal femoral anatomy and implant design can interfere with the placement of two screws in the femoral head and neck.

Effects of Micronized Cartilage Matrix on Cartilage Repair in Osteochondral Lesions of the Talus.

Background: The repair of osteochondral lesions remains a challenge due to its poor vascularity and limited healing potential. Micronized cartilage matrix (MCM) is dehydrated, decellularized, micronized allogeneic cartilage matrix that contains the components of native articular tissue and is hypothesized to serve as a scaffold for the formation of hyaline-like tissue. Our objective was to demonstrate that the use of MCM combined with mesenchymal stem cells (MSCs) can lead to the formation of hyaline-like cartilage tissue in a single-stage treatment model.

Why total knees fail-A modern perspective review.

Historically, the most common mechanism of total knee arthroplasty (TKA) failures included aseptic loosening, instability and malalignment. As polyethylene production improved, modes of failure from polyethylene wear and subsequent osteolysis became less prevalent. Newer longitudinal studies report that infection has become the primary acute cause of failure with loosening and instability remaining as the overall greatest reasons for revision.

Revision Meniscal Surgery in Children and Adolescents: Risk Factors and Mechanisms for Failure and Subsequent Management.

Background: The mechanisms of failure and risk factors for failed meniscal surgery in children and adolescents have not been well described.

Purpose: To investigate the risk factors, mechanisms of failure, and subsequent operative management for revision meniscal surgery in a pediatric population, as well as to identify the local incidence of failed meniscal surgery.

Study Design: Case-control study; Level of evidence, 3.