Nine Years of Continuous Flow LVAD (HeartMate 3): Survival and LVAD-Related Complications before and after Hospital Discharge.

Background: End-stage heart failure is associated with high mortality. Recent developments such as the left ventricular assist device (LVAD) have improved patient outcomes. The HeartMate 3 LVAD is a novel centrifugal pump that was developed to provide hemodynamic support in heart failure patients, either as a bridge-to-transplant (BTT), myocardial recovery, or destination therapy (DT).

An analytical model of lateral condylar plate working length.

Background: The locking plate is a common device to treat distal femur fractures. Healing is affected by construct stiffness, thus many surgeon-controlled variables such as working length have been examined for their effects on strain at the fracture. No convenient analytical model which aids surgeons in determining working length has yet been described.

Membrane oxygenator longevity was higher in argatroban-treated patients undergoing vvECMO.

Background: In severe acute respiratory distress syndrome (ARDS), venovenous extracorporeal membrane oxygenation (vvECMO) can be a lifesaver. However, anticoagulation therapy is mandatory because the nonendothelial extracorporeal surface increases the risk of thromboembolic problems. Heparin is still the most common anticoagulant, but argatroban could be an alternative.

Simulating Prophylactic Fixation Methods for Osteoporotic Femoral Neck Fracture Prevention.

Introduction: Geriatric patients who suffer femoral neck fractures have high morbidity and mortality. Prophylactic fixation of the femoral neck is a potential avenue to reduce the incidence of femoral neck fractures. We studied 3 different implants traditionally used to stabilize the femoral neck: 6.

Accuracy of guide wire placement for femoral neck stabilization using 3D printed drill guides.

Background: The goal of stabilization of the femoral neck is to limit morbidity and mortality from fracture. Of three potential methods of fixation, (three percutaneous screws, the Synthes Femoral Neck System, and a dynamic hip screw), each requires guide wire positioning of the implant(s) in the femoral neck and head. Consistent and accurate positioning of these systems is paramount to reduce surgical times, stabilize fractures effectively, and reduce complications.

Mini-Blade Plate to Obtain Length Across Lateral Malleolus Fractures: Surgical Technique and Biomechanical Evaluation.

Background: Restoration of fibular length is the main determinant in preventing mal-union and early ankle arthritis in lateral malleolus fractures. A 1/3 tubular plate fashioned into a mini-blade plate can be used to distract the distal fragment and achieve length in a controlled fashion over time. The purpose of this study was to describe the surgical technique and perform a biomechanical comparison of the blade plate to a locking plate.

Integrated Fragility Hip Fracture Program: A Model for High Quality Care.

Background: Hip fractures are a significant cause of morbidity and mortality among elderly patients. Coordinated multidisciplinary care is required to optimize medical outcomes.

Objective: To determine the effect of the implementation of standardized, evidence-based protocols on clinical outcomes and mortality in patients with fragility hip fractures.

Safe Zones for Cerclage Wiring of the Humeral Diaphysis.

Cerclage wiring of the humeral diaphysis entails particular danger to the radial nerve and the deep brachial artery. We sought to delineate safe zones for minimally invasive cerclage wiring of the humeral diaphysis, specifically in relation to the radial nerve and accompanying vasculature. Cerclage wires were percutaneously inserted into three groups of fresh-frozen cadaveric humeri.

Discriminative Ability for Adverse Outcomes After Surgical Management of Hip Fractures: A Comparison of the Charlson Comorbidity Index, Elixhauser Comorbidity Measure, and Modified Frailty Index.

Objectives: The Charlson comorbidity index (CCI), Elixhauser comorbidity measure (ECM), and modified frailty index (mFI) have been associated with mortality after hip fracture. The present study compares the clinically informative discriminative ability of CCI, ECM, and mFI, as well as demographic characteristics for predicting in-hospital adverse outcomes after surgical management of hip fractures.

Methods: Patients undergoing hip fracture surgery were selected from the 2013 National Inpatient Sample.

Catheter-based tricuspid valve replacement: first experimental data of a newly designed bileaflet stent graft prosthesis.

Objectives: Moderate or severe degree tricuspid valve regurgitation (TVR) is associated with high rates of morbidity and mortality. Surgical correction as the only therapeutic option offers unsatisfactory results. Recently, several interventional procedures have been introduced clinically in a limited cohort.

Implant options for the treatment of intertrochanteric fractures of the hip: rationale, evidence, and recommendations.

Aims: The aim of this paper is to review the evidence relating to the anatomy of the proximal femur, the geometry of the fracture and the characteristics of implants and methods of fixation of intertrochanteric fractures of the hip.

Materials And Methods: Relevant papers were identified from appropriate clinical databases and a narrative review was undertaken.

Results: Stable, unstable, and subtrochanteric intertrochanteric fractures vary widely in their anatomical and biomechanical characteristics, as do the implants used for their fixation.

Extramedullary compared with intramedullary implants for intertrochanteric hip fractures: thirty-day outcomes of 4432 procedures from the ACS NSQIP database.

Background: For more than thirty-five years, the sliding hip screw, an extramedullary implant, has been the standard treatment for the stabilization of intertrochanteric fractures. Over the last decade, intramedullary implants have replaced extramedullary implants as the most commonly used type of implant in the United States for the treatment of this condition, without strong evidence of superior outcomes.

Methods: We conducted a retrospective cohort study with use of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database.

Haptic biofeedback for improving compliance with lower-extremity partial weight bearing.

After lower-extremity orthopedic trauma and surgery, patients are often advised to restrict weight bearing on the affected limb. Conventional training methods are not effective at enabling patients to comply with recommendations for partial weight bearing. The current study assessed a novel method of using real-time haptic (vibratory/vibrotactile) biofeedback to improve compliance with instructions for partial weight bearing.

Diabetes confers little to no increased risk of postoperative complications after hip fracture surgery in geriatric patients.

Background: Diabetes and hip fractures in geriatric patients are common, and many elderly patients have a history of diabetes. However, the influence of diabetes on surgical complications may vary based on which particular type of diabetes a patient has. To our knowledge, no prior study has stratified patients with diabetes to compare patients with noninsulin-dependent and insulin-dependent diabetes regarding rates of postoperative adverse events, length of hospitalization, and readmission rate after surgical stabilization of hip fractures in geriatric patients.

Postoperative length of stay and 30-day readmission after geriatric hip fracture: an analysis of 8434 patients.

Objectives: To identify factors associated with increased postoperative length of stay (LOS) and readmission after surgical repair of geriatric hip fractures.

Methods: Patients aged 70 years and older who underwent hip fracture surgery from January 2011 through December 2012 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Patient characteristics were tested for association with postoperative LOS and readmission using bivariate and multivariate analyses.

Patient compliance with postoperative lower extremity touch-down weight-bearing orders at a level I academic trauma center.

After lower extremity fracture or surgery, physicians often prescribe limited weight bearing. The current study was performed to evaluate teaching and compliance of touch-down weight bearing (defined as 25 lb) at a level I academic trauma center. A survey was distributed to physical therapists (PTs) from the orthopedic ward to gauge their training methods and their confidence in patients' ability to comply.

Nationwide Inpatient Sample and National Surgical Quality Improvement Program give different results in hip fracture studies.

Background: National databases are being used with increasing frequency to conduct orthopaedic research. However, there are important differences in these databases, which could result in different answers to similar questions; this important potential limitation pertaining to database research in orthopaedic surgery has not been adequately explored.

Questions/purposes: The purpose of this study was to explore the interdatabase reliability of two commonly used national databases, the Nationwide Inpatient Sample (NIS) and the National Surgical Quality Improvement Program (NSQIP), in terms of (1) demographics; (2) comorbidities; and (3) adverse events.

Acetabular fractures: anatomic and clinical considerations.

Objective: Classifying acetabular fractures can be an intimidating topic. However, it is helpful to remember that there are only three basic types of acetabular fractures: column fractures, transverse fractures, and wall fractures. Within this framework, acetabular fractures are classified into two broad categories: elementary or associated fractures.

Osteoporotic pelvic ring injuries.

As with most fractures associated with osteoporosis, the incidence of pelvic ring injuries in this population of patients is rising rapidly. Osteoporotic pelvic ring injuries are exceedingly different in their etiology, natural history, and treatment from the more recognizable patterns in young patients with high-energy pelvic ring injuries. Recognition of a potentially unstable fracture pattern, careful evaluation of the ambulatory and functional status of each patient before injury, and the potential pitfalls and benefits of operative versus nonoperative care are critical to the effective treatment.

Lower-extremity weight-bearing compliance is maintained over time after biofeedback training.

Previous studies have shown immediate compliance with weight-bearing instructions to be better after biofeedback training than after verbal or scale training. This study assessed retention of biofeedback training to determine potential clinical applicability. Twelve participants were enrolled in a prospective clinical study at an academic orthopedic center.

Effect of age on partial weight-bearing training.

Biofeedback devices are increasingly used to train orthopedic patients to comply with partial weight-bearing instructions for an injured or postoperative extremity. In a previous study, the authors showed that biofeedback was effective in training young participants. However, because many partial weight-bearing orthopedic patients are of advanced age, the current study was designed to test the effect of age on partial weight-bearing training.

Current advances in training orthopaedic patients to comply with partial weight-bearing instructions.

Partial weight-bearing instructions are commonly given to orthopaedic patients and are an important part of post-injury and/or post-operative care. However, the ability of patients to comply with these instructions is poorly defined. Training methods for instructing these patients vary widely among institutions.

Is it possible to train patients to limit weight bearing on a lower extremity?

Orthopedic patients are often instructed on how much weight to bear on an injured or postoperative extremity. Although specific weight-bearing instructions are given to a majority of lower-extremity orthopedic patients, the ability of patients to comply with these instructions is questioned in the medical literature. This study compared the effectiveness of new forms of clinical interventions designed to train patients on weight bearing, focusing on the use of biofeedback devices designed to offer real-time feedback to partial weight-bearing patients.

Direct cellular vs. indirect pager communication during orthopaedic surgical procedures: a prospective study.

Background: Cellular phone use within the hospital setting has increased as physicians, nurses, and ancillary staff incorporate wireless technologies in improving efficiencies, cost, and maintaining patient safety and high quality healthcare [11]. Through the use of wireless, cellular communication, an overall improvement in communication accuracy and efficiency between intraoperative orthopaedic surgeons and floor nurses may be achieved.

Methods: Both communication types occurred while the surgeon was scrubbed in the operating room (OR).