Use of inherent anteversion of an intramedullary nail to avoid malrotation in femur fractures.

Rotational malalignment after intramedullary (IM) nailing of femoral fractures remains a significant problem. A technique using intraoperative fluoroscopy and the anteversion inherent to the IM nail for obtaining appropriate femoral rotational alignment is presented. The technique is advocated as a simple alternative to more complex methods for estimation of femoral anteversion during placement of femoral IM nails.

Functional outcomes in elderly patients with acetabular fractures treated with minimally invasive reduction and percutaneous fixation.

Objectives: To present the functional outcomes of elderly patients treated with percutaneous acetabular surgery and compare them with those treated with traditional open reduction and internal fixation in previously published series.

Design: Retrospective.

Setting: University level I trauma center.

A prospective study of thrombophilia in trauma patients with pulmonary embolism.

Background: Pulmonary embolism (PE) is a rare, but often fatal, complication of trauma. To date, there has been no study of the prevalence of thrombophilic abnormalities among trauma patients who sustain a PE. Our purpose was to determine whether heritable thrombophilia is associated with the development of PE in trauma patients.

Ipsilateral femoral shaft and neck fractures: are cephalomedullary nails appropriate?

A retrospective review was conducted to examine rates of malreduction and nonunion in ipsilateral femoral neck and shaft fractures using different fixation strategies. Twenty-two consecutive patients with 23 fractures were identified. Participants were treated with various fixation strategies for ipsilateral femoral neck and shaft fractures.

Percutaneous treatment of pelvic and acetabular fractures in obese patients.

A body mass index (BMI) greater than 30 is becoming increasingly common in the United States. Surgery for pelvic and acetabular fractures in this population is particularly problematic because conventional treatment often requires large surgical exposures. The surgery for both these fractures is technically difficult because of the volume of soft tissue and proneness to complications.

Survivorship of the native hip joint after percutaneous repair of acetabular fractures in the elderly.

Our purpose was to examine survivorship of the native hip joint in patients ages 60 and over who underwent percutaneous reduction and fixation of acetabular fractures. A retrospective review at a University Level I Trauma Center was performed. Our institutional trauma database was reviewed.

The effect of pelvic fracture on mortality after trauma: an analysis of 63,000 trauma patients.

Background: The understanding of the mortality risk posed by pelvic fracture is incomplete. The purposes of this study were (1) to compare the mortality risk associated with a pelvic fracture with the risk conferred by other injuries and (2) to determine if the association of a pelvic fracture with mortality varies when combined with other known risk factors.

Methods: Trauma registry records from two level-I trauma centers were examined.

A modified anterior exposure to the acetabulum for treatment of difficult anterior acetabular fractures.

Many approaches to the acetabulum have been described for the treatment of displaced acetabular fractures. However, the treatment of complex anterior column fractures remains difficult. Commonly used approaches allow access to the internal cortical surface of the anterior column or a limited view of the outer cortical surface of the anterior column.

Reduction of displaced pelvic ring disruptions using a pelvic reduction frame.

The need for reduction in displaced pelvic ring disruptions is well established, but actual techniques to perform this difficult task are evolving. Reduction is often difficult, especially if minimally invasive techniques are used. This pelvic reduction frame (Starr Frame LLC, Richardson, TX) provides stabilization of the intact hemipelvis to the operating table and facilitates multiplanar reduction of the injured hemipelvis with the use and manipulation of external fixator pins.

Case report: locked pubic symphysis: an open reduction technique.

A locked pubic symphysis occasionally occurs after a lateral compression injury of the pelvic ring. One pubic bone becomes entrapped behind the contralateral pubis. Lateral compression pelvic injuries are well recognized, but a lateral compression pelvic injury resulting in a locked pubic symphysis is rare.

Management of an unstable pelvic ring disruption in a 20-month-old patient.

A 20-month-old patient with a markedly displaced pelvic ring disruption was successfully managed with fluid resuscitation, immobilization using bolsters, and percutaneous screw fixation of the posterior ring coupled with hip spica casting.

Use of a midline anterior incision for isolated medial tibial plateau fractures.

A technique using an anterior midline incision with a medial parapatellar arthrotomy and a medial full-thickness skin flap for the open reduction and internal fixation of isolated medial tibial plateau fractures is presented. The approach is advocated as an alternative to a posteromedial approach when medial tibial plateau fractures are present alone. The anterior approach is simple and familiar for orthopaedic surgeons.

Superior pubic ramus fractures fixed with percutaneous screws: what predicts fixation failure?

Objective: The purpose of this study is to present the early complications of percutaneous screw fixation of superior pubic ramus fractures and to present a new classification scheme for superior pubic ramus fractures.

Design: Retrospective.

Setting: Level 1 trauma center.

Cephalomedullary nails in the treatment of high-energy proximal femur fractures in young patients: a prospective, randomized comparison of trochanteric versus piriformis fossa entry portal.

Objective: The purpose of this study is to compare a cephalomedullary nail that uses a piriformis fossa starting point to one that uses a trochanteric starting point, in the treatment of high-energy proximal femur fractures in young patients. Our hypothesis was that a nail that uses a trochanteric starting point would result in less blood loss than a nail that uses a piriformis fossa starting point.

Design: Prospective, randomized.

Vertically unstable pelvic fractures fixed with percutaneous iliosacral screws: does posterior injury pattern predict fixation failure?

Objective: To measure the failure rate of percutaneous iliosacral screw fixation of vertically unstable pelvic fractures and particularly to test the hypothesis that fixations in which the posterior injury is a vertical fracture of the sacrum are more likely to fail than fixations with dislocations or fracture-dislocations of the sacroiliac joint.

Design: Retrospective review.

Setting: Level 1 trauma center.

The effect of screening for deep vein thrombosis on the prevalence of pulmonary embolism in patients with fractures of the pelvis or acetabulum: a review of 973 patients.

Objectives: In patients with pelvic or acetabular fractures, to compare the prevalence of pulmonary embolism in a time period without screening for deep vein thrombosis to that seen when a screening protocol was in place.

Design: Retrospective.

Setting: County hospital.

Symptoms of posttraumatic stress disorder after orthopaedic trauma.

Background: The purpose of this study was to determine the prevalence of posttraumatic stress disorder among patients seen following an orthopaedic traumatic injury and to identify whether injury-related or demographic variables are associated with the disorder.

Methods: Five hundred and eighty patients who had sustained orthopaedic trauma completed a Revised Civilian Mississippi Scale for Posttraumatic Stress Disorder questionnaire. Demographic and injury data were collected to analyze potential variables associated with posttraumatic stress disorder.

Vertically unstable pelvic fractures fixed with percutaneous iliosacral screws: does posterior injury pattern predict fixation failure?

Objective: To measure the failure rate of percutaneous iliosacral screw fixation of vertically unstable pelvic fractures and particularly to test the hypothesis that fixations in which the posterior injury is a vertical fracture of the sacrum are more likely to fail than fixations with dislocations or fracture-dislocations of the sacroiliac joint.

Design: Retrospective review.

Setting: Level 1 trauma center.

Pelvic ring disruptions: prediction of associated injuries, transfusion requirement, pelvic arteriography, complications, and mortality.

Objective: To determine if age, fracture pattern, systolic blood pressure on arrival, base deficit, or the Revised Trauma Score is predictive of mortality, transfusion requirements, use of pelvic arteriography, later complications, or injuries associated with the pelvic ring disruption.

Study Design: Retrospective review of a prospectively collected database.

Methods: All closed pelvic ring disruptions seen between November 1, 1997 and November 30, 1999 were included.

Complications following the "T extensile" approach: a modified extensile approach for acetabular fracture surgery-report of forty-three patients.

Objective: Analyze the prevalence and severity of surgical complications encountered with a modified extended iliofemoral approach, the "T extensile" approach, in the treatment of complex acetabular fractures.

Study Design: Prospective.

Methods: During a sixteen-month study period, forty-three patients with complex acetabular fractures were treated via the T extensile approach.

Percutaneous screw fixation of fractures of the iliac wing and fracture-dislocations of the sacro-iliac joint (OTA Types 61-B2.2 and 61-B2.3, or Young-Burgess "lateral compression type II" pelvic fractures).

A technique for closed reduction and percutaneous screw fixation of fractures of the iliac wing and fracture-dislocations of the sacro-iliac joint is presented. Twenty-seven pelvic fractures were treated with attempted closed reduction followed by percutaneous screw fixation. Closed reduction failed in two patients.