Fate of Patients With a "Surprise" Positive Culture After Nonunion Surgery.

Objective: Review the impact of unexpected positive cultures from definitive surgery for nonunion regarding postoperative treatment and ultimate result.

Designs: Retrospective multicenter case series.

Setting: Three level-one trauma centers.

Postoperative radiographs after ACL reconstruction are not cost-effective.

Postoperative radiographs have become standard after anterior cruciate ligament (ACL) reconstruction, even though few findings in the literature substantiate their efficacy. The goal of this study was to determine whether routine postoperative radiographs were cost-effective in patients undergoing ACL reconstruction. In addition, the authors sought to determine whether these radiographs provided meaningful clinical information that changed postoperative management.

Predicting alignment after closed reduction and casting of distal radius fractures.

Purpose: We sought to independently validate the McQueen equation and LaFontaine's criteria as predictors of instability in a large series of distal radius fractures treated nonsurgically. In addition, we hypothesized that restoring the volar cortical integrity (ie, volar hook) would be another factor that would independently predict the maintenance of a closed reduction in a cast.

Methods: We screened 546 consecutive distal radius fractures with 168 meeting all inclusion criteria.

Management of acromioclavicular joint injuries.

Although recent advances have been made in the treatment of acromioclavicular (AC) joint injuries, they are still challenging for shoulder surgeons. There is a consensus that type I and II injuries should be treated nonoperatively, whereas acute type IV, V, and VI injuries should be treated surgically. There is no algorithm for correctly diagnosing and treating type III injuries, but the current trend is toward nonoperative treatment except for those with persistent symptoms and functional limitations after a course of conservative management.

Distal biceps and triceps injuries in athletes.

Biceps and triceps ruptures are rare, but can cause significant disability. They typically result from a forceful eccentric contraction, resulting in weakness and pain. Biceps and triceps tendon injuries represent the most and least common tendinous injuries about the elbow, respectively.

Infections in anterior cruciate ligament reconstruction.

Context: Anterior cruciate ligament (ACL) reconstruction is a safe, common, and effective method of restoring stability to the knee after injury, but evolving techniques of reconstruction carry inherent risk. Infection after ACL reconstruction, while rare, carries a high morbidity, potentially resulting in a poor clinical outcome.

Evidence Acquisition: Data were obtained from previously published peer-reviewed literature through a search of the entire PubMed database (up to December 2012) as well as from textbook chapters.

Preoperative diagnosis of infection in patients with nonunions.

Background: The surgical treatment of a fracture nonunion is complicated in the presence of infection. The purpose of the present study is to report on the utility of a standardized protocol to rule out infection in high-risk patients and to evaluate the efficacy of each component of the protocol.

Methods: A single protocol of preoperative laboratory tests (white blood-cell count, C-reactive protein level, and erythrocyte sedimentation rate) and a combined white blood cell/sulfur colloid scan were performed for patients with a high risk of fracture nonunion.

Compartment syndrome in Schatzker type VI plateau fractures and medial condylar fracture-dislocations treated with temporary external fixation.

Objective: Bicondylar tibial plateau fracture with metaphyseal-diaphyseal dissociation. Schatzker VI and medial plateau fracture-dislocations are commonly treated with initial external fixation until the soft tissues allow for more definitive internal fixation. The purpose of this study was to review the incidence of compartment syndrome (CS) in these injuries and the timing of their occurrence in relation to placement of the external fixator.