Acetabular fracture types vary with different acetabular version.

Purpose: Acetabular fractures typically occur in high energy trauma. Understanding of the various contributing biomechanical factors and trauma mechanisms is still limited. While several investigations figured out what role femoral position during impact plays in distinct fracture patterns, no data exists on the influence of acetabular version on the fracture type.

Does sleep deprivation impair orthopaedic surgeons' cognitive and psychomotor performance?

Background: Sleep deprivation may slow reaction time, cloud judgment, and impair the ability to think. Our purpose was to study the cognitive and psychomotor performances of orthopaedic trauma surgeons on the basis of the amount of sleep that they obtained.

Methods: We prospectively studied the performances of thirty-two orthopaedic trauma surgeons (residents, fellows, and attending surgeons) over two four-week periods at an urban academic trauma center.

Combined pelvic ring disruption and acetabular fracture: associated injury patterns in 40 patients.

Objectives: Combined pelvic ring disruptions and acetabular fractures are thought to be uncommon. Our objectives were to characterize concomitant injury patterns and to compare them with historically observed rates for each injury in isolation.

Design: Retrospective review comparing a study group with historical controls.

Normal values of Wiberg's lateral center-edge angle and Lequesne's acetabular index--a coxometric update.

Background: The historical pathological cut-off values for Wiberg's lateral center-edge (LCE) angle and Lequesne's acetabular index (AI) are below 20° and above 12° for the LCE and AI, respectively. The aim of this study was to reassess these two angles more than 50 years after their introduction using a standardized conventional radiological measurement method, considering changing social habits and their associated physiological changes.

Methods: A total of 1,226 anteroposterior radiographs of the pelvis (2,452 hips) were obtained according to a strict standardized radiographic technique allowing reliable measurements of the LCE angle and the AI.

A biomechanical comparison of a locking plate, a nail, and a 95° angled blade plate for fixation of subtrochanteric femoral fractures.

Objective: To compare the biomechanical performance of a cephalomedullary nail (CMN), a proximal femoral locking plate, and a 95° angled blade plate in a comminuted subtrochanteric fracture model.

Methods: A comminuted subtrochanteric femoral fracture model was created with a 2-cm gap below the lesser trochanter in 15 pairs of human cadaveric femora confirmed to be nonosteoporotic. The femora were randomized to treatment with one of the previously mentioned 3 devices.

Relationship between Wiberg's lateral center edge angle, Lequesne's acetabular index, and medial acetabular bone stock.

Objective: Knowledge of acetabular anatomy is crucial for cup positioning in total hip replacement. Medial wall thickness of the acetabulum is known to correlate with the degree of developmental dysplasia of the hip (DDH). No data exist about the relationship of routinely used radiographic parameters such as Wiberg's lateral center edge angle (LCE-angle) or Lequesne's acetabular index (AI) with thickness of the medial acetabular wall in the general population.

Surgeon variability in the treatment of pelvic ring injuries.

Pelvic ring injuries are associated with the potential for long-term disability and high mortality rates. No well-established, definitive treatment algorithms have been presented in the literature. We evaluated agreement among surgeons in selecting treatment of pelvic ring injuries and investigated the relationship between type of injury and treatment plan.

Radiographic markers of acetabular retroversion: correlation of the cross-over sign, ischial spine sign and posterior wall sign.

Radiological diagnosis of acetabular retroversion is based on the presence of the cross-over sign (COS), the posterior wall sign (PWS), and prominence of the ischial spine (PRISS). The primary purpose of the study was to correlate the quantitative cross-over sign with the presence or absence of the PRISS and PWS signs. The hypothesis was that both, PRISS and PWS are associated with a higher cross-over sign ratio or higher amount of acetabular retroversion.

Evaluation of computed tomography for determining the diagnosis of acetabular fractures.

Objective: We assessed whether, in contrast to reports in the literature, computed tomographic (CT) scans improve the ability to classify acetabular fractures in comparison with plain radiographs.

Design: Prospective.

Setting: Level I trauma center.

Modified stoppa approach for acetabular fractures with anterior and posterior column displacement: quantification of radiographic reduction and analysis of interobserver variability.

Objectives: To quantify the reduction of acetabular fractures with displacement of the anterior and posterior column by using only a single anterior approach that combines the modified Stoppa approach with the lateral window of the classic ilioinguinal approach. The second objective was to evaluate the interobserver variability of our technique for radiographic evaluation of the reduction.

Setting: Level I trauma referral center.

Resuscitation before stabilization of femoral fractures limits acute respiratory distress syndrome in patients with multiple traumatic injuries despite low use of damage control orthopedics.

Background: Femoral shaft fractures are associated with acute respiratory distress syndrome (ARDS). The idea that primary intramedullary nailing increases the incidence of ARDS has theoretical support. Our approach to treating femoral fractures in patients with multiple traumatic injuries is to perform reamed nailing after adequate resuscitation has been shown by normalizing lactate plus optimized ventilatory and hemodynamic parameters.

Classification of pelvic fractures: analysis of inter- and intraobserver variability using the Young-Burgess and Tile classification systems.

Classification systems for pelvic ring injuries have been developed to assist in understanding the anatomy of the injury, predicting prognosis, and helping define treatment. Despite the frequent clinical use of the Young-Burgess and Tile classification systems, to our knowledge little work has been conducted to validate either system. We assessed the degree of inter- and intraobserver variability when using both the Young-Burgess and Tile classification systems and thereby assessed their validity for clinical use.

Prevalence of acetabular dome retroversion in a mixed race adult trauma patient population.

The goals of the present investigation were to identify the prevalence of acetabular dome retroversion in a mixed race population, to quantify the average amount of cross-over ratio, and to determine normative values. The presence of the cross-over sign and its overlap ratio was assessed for 2,925 hips meeting strict radiographic criteria of the pelvic radiograph. Fifty-two percent of the hips had no cross-over sign whereas 48% had at least a minimal amount of overlap of the anterior and posterior acetabular wall.

Are locking screws advantageous with plate fixation of humeral shaft fractures? A biomechanical analysis of synthetic and cadaveric bone.

Objectives: To investigate whether locking screws offer any advantage over nonlocking screws for plate fixation of humeral shaft fractures for weight-bearing applications.

Design: : Mechanical evaluation of stiffness in torsion, bending, and axial loading and failure in axial loading in synthetic and cadaveric bone.

Setting: Biomechanical laboratory in an academic medical center.

Reconstruction of distal tibia fractures using a posterolateral approach and a blade plate.

Objective: The aim of this article is to report a technique for the management of distal tibia fractures with significant anteromedial soft-tissue injury. The patients were initially treated with a spanning external fixator, open reduction and internal fixation (ORIF) of the fibula at the discretion of the surgeon, and soft-tissue management or flap coverage. ORIF of the tibia was performed on a staged basis, using a 90-degree cannulated blade plate and autogenous iliac crest bone graft through a posterolateral approach.