Refined Techniques in Tibial Nailing.

Intramedullary nail fixation of unstable tibial diaphyseal fractures is commonly used with excellent clinical results. Indications for nailing have rapidly expanded over recent years, allowing for more difficult fractures to be addressed with "extreme nailing." Despite its widespread use, evolution of newer nailing systems and varying techniques for insertion bring new difficulties with tibial fracture reduction, and malalignment occurs with relative frequency.

Pathoanatomy of the anterior column-posterior hemitransverse acetabular fracture.

Purpose: To define the pathoanatomy of the anterior column-posterior hemitransverse (ACPHT) subtype of acetabulum fractures and assess the morphologic variation therein.

Methods: Retrospective cohort study including 50 patients age greater than 60 with an ACPHT acetabular fracture managed operatively over an 11-year period at an ACS Level 1 Trauma center. Cross-sectional CT images were reviewed for anterior column/wall comminution, anterior column fracture exit point, completeness of the anterior column and posterior column fractures, articular impaction and quadrilateral surface continuity with the posterior column.

Standardization and Reproducibility of Dynamic Stress Testing for Occult Pelvic Ring Instability.

Introduction: Examination under anesthesia (EUA) (stress fluoroscopy) is commonly done after pelvic ring injury to identify occult instability because unstable disruptions may displace causing morbidity. The force applied during EUA for these injuries has not been standardized. The purpose of this study was to examine the forces used during the EUA by experienced orthopaedic trauma pelvic surgeons.

Treatment Failure After Repair of Displaced Femoral Neck Fractures in Patients Compared by "Decade of Life": An Analysis of 565 Cases in Adults Less Than 60 years of Age.

Objectives: To study the results of displaced femoral neck fractures (FNFs) in adults less than 60 years of age by comparing patients, injury, treatment, and the characteristics of treatment failure specifically according to patients' age at injury, that is, by their "decade of life" [ie, "under 30" (29 years and younger), "the 30s" (30-39 years), "the 40s" (40-49 years), and "the 50s" (50-59 years)].

Design: Multicenter retrospective comparative cohort series.

Setting: Twenty-six North American Level 1 Trauma Centers.

Femoral Neck Fractures With Associated Ipsilateral Femoral Shaft Fractures in Young Adults <50 Years Old: A Multicenter Comparison of 80 Cases Versus Isolated Femoral Neck Fractures.

Objectives: To analyze patients, injury patterns, and treatment of femoral neck fractures (FNFs) in young patients with FNFs associated with shaft fractures (assocFNFs) to improve clinical outcomes. The secondary goal was to compare this injury pattern to that of young patients with isolated FNFs (isolFNFs).

Design: Retrospective multicenter cohort series.

Optimal Fixation Strategies for Displaced Femoral Neck Fractures in Patients 18-59 Years of Age: An Analysis of 565 Cases Treated at 26 Level 1 Trauma Centers.

Objectives: The objective of this study was to determine the difference in failure rates of surgical repair for displaced femoral neck fractures in patients younger than 60 years of age according to fixation strategy.

Design: This is a retrospective, comparative cohort study.

Setting: Twenty-six Level 1 North American trauma centers.

Assessment of Force Applied During Examination Under Anesthesia Used to Determine Stability in Posterior Wall Acetabular Fractures.

Objectives: Determination of hip instability associated with posterior wall acetabular fractures may be difficult. Thus, dynamic stress examination under anesthesia (EUA) was developed as a tool for guiding treatment. EUA uses positioning of the hip and application of force across the hip to detect instability.

Assessment of Prophylactic Antibiotic Coverage in Culture-positive Traumatic Open Fractures.

Guidelines provide varying recommendations for the prophylactic antimicrobial treatment of open fractures. This single-center, retrospective cohort study was conducted to determine how well an institutional prophylactic antibiotic protocol covered pathogens associated with open fractures. The authors included adult trauma patients with one or more open fractures and a positive culture from the site of the open fracture, and compared outcomes between patients who were covered by prophylactic antibiotics with patients not covered by prophylactic antibiotics.

Comparative Analysis of Supplemental Medial Buttress Plate Fixation for High-Energy Displaced Femoral Neck Fractures in Young Adults.

Objectives: To evaluate whether augmenting traditional fixation with a femoral neck buttress plate (FNBP) improves clinical outcomes in young adults with high-energy displaced femoral neck fractures.

Design: Multicenter retrospective matched cohort comparative clinical study.

Setting: Twenty-seven North American Level 1 trauma centers.

Effects of Technical Errors on the Outcomes of Operatively Managed Femoral Neck Fractures in Adults Less than 50 Years of Age.

Objective: To evaluate the effect of technical errors (TEs) on the outcomes after repair of femoral neck fractures in young adults.

Design: Multicenter retrospective clinical study.

Setting: 26 North American Level 1 Trauma Centers.

Locked Lateral Plating Versus Retrograde Nailing for Distal Femur Fractures: A Multicenter Randomized Trial.

Objectives: The 2 main forms of treatment for distal femur fractures are locked lateral plating and retrograde nailing. The goal of this trial was to determine whether there are significant differences in outcomes between these forms of treatment.

Design: Multicenter randomized controlled trial.

Hands-free Femoral Traction Using the Bookwalter Retractor System During Anterior Approaches to the Acetabulum.

Displaced acetabular fractures with medial and cranial displacement of the femoral head commonly require an anterior approach for reduction and stabilization. Restoration of the femoral head to its native position under the reduced acetabular dome is a primary goal of surgery. We present a surgical technique for applying traction to the proximal femur using the Bookwalter retractor system during the repair of acetabular fractures when using an anterior approach.

Trans-sacral screw fixation of posterior pelvic ring injuries: review and expert opinion.

Posterior pelvic ring injuries (i.e., sacro-iliac joint dislocations, fracture-dislocations, sacral fractures, pelvic non-unions/malunions) are challenging injury patterns which require a significant level of surgical training and technical expertise.

Treatment Failure in Femoral Neck Fractures in Adults Less Than 50 Years of Age: Analysis of 492 Patients Repaired at 26 North American Trauma Centers.

Objectives: To assess the operative results of femoral neck fractures (FNFs) in young adults in a large multicenter series, specifically focusing on risk factors for treatment failure.

Design: Large multicenter retrospective cohort series.

Setting: Twenty-six North American Level 1 trauma centers.

Quantitative Analysis of Growth Factors From Cancellous Bone Graft Collected With a Reamer-Irrigator-Aspirator System From Native Long Bones Versus Previously Reamed Long Bones.

Objective: Collection of bone graft with the Reamer-Irrigator-Aspirator (RIA) system has become common practice across the field of orthopaedic surgery. While RIA bone graft is typically obtained from native long bones, grafting material can likewise be harvested from long bones that have previously undergone the placement and removal of an intramedullary nail, a process termed re-reamed RIA (RRR). The purpose of this study was to evaluate the total protein and growth factor concentrations present in native-RIA (NR) compared with RRR samples.

Mapping of Vertical Femoral Neck Fractures in Young Patients Using Advanced 2 and 3-Dimensional Computed Tomography.

Objective: To better describe the pathoanatomy of young patients' femoral neck fractures with the goal of improving surgeons' decisions for treatment including reduction and fixation.

Design: This is a retrospective study of patient records, plain radiographs, and the modern computed tomography scans to study the pathoanatomy of Pauwels II and III femoral neck fractures (coronal angle >30 degrees) in young adults.

Setting: One American College of Surgeons Level 1 trauma center.

Exposure Provided by the Gibson Versus the Kocher-Langenbeck Approaches With and Without Trochanteric Osteotomy: A Cadaveric Mapping Study.

Objective: To determine if prevalent approaches in acetabular fracture surgery provide enhanced anterior and cranial exposure in a cadaveric model.

Methods: A Kocher-Langenbeck (K-L) approach (followed by a Gibson approach on the contralateral hip) was performed in the lateral position on 8 cadavers. A Steinmann pin was used to create holes outlining the bony surfaces available for instrumentation before and after a trochanteric osteotomy.

Radiographic Evaluation of the Tibial Intramedullary Nail Entry Point.

Introduction: Tibia fractures are common injuries that can often be effectively treated with intramedullary nail (IMN) fixation. The ideal starting point for IMN reaming and nail placement is well described and regarded as a crucial aspect in the technique. The purpose of this study is to determine the accuracy and precision with which the starting point is established and if this is maintained after nail insertion during fracture fixation.

Calcaneal Avulsion Fractures: A Multicenter Analysis of Soft-Tissue Compromise and Early Fixation Failure.

Objective: To characterize the presentation and outcomes of calcaneal avulsion fractures.

Design: Case series.

Setting: Two ACS Level I trauma centers.

Setting Yourself Up for Success: Locked Plating for Vancouver B1 Fractures.

This chapter discusses principles and controversies surrounding the treatment of periprosthetic fractures around a hip replacement, specifically the Vancouver B1 injury. Evaluation and treatment decisions, as well as surgical tips and tricks, are discussed.

Intramedullary Nails Yield Superior Results Compared With Plate Fixation When Using the Masquelet Technique in the Femur and Tibia.

Objectives: To determine the optimal fixation method [intramedullary nail (IMN) vs. plate fixation (PF)] for treating critical bone defects with the induced membrane technique, also known as the Masquelet technique.

Design: Retrospective cohort study.

Orthopedic Surgeons Have Inadequate Knowledge of the Cost of Trauma-Related Imaging Studies.

Radiographic imaging is integral to the diagnosis and treatment of orthopedic injuries. Previous studies have shown that orthopedists consistently underestimate the price of implants, but their knowledge of imaging charges is unknown. This study evaluated whether orthopedic residents and faculty could accurately estimate charges of imaging modalities at their respective institutions.

Morphology of the Posterior Malleolar Fracture Associated With a Spiral Distal Tibia Fracture.

Objective: To define the pathoanatomy of the posterior malleolus fracture associated with a spiral distal tibia fracture to guide clamp and implant placement when treating these common injuries.

Design: Retrospective cohort.

Setting: Level I trauma center.