Food Insecurity Is Common in the Orthopaedic Trauma Population.

Introduction: Food insecurity is the condition of limited access to healthy and safe food. Malnutrition resulting from food insecurity is a concern particularly in the surgical population due to the association with impaired healing. This aim of this study was to report the incidence and risk factors for food insecurity in the orthopaedic trauma population.

Advances in Dynamization of Plate Fixation to Promote Natural Bone Healing.

The controlled dynamization of fractures can promote natural fracture healing by callus formation, while overly rigid fixation can suppress healing. The advent of locked plating technology enabled new strategies for the controlled dynamization of fractures, such as far cortical locking (FCL) screws or active plates with elastically suspended screw holes. However, these strategies did not allow for the use of non-locking screws, which are typically used to reduce bone fragments to the plate.

Dynamic Fixation of Humeral Shaft Fractures Using Active Locking Plates: A Prospective Observational Study.

Background: Rigid locked plating constructs can suppress fracture healing by inhibiting interfragmentary motion required to stimulate natural bone healing by callus formation. Dynamic fixation with active locking plates reduces construct stiffness, enables controlled interfragmentary motion, and has been shown to induce faster and stronger bone healing in vivo compared to rigid locking plates. This prospective observational study represents the first clinical use of active locking plates.

Comparison of 4 Methods for Dynamization of Locking Plates: Differences in the Amount and Type of Fracture Motion.

Background: Decreasing the stiffness of locked plating constructs can promote natural fracture healing by controlled dynamization of the fracture. This biomechanical study compared the effect of 4 different stiffness reduction methods on interfragmentary motion by measuring axial motion and shear motion at the fracture site.

Methods: Distal femur locking plates were applied to bridge a metadiaphyseal fracture in femur surrogates.

Dynamic Stabilization of Simple Fractures With Active Plates Delivers Stronger Healing Than Conventional Compression Plating.

Objectives: Active plates dynamize a fracture by elastic suspension of screw holes within the plate. We hypothesized that dynamic stabilization with active plates delivers stronger healing relative to standard compression plating.

Methods: Twelve sheep were randomized to receive either a standard compression plate (CP) or an active plate (ACTIVE) for stabilization of an anatomically reduced tibial osteotomy.

Dynamic Stabilization with Active Locking Plates Delivers Faster, Stronger, and More Symmetric Fracture-Healing.

Background: Axial dynamization of fractures can promote healing, and overly stiff fixation can suppress healing. A novel technology, termed active plating, provides controlled axial dynamization by the elastic suspension of locking holes within the plate. This prospective, controlled animal study evaluated the effect of active plates on fracture-healing in an established ovine osteotomy model.

Dynamic locking plates provide symmetric axial dynamization to stimulate fracture healing.

Axial dynamization of an osteosynthesis construct can promote fracture healing. This biomechanical study evaluated a novel dynamic locking plate that derives symmetric axial dynamization by elastic suspension of locking holes within the plate. Standard locked and dynamic plating constructs were tested in a diaphyseal bridge-plating model of the femoral diaphysis to determine the amount and symmetry of interfragmentary motion under axial loading, and to assess construct stiffness under axial loading, torsion, and bending.

Elastically suspending the screw holes of a locked osteosynthesis plate can dampen impact loads.

Impact damping by elastic fixation is a principal engineering strategy to increase the durability of load-bearing structures exposed to prolonged dynamic loading. This biomechanical study evaluated axial impact damping provided by a novel dynamic locking plate. In this design, locking screw holes are elastically suspended within a silicone envelope inside the locking plate.

Dynamic fixation of distal femur fractures using far cortical locking screws: a prospective observational study.

Objectives: Document fixation and healing of distal femur fractures stabilized by plate osteosynthesis using far cortical locking (FCL) screws.

Design: Prospective and observational.

Setting: Two level 1 and 1 level 2 trauma centers.

Serum vitamin D levels in orthopaedic trauma patients living in the northwestern United States.

Objective: To determine the incidence of vitamin D deficiency in orthopaedic trauma patients undergoing fracture surgery living in the Northwest United States.

Design: Retrospective observational cohort study.

Setting: Level 2 trauma center.

A randomized, prospective study comparing intertrochanteric hip fracture fixation with the dynamic hip screw and the dynamic helical hip system in a community practice.

Objective: To evaluate the clinical performance of the Dynamic Helical Hip System (DHHS) spiral blade relative to the Dynamic Hip Screw (DHS) lag screw.

Design: Randomized prospective study.

Setting: One level-2 trauma center and one level-3 trauma center.

2010 mid-America Orthopaedic Association Physician in Training Award: healing complications are common after locked plating for distal femur fractures.

Background: Several mechanical studies suggest locking plate constructs may inhibit callus necessary for healing of distal femur fractures. However, the rate of nonunion and factors associated with nonunion are not well established.

Questions/purposes: We (1) determined the healing rate of distal femur fractures treated with locking plates, (2) assessed the effect of patient injury and treatment variables on fracture healing, and (3) compared callus formation in fractures that healed with those that did not heal.

Locking plates for distal femur fractures: is there a problem with fracture healing?

Objectives: Fractures of the distal femur are severe injuries that present many clinical challenges. Nonunion, delayed union, implant failure, and the need for secondary procedures can reflect complications of healing. This article reviews the literature on distal femur fractures treated with locking plates to determine the reported rate of healing difficulties.

Far cortical locking enables flexible fixation with periarticular locking plates.

The high stiffness of periarticular locked plating constructs can suppress callus formation and fracture healing. Replacing standard locking screws with far cortical locking (FCL) screws can decrease construct stiffness and can improve fracture healing in diaphyseal plating constructs. However, FCL function has not been tested in conjunction with periarticular plating constructs in which FCL screws are confined to the diaphyseal segment.

Biplanar fixation of a locking plate in the diaphysis improves construct strength.

Background: Elevation of a locking plate over the bone surface not only supports biological fixation, but also decreases the torsional strength of the fixation construct. Biplanar fixation by means of a staggered screw hole arrangement may combat this decreased torsional strength caused by plate elevation. This biomechanical study evaluated the effect of biplanar fixation on the torsional strength of locking plate fixation in the femoral diaphysis.

Stabilization of distal femur fractures with intramedullary nails and locking plates: differences in callus formation.

Objectives: This study compared callus formation in distal femur fractures stabilized with locking plates and intramedullary nails to test the hypothesis that locking plates induce less fracture callus than IM nails.

Design: Retrospective case matched study.

Setting: Two orthopaedic trauma centers.

Far cortical locking can improve healing of fractures stabilized with locking plates.

Background: Locked bridge plating relies on secondary bone healing, which requires interfragmentary motion for callus formation. This study evaluated healing of fractures stabilized with a locked plating construct and a far cortical locking construct, which is a modified locked plating approach that promotes interfragmentary motion. The study tested whether far cortical locking constructs can improve fracture-healing compared with standard locked plating constructs.

Far cortical locking can reduce stiffness of locked plating constructs while retaining construct strength.

Background: Several strategies to reduce construct stiffness have been proposed to promote secondary bone healing following fracture fixation with locked bridge plating constructs. However, stiffness reduction is typically gained at the cost of construct strength. In the present study, we tested whether a novel strategy for stiffness reduction, termed far cortical locking, can significantly reduce the stiffness of a locked plating construct while retaining its strength.

A nonlocking end screw can decrease fracture risk caused by locked plating in the osteoporotic diaphysis.

Background: Locking plates transmit load through fixed-angle locking screws instead of relying on plate-to-bone compression. Therefore, locking screws may induce higher stress at the screw-bone interface than that seen with conventional nonlocked plating. This study investigated whether locked plating in osteoporotic diaphyseal bone causes a greater periprosthetic fracture risk than conventional plating because of stress concentrations at the plate end.

Relative stability of conventional and locked plating fixation in a model of the osteoporotic femoral diaphysis.

Background: This study investigated the stiffness and strength of bridge plating with uni-cortical and bi-cortical locking plate constructs relative to a conventional, non-locked construct in the osteoporotic femoral diaphysis.

Methods: Four bridge plating configurations were applied to a validated model of the osteoporotic femoral diaphysis. A non-locked conventional configuration served as baseline.

A surrogate long-bone model with osteoporotic material properties for biomechanical testing of fracture implants.

In vitro comparative testing of fracture fixation implants is limited by the highly variable material properties of cadaveric bone. Bone surrogate specimens are often employed to avoid this confounding variable. Although validated surrogate models of normal bone (NB) exist, no validated bone model simulating weak, osteoporotic bone (OPB) is available.

Knee stability after articulated external fixation.

Background: Articulated external fixation has been proposed as a method to protect ligament reconstructions while allowing aggressive and early postoperative rehabilitation after knee dislocation. However, the ability of these fixators to protect and stabilize the knee joint has not been clearly determined.

Hypothesis: Articulated external fixation can reduce anteroposterior translation in the cruciate-deficient knee and reduce cruciate ligament strain in cases of intact or reconstructed ligaments.

Lag screws for hip fracture fixation: Evaluation of migration resistance under simulated walking.

Previous mechanical studies concerning cut-out of lag screws for pertrochanteric hip fractures have relied on static or dynamic uniaxial loading regimens to induce construct failure by varus collapse and superior cut-out. However, the hip is loaded in a multiplanar, dynamic manner during normal gait. We designed a hip implant performance simulator (HIPS) system to evaluate lag screw cut-out under multiplanar loading representative of normal gait.