A Curricular Model for Simulation Within Orthopaedic Residency Training.

Introduction: American Board of Orthopaedic Surgery/American Council on GraduateMedical Education Residency Review Committee training requirements have necessitated the need for the adoption of simulation education into existing programmatic requirements. Current guidelines focus only on interns at a potentially significant cost to programs; both in total dollar amount and time.

Methods: The authors aim to provide a model that can maximize utility for all resident levels, manage cost by maximizing the use of cadaveric material, and allow integration of varied industry support.

Outcomes of Fracture Surgery in Patients With Escalating Hemoglobin A1C in the Setting of Unmanaged Diabetes.

Objective: To determine whether there is a threshold of elevated hemoglobin A1C (HbA1c) above which the complication risk is so high that fracture fixation should be avoided.

Design: Retrospective cohort study.

Setting: Academic Level I trauma center.

Delay of fixation increases 30-day complications and mortality in traumatic pelvic ring injuries.

Purpose: While decreased time to fixation in femur fractures improves mortality, it remains unclear if the same relationship exists for pelvic fractures. The National Trauma Data Bank (NTDB) is a data repository for trauma hospitals in the United States (injury characteristics, perioperative data, procedures, 30-day complications), and we used this to investigate early, significant complications after pelvic-ring injuries.

Methods: The NTDB (2015-2016) was queried to capture operative pelvic ring injuries in adult patients with injury severity score (ISS) ≥ 15.

Radiographic bladder shift is a harbinger of intraoperative blood loss in acetabular surgical fixation.

Purpose: The purpose of this study was to characterize the relationship between a novel radiographic measurement on initial AP pelvis radiograph (termed "bladder shift," BS) to intraoperative blood loss (IBL) during acetabular surgical fixation.

Methods: All adult patients receiving unilateral acetabular fixation (Level 1 academic trauma; 2008-18) were reviewed. AP pelvis radiographs were reviewed for visible bladder outlines and then measured to determine the percentage deformation toward the midline.

Acetabular fracture pattern is altered by pre-injury sacroiliac joint autofusion.

Purpose: Acetabular fracture shape is determined by the direction of force applied. We perceive an anecdotally observed connection between pre-existing autofused sacroiliac joints (aSIJ) and high anterior column (HAC) injuries. The purpose of this study was to compare variations in acetabular fracture patterns sustained in patients with and without pre-injury sacroiliac (SI) joint autofusion.

Post Post-Mobilization Films for LC1 Pelvic Ring Injuries: Follow up Stress Imaging Demonstrates Minimal Utility.

Objective: To assess the utility of outpatient postmobilization radiographs in the nonoperative treatment of lateral compression type I (LC1) (OTA/AO 61-B1) pelvic ring injuries.

Design: Retrospective series.

Setting: Academic, Level 1 trauma center, 2008-2018.

Risk of Revision and Complications After Total Hip Arthroplasty for Acute Treatment of Acetabular Fracture.

Background: Total hip arthroplasty (THA) for the treatment of acute acetabular fractures may be indicated where there is high risk for failure of open reduction and internal fixation. This study aimed to determine risks of revision and rates of major complications of THA for acute acetabular fractures.

Methods: A retrospective review was performed (all-claims data files of a large national database) by querying International Classification of Disease, 10th revision procedure codes for THA within 14 days of acetabular fracture.

Reaming the intramedullary canal during tibial nailing does not affect in vivo intramuscular pH of the anterior tibialis.

Unlabelled: Many investigations have evaluated local and systemic consequences of intramedullary (IM) reaming and suggest that reaming may cause, or exacerbate, injury to the soft tissues adjacent to fractures. To date, no study has examined the effect on local muscular physiology as measured by intramuscular pH (IpH). Here, we observe in vivo IpH during IM reaming for tibia fractures.

Role of single-dose intravenous iron therapy for the treatment of anaemia after orthopaedic trauma: protocol for a pilot randomised controlled trial.

Introduction: Orthopaedic trauma and fracture care commonly cause perioperative anaemia and associated functional iron deficiency due to a systemic inflammatory state. Modern, strict transfusion thresholds leave many patients anaemic; managing this perioperative anaemia is an opportunity to impact outcomes in orthopaedic trauma surgery. The primary outcome of this pilot study is feasibility for a large randomised controlled trial (RCT) to evaluate intravenous iron therapy (IVIT) to improve patient well-being following orthopaedic injury.

Distribution of Bacterial Species and Resistance Patterns in Surgical Site Infection after Prior Administration of Vancomycin and Tobramycin Intrawound Powdered Antibiotic Prophylaxis.

Objective: Evaluate the species distribution and resistance patterns of bacterial pathogens causing surgical site infection (SSI) after operative fracture repair, with and without the use of intrawound powdered antibiotic (IPA) prophylaxis during the index surgery.

Design: Retrospective cohort study.

Setting: Academic, level 1 trauma center, 2018-2020.

Bicondylar Tibial Plateau Fractures: What Predicts Infection?

Objectives: The purpose of this study was to identify the patient, injury, and treatment factors associated with infection of bicondylar plateau fractures and to evaluate whether center variation exists.

Design: Retrospective review.

Setting: Eighteen academic 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.

Collagen X Longitudinal Fracture Biomarker Suggests Staged Fixation in Tibial Plateau Fractures Delays Rate of Endochondral Repair.

Objectives: To use a novel, validated bioassay to monitor serum concentrations of a breakdown product of collagen X in a prospective longitudinal study of patients sustaining isolated tibial plateau fractures. Collagen X is the hallmark extracellular matrix protein present during conversion of soft, cartilaginous callus to bone during endochondral repair. Previous preclinical and clinical studies demonstrated a distinct peak in collagen X biomarker (CXM) bioassay levels after long bone fractures.

Methods of Quantifying Intraoperative Blood Loss in Orthopaedic Trauma Surgery: A Systematic Review.

Objectives: To collect and present the recently published methods of quantifying blood loss (BL) in orthopaedic trauma.

Data Sources: A systematic review of English-language literature in PubMed, Cochrane Library, and Scopus databases was conducted according to the PRISMA guidelines on articles describing the methods of determining BL in orthopaedic trauma published since 2010.

Study Selection: English, full-text, peer-reviewed articles documenting intraoperative BL in an adult patient population undergoing orthopaedic trauma surgery were eligible for inclusion.

Methamphetamine in Orthopaedics: Considerations of an At-Risk Population.

»: Methamphetamine use by orthopaedic trauma patients has risen to epidemic proportions.

»: Perioperative methamphetamine use by orthopaedic trauma patients requires physicians to consider both medical and psychosocial factors during treatment.

»: Behavioral and psychosocial effects of methamphetamine use present barriers to care.

Smith-Petersen Versus Watson-Jones Approach Does Not Affect Quality of Open Reduction of Femoral Neck Fracture.

Objective: To compare immediate quality of open reduction of femoral neck fractures by alternative surgical approaches.

Design: Retrospective cohort study.

Setting: Twelve Level 1 North American trauma centers.

Unilateral Sacral Fractures Demonstrate Slow Recovery of Patient-Reported Outcomes Irrespective of Treatment.

Objectives: To report functional outcomes of unilateral sacral fractures treated both operatively and nonoperatively.

Design: Prospective, multicenter, observational study.

Setting: Sixteen Level 1 trauma centers.

Methamphetamines and Acetabular Reoperation Rates: Poor Outcomes From the Front Lines.

Objectives: To compare acetabular fracture reoperation rates within 1 year of surgery in methamphetamine ("meth") abusers and abstainers.

Design: Retrospective database analysis.

Setting: Level 1 academic trauma facility, 2008-2018.

Is the Iliac Cortical Density Similarly Positioned in the Developing Pediatric Pelvis?

Objectives: The iliac cortical density (ICD) is a critical fluoroscopic landmark for pelvic percutaneous screw placement. Our purpose was to evaluate the ICD as a landmark in pediatrics and quantify the diameter of osseous pathways for 3 screw trajectories: iliosacral (IS) at S1 and transiliac-transsacral (TSTI) at S1 and S2.

Methods: Two hundred sixty-seven consecutive pelvic CT scans in children 0-16 years of age were analyzed.

Complications of Intraosseous Access: Two Case Reports From a Single Center.

Cases: Intraosseous (IO) access is an effective surrogate for intravascular access in critically ill patients. We present 2 cases of IO complications. The first patient is a 44-year-old man with deep peroneal nerve sensorimotor dysfunction due to possible missed acute compartment syndrome from improper placement of a tibial IO needle.

Does Resident Participation in the Surgical Fixation of Hip Fractures Increase Operative Time or Affect Outcomes?

Background: Surgical fixation of hip fractures is a common procedure at teaching hospitals with resident support and in community hospitals.

Objective: We evaluated to what extent participation by residents in hip fracture fixation affects operative times or outcomes.

Setting: Operations were performed by three surgeons who operate at a teaching hospital with resident support, and at a community hospital without residents in the same metropolitan area.

When Is an Orthopedic Intern Ready to Take Call?

Objective: While orthopedic residency training varies among programs, an inevitable phenomenon is a transition for interns from consistent oversight to independent call with indirect supervision. It is therefore crucial to reliably assess trainees' ability to perform basic procedures. The objective of the study was to evaluate the utility of a novel Orthopaedic Intern Skills Assessment (OISA) to assess skill level.

Open Reduction Is Associated With Greater Hazard of Early Reoperation After Internal Fixation of Displaced Femoral Neck Fractures in Adults 18-65 Years.

Objectives: To determine (1) which factors are associated with the choice to perform an open reduction and (2) by adjusting for these factors, if the choice of reduction method is associated with reoperation.

Design: Retrospective cohort study with radiograph and chart review.

Setting: Twelve Level 1 North American trauma centers.