Oral vs Intravenous Antibiotics for Fracture-Related Infections: The POvIV Randomized Clinical Trial.

Importance: Fracture-related infection (FRI) is a serious complication following fracture fixation surgery. Current treatment of FRIs entails debridement and 6 weeks of intravenous (IV) antibiotics. Lab data and retrospective clinical studies support use of oral antibiotics, which are less expensive and may have fewer complications than IV antibiotics.

Small-Fragment Plate Fixation of Humeral Shaft Fractures.

Fixation of humeral shaft fractures is frequently performed with large-fragment (4.5 mm) plates to accommodate immediate weight bearing. Use of small-fragment (3.

Association of Radial Head Fracture Treatment With Long-Term Function.

Background: Radial head fractures are often associated with poor outcomes. Both open reduction and internal fixation (ORIF) and radial head arthroplasty (RHA) might be considered in operative cases. This study aimed to compare long-term patient-reported functional outcomes among patients with operatively treated radial head fractures.

Immediate Weight Bearing of Plated Both-Bone Forearm Fractures Using Eight Cortices Proximal and Distal to the Fracture in the Polytrauma Patient Is Safe.

Introduction: Rehabilitation of trauma patients is facilitated by surgical stabilization permitting weight bearing (WB) of the fractured extremity. Both-bone forearm fracture (BBFx) plate osteosynthesis is an accepted technique with high union and low complication rates; yet, postoperative WB protocols have not been adequately investigated. There exists concern for increased complications in plated BBFx fractures for patients prescribed immediate WB.

Management of vasopressor induced ischemia.

Purpose: We evaluated a cohort of patients who developed vasopressor-induced limb ischemia and the management options to prevent progression or minimize morbidity of digital necrosis.

Methods: We reviewed all current literature on pressor-induced limb ischemia and report options for the management of patients requiring vasopressors who developed limb ischemia. We then retrospectively reviewed presentation, treatment, and short-term outcomes for patients at our tertiary referral academic medical center that developed this complication.

Provisional Minifragment Plate Fixation of Acetabular Fractures-A Technical Trick.

Acetabular fractures may not always be amenable to classic clamp-assisted reductions and interfragmentary lag screw fixation. The routine clamp-assisted reductions with limited osseous territory availability can inhibit typical 3.5-mm reconstruction plate application.

Timing of Treatment of Open Fractures of the Distal Radius in Patients Younger Than 65 Years.

The authors aimed to characterize surgical and functional outcomes of open fractures of the distal radius in patients younger than 65 years. At their level I trauma center, the authors conducted a retrospective review of 92 patients (age range, 16-64 years) who had 94 open fractures of the distal radius (average follow-up, 30 months; range, 3-95 months). Sixty-four fractures received definitive treatment at the time of initial débridement; 30 received definitive fixation and soft tissue coverage after staged débridement.

Efficacy of Wound Coverage Techniques in Extremity Necrotizing Soft Tissue Infections.

Little data exist about management of wounds created by debridement in necrotizing soft tissue infections (NSTIs). Multiple wound coverage techniques exist, including complete primary wound closure, split-thickness skin grafting, secondary intention, and flap creation. We hypothesized that all wound coverage techniques would be associated with high rates of successful wound coverage and low crossover rates to other wound coverage techniques.

Physiology, not modern operative approach, predicts mortality in extremity necrotizing soft tissue infections at a high-volume center.

Background: Multiple factors are associated with mortality in necrotizing soft tissue infection, such as organ dysfunction and underlying medical comorbidities, but are not often modifiable. Operative interventions are an attractive modifiable variable in modern management of extremity necrotizing soft tissue infection, but the influence of amputation and advanced wound management techniques on mortality is unknown.

Methods: A single-institution review was performed of extremity necrotizing soft tissue infection .

Magnitude of Soft-Tissue Defect as a Predictor of Free Flap Failures: Does Size Matter?

Objectives: To examine the relationship between the magnitude of soft-tissue defect and the risk of free-flap and limb-salvage complications/failures.

Design: Retrospective cohort.

Setting: Level I Trauma Center.

Osteosynthesis of AO/OTA 13-C3 distal humeral fractures in patients older than 70 years.

Objective: The purpose of this retrospective case series was to examine the AO Foundation and Orthopaedic Trauma Association (AO/OTA) 13-C3 distal humeral fractures treated with open reduction-internal fixation (ORIF) in patients older than 70 years.

Methods: During an 8-year period, 21 patients older than 70 years with AO/OTA 13-C3 distal humeral fractures were treated with ORIF performed by 2 senior upper extremity traumatologists. There were 16 patients with >1 year of follow-up, with a mean age of 78 (70-84) years.

The Adult Monteggia Fracture: Patterns and Incidence of Annular Ligament Incarceration Among 121 Cases at a Single Institution Over 19 Years.

Purpose: The purposes of this study were to identify the relative frequency of Monteggia fracture patterns and to investigate the required frequency of open reduction of the proximal radiocapitellar joint.

Methods: We identified 121 Monteggia fractures at a Level I trauma center from 1996 to 2015 and included 119 in this study. These fractures were identified using a database search for the appropriate International Classification of Diseases, Ninth Revision and Current Procedural Terminology codes as well as individual surgeons' logs.

Intercondylar Fractures of the Distal Humerus in Patients Younger Than 20 Years: Capsulectomy Results.

Few reports in the literature have been dedicated to young patients with distal fractures of the humerus, and few have addressed subsequent indications to improve range of motion (ROM). This article is a retrospective review of the elbow flexion-extension ROM in 31 patients (age, 12-19 years) who had been treated with open reduction and internal fixation of intercondylar fractures of the distal humerus at a level I trauma center from 1991 through 2013. The ROM of patients who underwent capsulectomy was compared with that of those who did not.

Brachial Artery Transection After a Closed Traumatic Isolated Medial Epicondyle Fracture in a Pediatric Patient: A Case Report.

Background: Medial epicondyle fractures in pediatric patients might be associated with an occult elbow dislocation and neurovascular damage.

Methods: A single case of a medial epicondyle fracture presenting with brachial artery transection was reviewed. Presentation, clinical course, and early outcome are reported.

Radiographic predictors of symptomatic screw removal after retrograde femoral nail insertion.

Introduction: Removal of symptomatic implants is a common procedure performed by orthopaedic trauma surgeons. No guidance is available regarding which factors contribute to the likelihood of an implant becoming symptomatic. Our objective was to determine whether radiographic parameters associated with distal interlocks in retrograde femoral nails are associated with the rate of symptomatic screw removal.

Extensor Digitorum Brevis Flap for the Coverage of Ankle and Dorsal Foot Wounds: A Technical Trick.

Soft tissue wounds overlying the dorsum of the foot and ankle are difficult to treat, and historically have been treated with free tissue transfer. Advances in surgical technique have expanded the use of pedicle perforator flaps to avoid free tissue transfer in certain situations. The authors describe a technique for using an extensor digitorum brevis flap to provide soft tissue coverage for wounds of the ankle and foot.

Motorcyclist's thumb: carpometacarpal injuries of the thumb sustained in motorcycle crashes.

Unlabelled: The purpose of this study was to investigate motorcycle crash thumb injury patterns. We hypothesized that ulnar collateral ligament injuries at the thumb metacarpophalangeal joint would be most common and there would be a side predilection due to the clutch and brake positions. Motorcyclist admissions following injury between 2002 and 2013 were reviewed, and phalangeal and metacarpal injuries treated acutely identified.

Sustentaculum Lunatum: Appreciation of the Palmar Lunate Facet in Management of Complex Intra-Articular Fractures of the Distal Radius.

Fracture of the distal radius is the most common wrist injury. Treatment of complex intra-articular fractures of the distal radius requires an accurate diagnosis of the fracture pattern and a thoughtful approach to fixation. We propose a new term, sustentaculum lunatum, for the palmar lunate facet.

Upper extremity injuries in motorcyclists: Implications for mortality and need for rehabilitation services.

Background: Motorcycle crashes (MCCs) constitute a disproportionately high number of road accidents that result in mortality and injury, compared with other motor vehicle collisions. Distribution and characteristics of upper extremity injuries sustained by motorcyclists and their implications are not well established. We sought to determine the epidemiology of upper extremity injuries in motorcyclists and the independent effects of the injuries on mortality and need for rehabilitative services.

Comparison of intramedullary fixation techniques in the maintenance of functional anatomy of the elbow after fixation of the proximal ulna.

The objective of this study was to compare intramedullary (IM) nail and IM screw fixation for reattachment of the proximal ulna. Preserved elbow anatomy served as the primary outcome and was defined as the distance between the coronoid process and the olecranon. A retrospective cohort study of 31 patients treated with IM fixation of the proximal ulna was performed.

Salvage of upper extremities with humeral fracture and associated brachial artery injury.

Background: Humeral fractures with brachial artery injury present a challenge for treating surgeons. Treatment practices vary, including use of vascular shunts, multispecialty teams versus an upper-extremity surgeon, and temporizing external fixation. Our objectives were to describe our treatment approach, to define “absolute ischaemia,” to determine whether to use a vascular shunt, and to identify variables that could improve limb salvage rate.

Fracture of the radial styloid and concomitant first dorsal compartment musculotendinous injuries.

In the absence of preexisting inflammatory conditions, pure traumatic rupture of the extensor pollicis brevis (EPB) and abductor pollicis longus (APL) tendons are rare injuries. We present a report of 2 cases of extensor tendon ruptures at the musculotendinous junction occurring after concomitant fractures of the radial styloid in patients who were involved in high-energy trauma. The presence of a radial styloid fracture should raise suspicion for a greater spectrum of injury that can contribute to multidirectional instability.

Do one-time intracompartmental pressure measurements have a high false-positive rate in diagnosing compartment syndrome?

Background: Intracompartmental pressure measurements are frequently used in the diagnosis of compartment syndrome, particularly in patients with equivocal or limited physical examination findings. Little clinical work has been done to validate the clinical use of intracompartmental pressures or identify associated false-positive rates. We hypothesized that diagnosis of compartment syndrome based on one-time pressure measurements alone is associated with a high false-positive rate.

Safety of immediate open reduction and internal fixation of geriatric open fractures of the distal radius.

Introduction And Aim: There is a paucity of literature regarding outcomes of open fractures of the distal radius. No study has detailed this injury or treatment strategy in the geriatric population. The purpose of this study was to determine the safety of immediate open reduction and internal fixation of geriatric open fractures of the distal radius.