Does Local Aqueous Tobramycin Injection Reduce Open Fracture-Related Infection Rates?

Objectives: To examine the effect of local aqueous tobramycin injection adjunct to perioperative intravenous (IV) antibiotic prophylaxis in reducing fracture-related infections (FRIs) following reduction and internal fixation of open fractures.

Design: Retrospective cohort study.

Setting: Single academic Level I trauma center.

Nonoperative Treatment of Humeral Shaft Fractures With Immediate Functional Bracing Versus Coaptation Splinting and Delayed Functional Bracing: A Retrospective Study.

Objectives: To compare radiographic and clinical outcomes in nonoperative management of humeral shaft fractures treated initially with coaptation splinting (CS) followed by delayed functional bracing (FB) versus treatment with immediate FB.

Design: Retrospective cohort study.

Setting: Academic Level 1 Trauma Center.

The Hawkins Sign of the Talus: The Impact of Patient Factors on Prediction Accuracy.

Background: Osteonecrosis is a complication of talar neck fractures associated with chronic pain and poor functional outcomes. The Hawkins sign, the radiographic presence of subchondral lucency seen in the talar dome 6 to 8 weeks after trauma, is a strong predictor of preserved talar vascularity. This study sought to assess the accuracy of the Hawkins sign in a contemporary cohort and assess factors associated with inaccuracy.

Talar Neck Fractures With Associated Ipsilateral Foot and Ankle Fractures Have a Higher Risk of Avascular Necrosis.

Objectives: To determine if talar neck fractures with concomitant ipsilateral foot and/or ankle fractures (TNIFAFs) are associated with higher rates of avascular necrosis (AVN) compared with isolated talar neck fractures (ITNs).

Design: Retrospective cohort.

Setting: Single level I trauma center.

Preventing the Slide in High-Energy Intertrochanteric Fractures With Intramedullary Nails.

Therapeutic Level V.

Association of Talar Neck Fractures With Body Extension and Risk of Avascular Necrosis.

Background: The objective of this study was to determine whether talar neck fractures with proximal extension (TNPE) into the talar body are associated with higher rates of avascular necrosis (AVN) compared to isolated talar neck (TN) fractures.

Methods: A retrospective review of patients sustaining talar neck fractures at a level I trauma center from 2008 to 2016 was performed. Demographic and clinical data were collected from the electronic medical record.

Effect of a Multimodal Analgesic Protocol on Short-Term and Long-Term Opioid Use After Orthopaedic Trauma.

Objective: To determine whether the use of a multimodal analgesic protocol reduced short-term and long-term opioid use in patients hospitalized after orthopaedic trauma.

Design: Retrospective pre-post intervention study.

Setting: Regional, academic, Level 1 trauma center in Central Kentucky.

Radiation Exposure Among Orthopaedic Trauma Surgeons: Deconstructing Commonly Held Myths and Misperceptions.

Objectives: To review and evaluate the validity of common perceptions and practices regarding radiation safety in orthopaedic trauma.

Design: Retrospective study.

Setting: Level 1 trauma center.

Is the Presence of a Psychiatric Disorder Associated With More Aggressive Management of Compartment Syndrome?

Objective: To determine whether pre-existing psychiatric disorder is associated with potentially unnecessary fasciotomy.

Design: Retrospective cohort study.

Setting: Academic Level-1 trauma center.

Newer generation of proximal tibia locking plates demonstrate large variability in their ability to capture the posteromedial fragment in bicondylar tibial plateau fractures.

Introduction: The early generations of proximal tibial locking plates demonstrated inferior results when compared to dual plating in bicondylar tibial plateau fractures with posteromedial fragments (PMF). Modern plates have multiple rows of locking screws and variable angle technology -which tote the ability to capture the PMF. The purpose of this study was to determine if the modern plates could capture the PMF in a large series of bicondylar tibial plateau fractures.

Early Antibiotic Administration Is Associated with a Reduced Infection Risk When Combined with Primary Wound Closure in Patients with Open Tibia Fractures.

Background: Early administration of antibiotics and wound coverage have been shown to decrease the deep infection risk in all patients with Type 3 open tibia fractures. However, it is unknown whether early antibiotic administration decreases infection risk in patients with Types 1, 2, and 3A open tibia fractures treated with primary wound closure.

Questions/purposes: (1) Does decreased time to administration of the first dose of antibiotics decrease the deep infection risk in all open tibia fractures with primary wound closure? (2) What patient demographic factors are associated with an increased deep infection risk in Types 1, 2, and 3A open tibia fractures with primary wound closure?

Methods: We identified 361 open tibia fractures over a 5-year period at a Level I regional trauma center that receives direct admissions and transfers from other hospitals which produces large variation in the timing of antibiotic administration.

Minimally Invasive Plate Osteosynthesis Posterior Approach to Distal Humeral Shaft Fractures-A Surgical Technique.

Comminuted extraarticular metaphyseal and diaphyseal fractures of the distal humerus frequently require operative fixation through a posterior approach. Most of the previously described approaches to the posterior humerus are dependent on large and extensile approaches. This video demonstrates open reduction and internal fixation of a comminuted metaphyseal distal humerus fracture through a minimally invasive posterior approach.

The Learning Curve of Suprapatellar Nailing: Adoption Over Time Can Decrease Operative Time and Radiation Exposure.

Objective: To determine whether suprapatellar nailing (SPN) over time can decrease operative time and radiation exposure when compared with infrapatellar nailing (IPN) of tibial shaft fractures.

Design: Retrospective.

Setting: Single, Level 1 trauma center.

Below-Knee Amputation Resulting from an Arterial Thrombosis from Tourniquet Use in a Patient with Undiagnosed Factor V Leiden: A Case Report.

Case: A 38-year-old woman presented with previously undiagnosed factor V Leiden (FVL), who suffered a complete superficial femoral arterial thrombosis after tourniquet use during the surgical repair of one of her bilateral tibial plafond fractures. This patient's injury eventually resulted in a below-knee amputation.

Conclusion: We recommend expanding hypercoagulable screening on patients with risk factors based on a detailed history and physical examination.

Are Routine Postoperative Computer Tomography Scans Warranted for All Patients After Operative Fixation of Pelvic Ring Injuries?

Objective: To evaluate the efficacy of routine postoperative computed topography (CT) scan after percutaneous fixation of unstable pelvic ring injuries.

Design: Retrospective chart review.

Setting: Level I Trauma Center.

Alzheimer Dementia in the Orthopaedic Patient.

Alzheimer disease is a neurologic disorder characterized by the progressive cognitive decline. As the population continues to age, orthopaedic surgeons need to become familiar with surgical and nonsurgical treatment considerations in this complex population. Despite the advances in geriatric and dementia care, surgical and postoperative management of both elective and emergent surgery remain complex and controversial in this patient population.

Intraoperative Assessment of Coronal Alignment in Distal Femur Fracture Fixation: Technical Trick.

Supracondylar femur fractures represent a challenging and common injury treated by many orthopedic surgeons. An array of surgical fixation options has been developed to help the treating surgeon restore normal anatomic alignment of these fractures, and lateral precontoured condylar femoral locking plates have become a common implant for most surgeons in treating these fractures. Although these precontoured plates provide significant benefit to the treating physician in regards to gaining appropriate bony fixation, common technical errors that may lead to malalignment when using these plates have been described.

Early-Onset Fat Embolism Syndrome: A Case Report.

Case: We present the case of a 26-year-old otherwise healthy man with an isolated tibial and fibular shaft fracture who developed signs of fat embolism syndrome (FES) within 6 hours of injury and prior to any operative treatment.

Conclusion: General orthopaedists and traumatologists should be aware that the onset of FES is not always delayed for several days, but can develop within 6 hours of injury. After initiation of appropriate management, including respiratory support, our patient did well.

Titanium Elastic Nailing has Superior Value to Plate Fixation of Midshaft Femur Fractures in Children 5 to 11 Years.

Background: American Academy of Orthopaedic Surgeons (AAOS) Clinical Practice Guidelines for pediatric femoral shaft fractures indicate titanium elastic nails (TENs) for children 5 to 11 years old. Growing evidence suggests these fractures may also be treated with open or submuscular plating. The purpose of this study was to compare estimated blood loss (EBL), operative time, fluoroscopy time, cost, and subjective and objective pain scores between TENs and plating techniques used in 5- to 11-year-old children with midshaft femur fractures based on length stability.

The Jones-Powell Classification of open pelvic fractures: a multicenter study evaluating mortality rates.

Background: Historically, open pelvic fractures have a high mortality rate. The Jones-Powell Classification system was developed to assist with morbidity and mortality prediction.The purposes of our study were twofold: 1.

Bilateral asymmetric hip dislocation: A case series and literature review of a rare injury pattern.

Background: Bilateral asymmetric hip dislocation, with one hip dislocated posteriorly and with anterior dislocation of the contralateral hip, is a rare injury pattern. A total of 34 cases have been reported in English literature, but only 24 cases detail injury mechanism and patient demographic factors, 3 of which reported bilateral asymmetric hip dislocation in female patients. Only one report describes more than one example.

Use of the obturator-outlet oblique view to guide percutaneous retrograde posterior column screw placement.

In contrast to open reduction internal fixation, percutaneous fixation is a relatively new option for operative fixation of acetabular fractures. The techniques for percutaneous insertion of anterior and posterior column screws have been previously described. For technical aspects of retrograde percutaneous posterior column screws, much attention has been paid to the proper start point.