Comparison of software-assisted and freehand methods of rotational assessment for diaphyseal femur fractures.

Objective: Accurate rotational reduction following femoral shaft fracture fixation is absent in up to 28% of cases yet is critical for lower extremity biomechanics. The objective of this cadaveric study was to compare the results of freehand methods of rotational reduction with software-assisted rotational reduction.

Methods: Four fellowship-trained orthopedic trauma surgeons attempted rotational correction in a cadaveric model with fluoroscopic assistance using (1) their method of choice (MoC) and (2) software assistance (SA).

Automated Balanced Cable Trifocal Bone Transport: A Case Report.

Case: A 14-year-old adolescent boy sustained a Gustilo-Anderson Type 3A tibia fracture treated with medullary nailing. He developed an atrophic nonunion with a 10.5-cm defect after debridement.

Radiographic Accuracy of Identifying Anterolateral Tibial Plafond Involvement in Pronation Abduction Ankle Fractures.

Objectives: To evaluate the incidence of anterolateral tibial plafond involvement in pronation-abduction (PAB) ankle fractures and analyze the accuracy of radiographs in detecting anterolateral tibial plafond involvement, impaction, and predicting the need for direct visualization and an articular reduction.

Methods: Design: A multi-institutional retrospective chart review.

Setting: Five level 1 trauma centers in the United States.

Success of Resident Research Grants in Orthopaedic Trauma From 2000 to 2022: A Retrospective Review.

Objectives: The objective of this study was to determine the publication rate for orthopaedic trauma resident research projects that receive grant funding and the long-term academic involvement of the grant recipients.

Design: Retrospective.

Setting: Publically available records for resident research grant recipients.

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.

Biomechanical evaluation of a central collinear entry reconstruction nail for femoral neck fracture prophylaxis.

Introduction: Reconstruction nails are commonly used to treat proximal femur fractures, with cephalic screw placement for femoral neck "prophylaxis" becoming standard practice. These implants are traditionally introduced through piriformis fossa (PF) or greater trochanter (GT) entry portals. A third "central collinear" (CC) portal has been proposed that allows entry along the femoral anatomic axis and central placement of cephalic screws.

Subchondral rafting wires reduce tibial plateau fracture subsidence.

Purpose: To determine if subchondral rafting wires retained as adjunctive tibial plateau fracture fixation affect postoperative articular subsidence.

Methods: A retrospective cohort study was conducted at one Level 1 trauma center and one academic university hospital. Consecutive adults with closed, displaced OTA/AO 41B/C tibial plateau fractures treated between 2018 and 2023 with open reduction internal fixation were included.

Current Management of Acute and Posttraumatic Critical Bone Defects.

Limb reconstruction in patients with critical-sized bone defects remains a challenge due to the availability of various technically demanding treatment options and a lack of standardized decision algorithms. Although no consensus exists, it is apparent from the literature that the combination of patient, surgeon, and institutional collaborations is effective in providing the most efficient care pathway for these patients. Success relies on choosing a particular surgical approach that manages infection, soft tissue defects, stability, and alignment.

Optimizing the Entry Point for Medullary Hip Screws.

Introduction: Medullary hip screws (MHSs) are the most common treatment of intertrochanteric hip fractures because they can be used for varied fracture patterns and resist shortening. Identifying the appropriate MHS entry point can be intellectually and technically challenging. We aimed to quantify the variability in the ideal entry point (IEP) for MHSs.

Axial Plane Deformity: How to Avoid It and How to Correct It.

Malreductions in the axial plane (ie, length and rotation) are common when managing long bone fractures. Careful attention to detail during the initial treatment can prevent these malreductions. Various fluoroscopy-based techniques exist for the prevention of malrotation and limb-length discrepancy during surgery for fracture.

Does Fibular Displacement Predict Tibial Malrotation in Simulated Tibia-Fibula Fractures.

Introduction: Tibial malrotation can occur with medullary nailing of diaphyseal tibial fractures. Fibular alignment has been proposed as a surrogate for axial plane reduction intraoperatively. The purpose of this study was to determine whether fibular alignment is a reliable marker of accurate tibial rotation.

Limb position affects intraoperative assessment of condylar width.

Purpose: We sought to define how changes in position and rotation of fluoroscopic imaging may affect the assessment of condylar widening intraoperatively.

Methods: Thirty-three patients with tibial plateau fractures were prospectively identified and included in this study. Fluoroscopic images of the uninjured tibial plateau were obtained in (1) full extension and (2) slight flexion on foam ramp.

Orthopaedic Advances: Use of Three-Dimensional Metallic Implants for Reconstruction of Critical Bone Defects After Trauma.

Multiple successful strategies exist for the management of critical-sized bone defects. Depending on the location and etiology of an osseous defect, there are nuances that must be considered by the treating surgeon. The induced membrane technique and various modifications of the Ilizarov method (bone transport by distraction osteogenesis) have been the most common methods for biologic reconstruction.

Standard versus low-dose computed tomography for assessment of acetabular fracture reduction using novel step and gap measurement technique.

Purpose: Quality of reduction is of paramount importance after acetabular fracture and is best assessed on computed tomography (CT). A recently proposed measurement technique for assessment of step and gap displacement is reproducible but has not been validated. The purpose of this study is to validate a well-established measurement technique against known displacements and to determine if it can be used with low dose CT.

Optimizing the Entry Point for Reconstruction Nailing of the Femur.

Introduction: Varus after antegrade medullary nailing of the proximal femur is associated with worse outcomes. Anecdotally, a more medialized "trochiformis" entry is beneficial to avoid varus with valgus-bend (greater trochanteric entry) femoral nails. However, the optimal entry point remains unknown.

Free Vascularized Fibula Graft for Staged Reconstruction of Infected Humerus Nonunions.

Objective: To evaluate the union rate and rate of postoperative complications in patients with septic nonunions of the humerus after a two-stage reconstruction using a free vascularized fibula graft.

Design: Retrospective case series.

Setting: Academic, tertiary referral center.

A Central Collinear Start Point for Reconstruction Nailing of Femur Fractures: A Technical Trick and Case Series.

Selecting the optimal entry point for reconstruction nailing is critical to avoid iatrogenic malalignment and optimize mechanical stability. In-line nailing is familiar to surgeons and desirable for its on-axis position. However, there are several potential drawbacks.

Adaptation of the Centers for Disease Control Surgical Wound Classification System for Orthopaedic Trauma Surgery.

Objectives: To evaluate a proposed orthopaedic-specific surgical wound classification system (SWCS) and the current Centers for Disease Control (CDC) system in a series of detailed clinical vignettes and to identify the degree of satisfaction with CDC SWCS and desire for institution of an orthopaedic-specific SWCS.

Methods: Forty-five clinical vignettes and a 5-question survey were distributed to current and past members of the Orthopaedic Trauma Association's Classification Committee. Respondents were asked to provide wound class for each vignette using the CDC system and orthopaedic-specific SWCS.

Survey Analysis of Orthopedic Call Compensation.

We sought to determine the type, frequency, and compensation details of orthopedic call for orthopedic traumatologists. We administered a 24-question survey to all members of the Orthopaedic Trauma Association regarding the number and type of orthopedic surgeons within the call pool, frequency of call, number of hospitals covered, and compensation for weekday, weekend, holiday, and pediatric calls. A total of 105 orthopedic surgeons replied.

Radiographic detection of lateral plateau involvement in medial tibial plateau fractures (AO/OTA 41-B1.2, 1.3, 3.2 and 3.3).

Purpose: To assess the accuracy of radiographs in detecting the lateral plateau involvement of medial tibial plateau fractures as well as describe the impact of CT on preoperative planning for this specific fracture morphology.

Methods: Radiograph and CT imaging of patients with a Schatzker type IV tibial plateau fractures (AO/OTA 41-B1.2, B1.

Delayed debridement of open tibia fractures beyond 24 and 48 h does not appear to increase infection and reoperation risk.

Purpose: Surgical debridement is critical to the treatment of open tibia fractures, although the effects of delayed debridement have not been well-established. Other factors such as Gustilo-Anderson type, prompt initiation of antibiotics, and time to definitive closure may be more predictive of infection than time to surgery. We sought to determine the effect of a prolonged delay to surgical debridement with respect to infection and reoperation rates for open tibia fractures.

Large Individual Bilateral Differences in Tibial Torsion Impact Accurate Contralateral Templating and the Evaluation of Rotational Malalignment.

Objective: To determine individual bilateral differences (IBDs) in tibial torsion in a diverse population.

Methods: Computed tomography scans of uninjured bilateral tibiae were used to determine tibial torsion and IBDs in torsion using 4 measurement methods. Age, sex, and self-identified race/ethnicity were also recorded for each subject.

Treatment of tibial plateau fractures with a novel fenestrated screw system for delivery of bone graft substitute.

Purpose: The purpose of this study was to describe the incidence of subsidence in patients with AO/OTA 41 (tibial plateau) fractures which were repaired with a novel fenestrated screw system to used to deliver CaPO4 bone substitute material to fill the subchondral void and support the articular reduction.

Methods: Patients with unicondylar and bicondylar tibial plateau fractures were treated according to the usual technique of two surgeons. After fixation, the Zimmer Biomet N-Force Fixation System®, a fenestrated screw that allows for the injection of bone substitute was placed and used for injection of the proprietary calcium phosphate bone graft substitute into the subchondral void.