Complications of Morbid Obesity in the Treatment of Acetabular Fractures: Re-evaluating Outcomes a Decade Later.

Objectives: To determine the rate of perioperative complications between morbidly obese (body mass index greater than 40 kg/m2) and nonmorbidly obese patients undergoing operative treatment of acetabular fractures across 2 periods (2000-2005 and 2012-2019).

Design: Retrospective, case-control study.

Setting: Level I academic trauma center.

The Clamshell Osteotomy for Diaphyseal Malunion in Deformity Correction and Fracture Surgery.

Diaphyseal malunion poses a great challenge for the orthopedic surgeon, and an inundation of morbidity for the patient. Diaphyseal malunion can cause altered gait, adjacent joint osteoarthritis and body dissatisfaction. This problem is fraught with complications without surgical intervention.

Geriatric Acetabular Fractures and Femoral Head Protrusio: Methods of Fixation and the Option of Total Hip Arthroplasty.

Currently, the literature is unclear regarding the optimal treatment algorithm for geriatric acetabular fractures. In a recent epidemiological study, 70% of all acetabular fractures in patients older than 65 years were classified as either associated both column or anterior column/posterior hemitransverse. Within the subset of these fractures, variants with significant femoral head protrusio, which is defined as the displacement of the femoral head medial to the ilioischial line, present with unique challenges.

Tibial Shaft and Pilon Fractures With Associated Syndesmotic Injury: A Matched Cohort Assessment.

Objective: To determine the outcomes of pilon and tibial shaft fractures with syndesmotic injuries compared with similar fractures without syndesmotic injury.

Design: Retrospective case-control study.

Setting: Level 1 trauma center.

Treatment of Distal Femur Fractures With the DePuy-Synthes Variable Angle Locking Compression Plate.

Objectives: To determine the failure rate of the DePuy-Synthes variable angle locking compression curved condylar plate (VA-LCP) and quantify failure modes.

Design: Retrospective review.

Setting: Level I Trauma Center.

Delay in Hip Fracture Surgery Prolongs Postoperative Hospital Length of Stay but Does Not Adversely Affect Outcomes at 30 Days.

Objectives: To evaluate the association between the timing of hip fracture surgery with postoperative length of stay and outcomes.

Design: Retrospective review using the American College of Surgeons National Surgical Quality Improvement Program database.

Setting: National inquiry database incorporating 140 academic and private medical centers.

Risk Factors for Kidney Dysfunction With the Use of Gentamicin in Open Fracture Antibiotic Treatment.

Objectives: To evaluate all patients who received gentamicin for open fracture treatment and determine the incidence of, and risk factors for, kidney injury in this population.

Design: Retrospective, case control.

Setting: Single institution; Level 1 trauma center.

Management of Pelvic and Acetabular Fractures in the Obese Patient.

Acetabular and pelvic ring injuries in obese patients are difficult to treat. Obese patients require great attention to detail during the trauma evaluation to prevent medical and anesthetic complications in the perioperative period. Radiographic evaluation is often compromised by modalities available and loss of resolution with plain film imaging.

Obesity in the Polytrauma Patient.

The rates of obesity continue to increase in the United States and the overall impact of obesity on health care spending and patient outcomes after trauma is considerable. The unique physiology of the obese places them at higher risk for complications, including infection, failure of fixation, nonunion, multiorgan failure, and death. These physiologic differences and overall patient size can make orthopedic care in obese patients with trauma more difficult, but appropriate initial resuscitation, careful preoperative planning, meticulous surgical technique, diligent postoperative medical management, and specialized rehabilitation give these patients their best opportunity for a good outcome.

Objective Methodology to Assess Meaningful Research Productivity by Orthopaedic Residency Departments: Validation Against Widely Distributed Ranking Metrics and Published Surrogates.

The mission of any academic orthopaedic training program can be divided into 3 general areas of focus: clinical care, academic performance, and research. Clinical care is evaluated on clinical volume, patient outcomes, patient satisfaction, and becoming increasingly focused on data-driven quality metrics. Academic performance of a department can be used to motivate individual surgeons, but objective measures are used to define a residency program.

Increasing Severity of Malnutrition Is Associated With Poorer 30-Day Outcomes in Patients Undergoing Hip Fracture Surgery.

Objectives: Low serum albumin levels (hypoalbuminemia) have classically been used to identify malnutrition. The effect of increasing severity of malnutrition on postoperative outcomes in patients undergoing hip fracture surgery has not been well delineated on a large scale.

Design: Retrospective.

Endosteal Substitution With an Intramedullary Rod in Fractures of the Femur.

Background: Morbid obesity and segmental fracture/bone loss are challenging problems in the treatment of fractures and nonunions of the distal femur. The use of an intramedullary rod as an endosteal substitute for a deficient medial cortex along with a lateral locked plate is 1-tool to combat these problems. This article describes the technique used and its results at a single Level 1 trauma center.

Intraosseous Plating for the Management of Cortical Defects.

The management of fractures with segmental bone loss or abundant comminution on the far cortex is often complicated by deformity or frank hardware failure. Using plate constructs that rely on off-axis loading may not be sufficient to support the limb until healing occurs. There are a number of techniques to mitigate this problem, notably the use of intramedullary nails and bicolumnar plating of the fracture.

Stability of the Syndesmosis After Posterior Malleolar Fracture Fixation.

Background: We sought to define the rate of syndesmotic instability after anatomic reduction of the posterior malleolus when posterior stabilization of a trimalleolar or trimalleolar equivalent ankle fracture was chosen vs when a supine position and initially conservative management of the posterior elements was chosen.

Methods: The types of syndesmotic and posterior malleolar fixation used to treat adult patients with ankle fractures involving the posterior malleolus at our level I trauma center were retrospectively assessed (N = 198). Specifically, both bimalleolar and trimalleolar fractures were included.

Extent and Morbidity of Lateralization of a Trochanteric Fixation Nail Blade.

This study examined the incidence and risk factors associated with lateral helical blade migration and trochanteric pain with the trochanteric fixation nail. A retrospective review was performed of 141 cases of pertrochanteric femur fracture treated with a trochanteric fixation nail at a level I trauma center over a period of 42 months. Exclusion criteria included follow-up of less than 60 days, preexisting osteonecrosis of the femoral head, and prophylactic trochanteric fixation nail treatment.

Lower Extremity Fracture Reduction: Tips, Tricks, and Techniques So That You Leave the Operating Room Satisfied.

It can be challenging for surgeons to obtain proper alignment and to create stable constructs for the maintenance of many lower extremity fractures until union is achieved. Whether lower extremity fractures are treated with plates and screws or intramedullary nails, there are numerous pearls that may help surgeons deal with these difficult injuries. Various intraoperative techniques can be used for lower extremity fracture reduction and stabilization.

The effects of obesity in orthopaedic care.

Obesity is a costly, difficult, and increasingly prevalent challenge facing orthopaedic care. It adds complexity to caring for patients throughout all types and stages of treatment in all orthopaedic subspecialties. There are medical complications to mitigate, anesthetic challenges to meet, and surgical complexities to overcome.

Prevalence of post-traumatic osteoarthritis in morbidly obese patients after acetabular fracture fixation.

Background: Morbid obesity and osteoarthritis are conditions that place a significant burden on the US healthcare system. Acetabular fracture is a known cause of post-traumatic osteoarthritis (PTOA) and morbid obesity contributes to the development of osteoarthritis. This study aimed to determine the prevalence of PTOA in morbidly obese patients who underwent acetabular fracture fixation.

Modifier 22 for acetabular fractures in morbidly obese patients: does it affect reimbursement?

Background: Modifier 22 in the American Medical Association's Current Procedural Terminology (CPT®) book is a billing code for professional fees used to reflect an increased amount of skill, time, and work required to complete a procedure. There is little disagreement that using this code in the setting of surgery for acetabulum fractures in the obese patient is appropriate; however, to our knowledge, the degree to which payers value this additional level of complexity has not been determined.

Questions/purposes: We asked whether (1) the use of Modifier 22 increased reimbursements in morbidly obese patients and (2) there was any difference between private insurance and governmental payer sources in treatment of Modifier 22.

Computerized tomography-based radiotherapy improves heterotopic ossification outcomes.

Purpose: To report the impact of computerized tomography (CT) based radiotherapy (RT) on heterotopic ossification (HO) outcomes.

Methods: This is a single institution, retrospective study of 532 patients who were treated for traumatic acetabular fractures (TAF). All patients underwent open-reduction internal-fixation (ORIF) of the TAF followed by RT for HO prophylaxis.

Biomechanical analysis comparing titanium elastic nails with locked plating in two simulated pediatric femur fracture models.

Background: Increasing attention is being paid to the influences that the body habitus and weight of the pediatric patient impose upon the fixation methods for femur fractures. Of the widely accepted treatment options, little biomechanical or clinical data exist comparing flexible intramedullary nailing and locked plating. The aim of this study was to compare the mechanical stability of unstable pediatric diaphyseal femur fractures fixed with titanium flexible intramedullary nails or a titanium locking plate using a synthetic femur model.

Impaired blood pressure recovery to hemorrhage in obese Zucker rats with orthopedic trauma.

We have shown that obese Zucker rats with orthopedic trauma (OZT) exhibit a loss of arteriolar tone in skeletal muscle. We hypothesize that the loss of arteriolar tone in OZT blunts vasoconstrictor responses to hemorrhage, resulting in an impaired blood pressure recovery. Orthopedic trauma was induced with soft tissue injury and local injection of bone components in both hindlimbs in lean (LZT) and OZT (11-13 wk).

Acetabular fracture reductions in the obese patient.

Objectives: To evaluate the radiographic and computed tomographic reduction qualities after acetabular fracture repair in obese and nonobese patients.

Design: Retrospective review.

Setting: University medical center.