Effects of Tranexamic Acid on Human Osteoblasts as Proxy for Fracture Healing.

Objectives: To investigate the effect of tranexamic acid (TXA) through in vitro culture of primary human osteoblasts (HOB) and in vivo using an operative rat femur fracture model. It was hypothesized that there would not be any effect on fracture healing in both studies.

Methods: Primary HOBs were exposed to varying concentrations of TXA over different time periods.

A Data-Driven Methodology to Comprehensively Assess Bone Drilling Using Radar Plots.

Background: The study aims to develop a data-driven methodology to assess bone drilling in preparation for future clinical trials in residency training. The existing assessment methods are either subjective or do not consider the interdependence among individual skill factors, such as time and accuracy. This study uses quantitative data and radar plots to visualize the balance of the selected skill factors.

Developing a National Trauma Research Action Plan: Results from the long-term outcomes research gap Delphi survey.

Background: In the National Academies of Sciences, Engineering, and Medicine 2016 report on trauma care, the establishment of a National Trauma Research Action Plan to strengthen and guide future trauma research was recommended. To address this recommendation, the Department of Defense funded the Coalition for National Trauma Research to generate a comprehensive research agenda spanning the continuum of trauma and burn care. We describe the gap analysis and high-priority research questions generated from the National Trauma Research Action Plan panel on long-term outcomes.

Reformatting of Computed Tomography Scans Parallel to the S1 End Plate Increases Visualization of Trans Sacral Pathway in the First Sacral Segment, Especially With Dysmorphism.

Objective: To determine whether reformatted computed tomography (CT) scans would increase surgeons' confidence in placing a trans sacral (TS) screw in the first sacral segment.

Setting: Level 1 trauma center.

Design: A retrospective cohort study.

An objective assessment for bone drilling: A pilot study on vertical drilling.

The purpose of this study is to propose a quantitative assessment scheme to help with surgical bone drilling training. This pilot study gathered and compared motion and force data from expert surgeons (n = 3) and novice residents (n = 6). The experiment used three-dimensional printed bone simulants of young bone (YB) and osteoporotic bone (OB), and drilling overshoot, time, and force were measured.

The injury characteristics of open pilon fractures predictive of complications.

Objective: Determine predictive injury factors for wound complications in open pilon fractures (OTA/AO 43B and 43C).

Design: Retrospective Case Series.

Setting: Level I Trauma Center.

The Competitive Orthopaedic Trauma Fellowship Applicant: A Program Director's Perspective.

Introduction: In 2018, orthopaedic trauma had the lowest match rate among orthopaedic subspecialties. The purpose of this study was to determine the importance of factors evaluated by orthopaedic trauma fellowship directors when ranking applicants after the interview.

Methods: An electronic survey was submitted to fellowship directors and consisted of 16 factors included in a fellowship application.

Improvement of Orthopedic Residency Programs and Diversity: Dilemmas and Challenges, an International Perspective.

Background: To date, little has been published comparing the structure and requirements of orthopedic training programs across multiple countries. The goal of this study was to summarize and compare the characteristics of orthopedic training programs in the U.S.

Improved Intraoperative Fluoroscopy for Pelvic and Acetabular Surgery.

Over the past 3 decades, the evolution of pelvic and acetabular surgery has been supported by the advances in intraoperative pelvic fluoroscopic imaging technology. The new Ziehm RFD 3D C-arm unit provides routine fluoroscopic pelvic imaging but also offers rapid and high-quality real-time axial, sagittal, and coronal intraoperative imaging. This technology allows the surgeon to accurately assess fracture reduction, loose body removal, and implant locations while the patient is still under anesthesia.

Hip Fracture Nonunions: Diagnosis, Treatment, and Special Considerations in Elderly Patients.

In the United States, more than 300,000 hip fractures occur annually in the elderly population with associated significant morbidity and mortality. Both intracapsular and extracapsular hip fractures have inherent treatment challenges and therefore are at risk of nonunion complications. A systematic assessment including radiographic, metabolic, and infectious evaluations should be completed for all patients suspected of nonunion.

Secondary Union of a Critical Segmental Femoral Defect: A Case Report.

Case: We report the case of a 41-year-old man who sustained an open femoral shaft fracture with 10 cm of segmental bone loss in a motorcycle collision. He underwent serial irrigation and debridement procedures and intramedullary nailing of the fracture. He was lost to follow-up, but presented 9 months after the injury with abundant callus formation; at 11 months, the simple hypertrophic nonunion was treated with exchange nailing.

External validation of the clinical indications of computed tomography (CT) of the head in patients with low-energy geriatric hip fractures.

Introduction: On evaluation of the clinical indications of computed tomography (CT) scan of head in the patients with low-energy geriatric hip fractures, Maniar et al. identified physical evidence of head injury, new onset confusion, and Glasgow Coma Scale (GCS)<15 as predictive risk factors for acute findings on CT scan. The goal of the present study was to validate these three criteria as predictive risk factors for a larger population in a wider geographical distribution.

The Core Competencies for General Orthopaedic Surgeons.

Background: With the changing delivery of orthopaedic surgical care, there is a need to define the knowledge and competencies that are expected of an orthopaedist providing general and/or acute orthopaedic care. This article provides a proposal for the knowledge and competencies needed for an orthopaedist to practice general and/or acute care orthopaedic surgery.

Methods: Using the modified Delphi method, the General Orthopaedic Competency Task Force consisting of stakeholders associated with general orthopaedic practice has proposed the core knowledge and competencies that should be maintained by orthopaedists who practice emergency and general orthopaedic surgery.

Early Mechanical Failures of the Synthes Variable Angle Locking Distal Femur Plate.

Objectives: To document the high failure rate of a specific implant: the Synthes Variable Angle (VA) Locking Distal Femur Plate.

Design: Retrospective.

Setting: Urban University Level I Trauma Center.

Type III open tibia fractures: immediate antibiotic prophylaxis minimizes infection.

Objective: To examine the association between antibiotic timing and deep infection of type III open tibia fractures.

Design: Retrospective prognostic study.

Setting: Level 1 Trauma Center.

Musculoskeletal function assessment outcomes scores over time for tibial plafond (OTA/AO 43) and proximal humeral (OTA/AO 11) fractures: a pilot project.

Objectives: What is the return to function after an isolated proximal humerus or tibial plafond fracture?

Design: Prospective observational.

Setting: Orthopaedic outpatient clinics.

Patients/participants: Consecutive patients were enrolled with isolated proximal humerus (N = 155) and tibial plafond fractures (N = 120).

The AO Foundation and Orthopaedic Trauma Association (AO/OTA) scapula fracture classification system: focus on body involvement.

Background: A comprehensive system has been developed by the AO Classification Advisory Group to allow in-depth classification of scapular fractures for clinical research and surgical decision making. This paper evaluates a detailed classification system of scapular body fractures to better address the need for clinical relevance.

Methods: Seven experienced shoulder and orthopaedic trauma specialist surgeons participated in a follow-up series of agreement studies to specify and to evaluate the involvement of the body in scapula fractures.

Genomewide molecular and biologic characterization of biomembrane formation adjacent to a methacrylate spacer in the rat femoral segmental defect model.

Objectives: This study focuses upon the morphologic and molecular features of the layer of cells, termed the "biomembrane," which forms around methacrylate spacers in bone segmental defects. The objective of this research was to assess the biomembrane formed in a novel rodent femoral segmental defect model at 4, 8, and 16 weeks with histologic and molecular studies.

Methods: Following Institutional Animal Care and Use Committee approval, a segmental defect was created in the rat femur and stabilized with the AO LockingRatNail and analyzed at 4, 8, and 16 weeks postsurgery using digital radiologic imaging, morphological and immunohistochemical studies, and genomewide gene expression studies employing microarray analysis.