Thrombopoietic agents enhance bone healing in mice, rats, and pigs.

Achieving bone union remains a significant clinical dilemma. The use of osteoinductive agents, specifically bone morphogenetic proteins (BMPs), has gained wide attention. However, multiple side effects, including increased incidence of cancer, have renewed interest in investigating alternatives that provide safer, yet effective bone regeneration.

Pelvic Reduction Frame Facilitating Percutaneous Fixation to Pelvic Fractures.

This article is a retrospective report of the outcome of 43 unilateral unstable, vertically displaced pelvic ring injuries using a reduction frame which is attached to the OR table, along with special instruments allowing "unlocking" of the fracture to facilitate reduction. The frame utilized by the authors is a modification of the Starr Frame® (Starr Frame, LLC, Richardson), which has been refined to be lower profile, more accessible, and more versatile in pin placement. They have also reported a new attachment for the frame to apply lateral traction to the fractured hemipelvis.

Bone Morphogenetic Protein-2 Rapidly Heals Two Distinct Critical Sized Segmental Diaphyseal Bone Defects in a Porcine Model.

Introduction: Segmental bone defects (SBDs) are devastating injuries sustained by warfighters and are difficult to heal. Preclinical models that accurately simulate human conditions are necessary to investigate therapies to treat SBDs. We have developed two novel porcine SBD models that take advantage of similarities in bone healing and immunologic response to injury between pigs and humans.

Internal Fixation Construct and Defect Size Affect Healing of a Translational Porcine Diaphyseal Tibial Segmental Bone Defect.

Background And Objective: Porcine translational models have become the gold-standard translational tool to study the effects of major injury and hemorrhagic shock because of their similarity to the human immunologic response to trauma. Segmental bone defects (SBDs) typically occur in warfighters with associated severe limb trauma. The purpose of this study was to develop a translational porcine diaphyseal SBD model in Yucatan minipigs (YMPs), which could be used in bone healing investigations that simulate injury-relevant conditions.

A multicenter study on definitive surgery for isolated hip fracture within 24 hours.

Introduction: Isolated hip fractures (IHFs) in the elderly are high-frequency, life-altering events. Definitive surgery ≤24 hours of admission is associated with improved outcomes. An IHF process management guideline (IHF-PMG) to expedite definitive surgery ≤24 hours was developed for a multihospital network.

Softer Tissue Issues in Orthopaedic Trauma.

There are number of significant issues outside of the bone and/or fracture that are important to consider in the treatment of orthopaedic trauma. Joint contractures, heterotopic bone formation, managing a traumatized soft-tissue envelope or substantial soft-tissue defects represent a few of these important issues. This article reviews these issues, including the best available evidence on how to manage them.

A Retrospective Comparative Analysis of the Use of Implantable Bone Stimulators in Nonunions.

This study details the use of implantable bone stimulators in the setting of nonunion. A retrospective comparative analysis was used to evaluate the efficacy of implantable bone stimulators in achieving union in the setting of atrophic or oligotrophic nonunion by two fellowship-trained orthopaedic trauma surgeons. Initially, 72 patients underwent surgical intervention for nonunion.

Comparison of submuscular and open plating of pediatric femur fractures: a retrospective review.

Background: Plate osteosynthesis is an accepted method of treatment of pediatric femur fractures. Historically, open plating has been used. Submuscular bridge plating has gained recent popularity due to the theoretical advantages of decreased operative time, decreased blood loss, and decreased risk for infection.

Heterotopic ossification in orthopaedic trauma.

Heterotopic ossification (HO) can be defined as the pathologic formation of bone in extraskeletal tissues. There has been a substantial amount of recent research on the pathophysiology, prophylaxis, and treatment of HO and traumatic conditions associated with the development of HO. This research has advanced our understanding of this disease and helped to clarify evidence-based approaches to both the prophylaxis and treatment of HO.

Incisional negative pressure wound therapy after high-risk lower extremity fractures.

Objectives: To investigate negative pressure wound therapy (NPWT) to prevent wound dehiscence and infection after high-risk lower extremity trauma.

Design: Prospective randomized multicenter clinical trial.

Setting: Four Level I trauma centers.

Nonunion of a pertrochanteric femur fracture due to a low-velocity gunshot.

The treatment of nonunions often can be a complex and challenging venture. This case report details the treatment of a young patient's pertrochanteric femoral nonunion due to a low-velocity gunshot. Fracture fixation and union were attempted with various implants, including a sliding hip screw, blade plate, and proximal femoral locking plate; however, all eventually failed.

The role of débridement in low-velocity civilian gunshot injuries resulting in pelvis fractures: a retrospective review of acute infection and inpatient mortality.

Objectives: To determine the use of surgical débridement in the management of low-velocity gunshot injuries (GSIs) resulting in pelvis fractures.

Design: : Retrospective chart review.

Setting: Level I trauma center in a major metropolitan area.

Adult trauma: getting through the night.

It is now recognized that the treatment of many orthopaedic injuries can be, and in many cases should be, deferred until a later date. For example, surgical repair of most fractures of the proximal and distal tibia is now delayed until soft-tissue healing has occurred. Acute treatment involves only provisionally reducing and stabilizing such fractures using a joint-spanning external fixator.

The use of implantable bone stimulators in nonunion treatment.

Delayed or failure of bone healing in fracture, osteotomy, and arthrodesis patients continues to be a clinical dilemma. Electromagnetic stimulation is 1 modality demonstrated in many studies to aid bone healing; however, relatively few studies depict the use and complications associated with direct current implantable bone stimulators. Over a 9-year period, we studied a consecutive series of 120 adult patients who underwent implantation of a direct current bone stimulator.

Locking plates for extremity fractures.

Thirty-three peer-reviewed studies met the inclusion criteria for the Overview. Criteria were framed by three key questions regarding indications for the use of locking plates, their effectiveness in comparison with traditional nonlocking plates, and their cost-effectiveness. The studies were divided into seven applications: distal radius, proximal humerus, distal femur, periprosthetic femur, tibial plateau (AO/OTA type C), proximal tibia (AO/OTA type A or C), and distal tibia.

An analysis of gait changes and functional outcome in patients surgically treated for displaced acetabular fractures.

Objectives: To determine the relationship between gait, muscle strength, and functional outcome in patients who underwent Open Reduction Internal Fixation (ORIF) of a displaced acetabular fracture using an anterior ilioinguinal approach and to compare gait and functional outcome in patients who have undergone ORIF via an anterior approach with a similar group of patients who have undergone ORIF of a displaced acetabular fracture via a posterior approach and a group of able-bodied cohorts and to investigate relationships between gait, strength, and functional outcome within the entire group of patients.

Design: Case series.

Setting: University Medical Center.

The management of complications associated with tibial fractures.

Tibial fractures are common and frequently require surgical stabilization. These two factors mean that complications when treating this difficult injury are to be expected. The objectives in the treatment of open tibial shaft fractures are to prevent sepsis, achieve union, and restore function of the limb.

Avoiding complications in the treatment of pronation-external rotation ankle fractures, syndesmotic injuries, and talar neck fractures.

Fractures of the foot and ankle are common injuries that often are successfully treated nonsurgically; however, some injuries require surgical intervention. To restore anatomy and avoid the need for additional surgery, surgeons must pay attention to detail and understand common, avoidable complications. The surgeon should have an understanding of the pathologic characteristics of three common injuries of the foot and ankle as well as the potential complications and their prevention.

Avoiding complications in the care of fractures of the tibia.

Tibial fractures are the most common long-bone fractures. Orthopaedic surgeons, regardless of their subspecialty, often must treat these injuries, which range from low-energy, minimally displaced fractures to limb-threatening injuries with neurologic and vascular damage and significant damage to the soft-tissue envelope. Tibial shaft fractures are often prone to complications, such as apex-anterior and valgus malalignments after nailing of the fractures in the proximal one third of the tibia, infection after open fractures, and aseptic nonunions.

Prevention of complications after treatment of femoral shaft and distal femoral fractures.

The need for surgical treatment of femoral shaft and distal femoral fractures is undisputed. The treatment options are varied, and often the choice is based on the surgeon's preference rather than orthopaedic science. The decision should be determined by the predicted functional outcome rather than by the type of implant to be used.

Prevention of complications after treatment of proximal femoral fractures.

Two factors are primarily responsible for complications after treatment of proximal femoral fractures. First, the strong deforming forces across the hip joint and proximal femur can make fracture reduction difficult. Second, the placement of the implant affects fracture healing and outcome more dramatically than in other areas of the body.

Avoiding complications in the treatment of humeral fractures.

Three of the most common complications that may occur after the treatment of humeral fractures are nonunion, loss of fixation, and nerve injury. Nonunion may occur in up to 15% of patients who have been treated surgically. Loss of fixation often is caused by poor quality bone in the osteopenic humeral head.