Developing a Risk Score for Predicting Multiple Revision Surgeries in Patients With Fracture-Related Infections.

Introduction: Postoperative infections are a leading cause of morbidity following fracture repair. The purpose of this study is to develop a risk score predicting fracture-related infection (FRI) that will require one versus multiple revision surgeries related to infection eradication and bone healing.

Methods: This is a retrospective cohort study conducted at a single level I trauma center from 2013 to 2020.

Prehospital Antibiotic Administration for Suspected Open Fractures: Joint COT/OTA/ACEP/NAEMSP/NAEMT Position Statement.

One of the primary concerns associated with open fractures is the development of a fracture-related infection (FRI). To minimize the risk of developing an FRI and subsequent morbidity, prophylactic antibiotics should be administered to patients with open fractures as soon as possible. While the antibiotic recommendations for severe open fractures are somewhat debatable, the use of a cephalosporin remains a mainstay of prophylactic treatment.

The Effect of Extracorporeal Membrane Oxygenation in Patients With Multiple Orthopaedic Injuries.

Introduction: Extracorporeal membrane oxygenation (ECMO) plays a vital role in providing life support for patients with reversible cardiac or respiratory failure. Given the high rate of complications and difficulties associated with caring for ECMO patients, the goal of this study was to compare outcomes of orthopaedic surgery in polytrauma patients who received ECMO with similar patients who have not. This will help elucidate the timing and type of fixation that should be considered in patients on ECMO.

A Look Into How the "Blue Zone" Lifestyle May Affect Patients' Lives Before and After Hip Fracture: A Propensity-Matched Cohort Study.

Introduction: Hip fractures are life-changing injuries with associated one-year mortality up to 30%. Five locations in the world have been termed "blue zones," where the longevity of the population is markedly higher than that of surrounding areas and there are 10 times more centenarians. The United States has one blue zone (Loma Linda, California), which is believed to be because of the lifestyle of the Seventh-day Adventist population living there.

Femoral shaft displacement and Winquist classification provide predictive characteristics for combined femoral neck and femoral shaft fractures.

Objectives: The goal of this study is to establish radiographic features and characteristics of patient injury in cases of femoral shaft fractures that predict the presence of ipsilateral femoral neck fractures (IFNFs).

Methods: Patient data was retrospectively assessed from a single level I trauma center through the electronic health record using (Current Procedural Terminology) CPT codes for both isolated and combined ipsilateral femoral shaft and neck fractures. Demographic information, injury characteristics, and independently reviewed radiographic features were collected and compared against the same information from a group of isolated femoral shaft fractures.

The Impact of Smoking on Hospital Course and Postoperative Outcomes in Patients With Fracture-Related Infections.

Objectives: To assess the relationship between patient smoking status and fracture-related infection (FRI) characteristics including patient symptoms at FRI presentation, bacterial species of FRI, and rates of fracture union.

Design: Retrospective cohort study.

Setting: Urban level 1 trauma center.

High-energy Femoral Neck Fractures in Young Patients.

Femoral neck fractures in physiologically young patients typically occur from high-energy axial loading forces through the thigh with the hip in an abducted position. These fractures have a high rate of associated head, chest, abdominal, and musculoskeletal injuries. High-energy hip fractures differ from traditional geriatric hip fractures regarding incidence, mechanism, management algorithms, and complications.

Outcomes of SARS-CoV-2 infection among patients with orthopaedic fracture surgery in the National COVID Cohort Collaborative (N3C).

Background: The objective of this study was to investigate the outcomes of COVID-19-positive patients undergoing orthopaedic fracture surgery using data from a national database of U.S. adults with a COVID-19 test for SARS-CoV-2.

Pelvic Ring Injuries: Stable or Not?

Pelvic ring injuries occur in varying severity and in vastly different patient demographics. Knowledge regarding which of these injuries require surgical intervention and which can be managed nonsurgically continues to evolve. Previous studies have shown validated criteria for sacral fractures and the posterior ring, explored the role of examination under anesthesia, and other forms of dynamic imaging.

Surgical treatment of sacral nonunions.

Sacral fractures are complex injuries that follow a bimodal distribution, typically involving acute high energy trauma in young adults and low energy trauma in older adults (> 65 years old). Nonunion is a rare but debilitating potential complication of undiagnosed or improperly managed sacral fractures. Various surgical techniques, including open reduction and internal fixation, sacroplasty, and percutaneous screw fixation, have been used to manage these fracture nonunions.

Fracture healing-orthobiologics: from basic science to clinical application.

Orthopaedics as a field and a profession is fundamentally concerned with the treatment of musculoskeletal disease, in all of its many forms. Our collective understanding of the cellular mechanisms underlying musculoskeletal pathology resulting from injury continues to evolve, opening novel opportunities to develop orthobiologic treatments to improve care. It is a long path to move from an understanding of cellular pathology to development of successful clinical treatment, and this article proposes to discuss some of the challenges to achieving translational therapies in orthopaedics.

Management of open pelvic ring injuries.

Open pelvic ring injuries are rare clinical entities that require multidisciplinary care. Due to the scarcity of this injury, there is no well-defined treatment algorithm. As a result, conflicting evidence surrounding various aspects of care including wound management and fecal diversion remain.

Risk Factors for Prolonged Hospital Stay After Femoral Neck Fracture.

The purpose of this study was to investigate the association between pre-operative anemia and prolonged hospital stay among geriatric patients with operative femoral neck fractures. This retrospective cohort study was performed at a level I trauma center and included geriatric patients with femoral neck fractures (OTA/AO 31) and operative treatment with code 27236. Exclusion criteria were admission to the intensive care unit, evacuation of subdural hematoma, and conditions requiring exploratory laparotomy.

Diagnosis and Management of Traumatic Hemipelvectomy.

Traumatic hemipelvectomy (THP) is a catastrophic injury associated with high-energy trauma and high mortality. THP has been defined as a complete dislocation of the hemipelvis, often with disruption through the symphysis pubis and sacroiliac joint with concurrent traumatic rupture of the iliac vessels. Despite recent advances in prehospital resuscitative techniques, the true incidence of THP is difficult to ascertain because many patients die before hospital arrival.

Phantom limb syndrome: Assessment of psychiatric and medical comorbidities associated with Phantom pain in 44,028 below knee amputees.

Introduction: Phantom limb syndrome is a debilitating complication after extremity amputation that poses significant challenges to recovery. This study aims to examine the relationship between phantom limb syndrome and mental and physical comorbidities, including a comparison between phantom limb pain and phantom limb syndrome without pain in below knee amputees.

Methods: This is a retrospective cohort study of patients who underwent below knee amputation of the lower extremity in the PearlDiver database, as identified using CPT codes.

Association Between COVID-19 and Mortality in Hip Fracture Surgery in the National COVID Cohort Collaborative (N3C): A Retrospective Cohort Study.

Background: This study investigated the outcomes of coronavirus disease (COVID-19)-positive patients undergoing hip fracture surgery using a national database.

Methods: This is a retrospective cohort study comparing hip fracture surgery outcomes between COVID-19 positive and negative matched cohorts from 46 sites in the United States. Patients aged 65 and older with hip fracture surgery between March 15 and December 31, 2020, were included.

Oxidative Stress and Osteoporosis.

➤: Oxidative stress has been implicated as a causative factor in many disease states, possibly including the diminished bone mineral density in osteoporosis.

➤: Understanding the effects of oxidative stress on the development of osteoporosis may lead to further research improving preventative and therapeutic measures that can combat this important contributor to morbidity and mortality worldwide.

➤: A diet rich in whole plant foods with high antioxidant content along with antioxidant-preserving lifestyle changes may improve bone mineral density and reduce the risk of fragility-related fractures.

Anatomic Analysis of a Percutaneous Fixation Technique for the Posterior Malleolus Using Posterior-to-Anterior-Directed Cannulated Screws: A Cadaveric Study and Technique Description.

Background: Posterior malleolus fractures are traditionally managed with open reduction and internal fixation or percutaneous anterior-to-posterior screws. We present a third option using a percutaneous technique for the placement of posterior-to-anterior-directed screws. An anatomic safety analysis is done using cadaveric specimens.

A Simple Initiative to Decrease Time to Antibiotic Prophylaxis for Open Fractures Is Durable After 2 Years.

Introduction: A simple antibiotic prophylaxis initiative can effectively decrease the time to antibiotic administration for patients with open fractures. We aim to determine whether adherence to the protocol decreased over time without active input from the orthopaedic trauma team.

Patients And Methods: This retrospective cohort study included adult patients with open fractures (excluding hand) presenting directly to the emergency department at one Level I trauma center.

Implant Charge Differences Between Distal Radius Fixation Constructs (CPT 25607, 25608, and 25609).

Background: Implants are a significant contributor to health care costs. We hypothesized that extra-articular fracture patterns would have a lower implant charge than intra-articular fractures and aimed to determine risk factors for increased cost.

Methods: In total, 163 patients undergoing outpatient distal radius fracture fixation at 2 hospitals were retrospectively reviewed stratified by Current Procedural Terminology codes.

Adding a Fibular Strut Allograft to Intramedullary Nail and Cancellous Autograft During Stage II of the Masquelet Technique for Segmental Femur Defects: A Technique Tip.

Reconstruction of segmental diaphyseal bone defects has been a major challenge in limb salvage surgery. Staged reconstruction as first described by Masquelet is a common strategy to deal with this problem in limb salvage surgery. One consequence of this technique is a time period of prolonged limited weightbearing while the segmental defect heals.

Treatment of a periprosthetic femur fracture around an antibiotic spacer with revision and an antibiotic plate.

Infection following total hip arthroplasty can be a devastating complication, often necessitating a 2-stage surgery with the temporary placement of an antibiotic spacer. Fracture around this spacer is an uncommon complication that presents serious treatment challenges. Our manuscript details the successful surgical treatment of a previously unreported fracture around an antibiotic spacer, treated with revision to a hemiarthroplasty and placement of an antibiotic plate.

Development of a novel murine femur fracture and fixation model.

Background: Animal models have been used for decades to simulate human fractures in the laboratory setting. Fracture models in mice are attractive because they offer a high volume, relatively low-cost method of investigating fracture healing characteristics. We report on the development of a novel murine femur fracture model that is rapid, reproducible and inexpensive.

Treatment of Incarcerated Impaction of Acetabular Fractures With Concomitant Osteochondral Femoral Head Fractures by the Use of a Posterior Wall Osteotomy and Surgical Hip Dislocation: A Novel Technique.

Acetabular articular impaction may well accompany acetabular fractures. Anatomic restoration of acetabular congruence is imperative to achieve longevity of the hip joint. Combination of incarcerated acetabular impaction with osteochondral femoral fracture is a true challenge for the pelvic surgeon to address.