New Imaging, Diagnostic, and Assessment Techniques in Orthopedic Trauma.

This article examines new imaging, diagnostic, and assessment techniques that may affect the care of patients with orthopedic trauma and/or infection. Three-dimensional imaging has assisted in fracture assessment preoperatively, whereas improvement in C-arm technology has allowed real-time evaluation of implant placement and periarticular reduction before leaving the operating room. Advances in imaging techniques have allowed earlier and more accurate diagnosis of nonunion and infection.

The Effect of Under-Dosing Prophylactic Antibiotics in the Care of Open Tibial Fractures.

Objectives: To determine the frequency and effect of under-dosing prophylactic weight-based antibiotics in patients with open tibial fractures. We hypothesized that patients who did not receive appropriate weight-based dosing of prophylactic antibiotics would have higher rates of infection.

Design: Retrospective cohort study.

The Role of Implant Removal in Orthopedic Trauma.

Although implant removal is common after orthopedic trauma, indications for removal remain controversial. There are few data in the literature to allow evidence-based decision-making. The risk of complications from implant removal must be weighed against the possible benefits and the likelihood of improving the patient's symptoms.

Lateral Compression-I Pelvic Ring Injury: Not Benign to the Developing Fetus.

Objective: To determine whether certain patterns of pelvic ring injury are associated with more frequent intrauterine fetal demise (IUFD).

Design: Retrospective review.

Setting: Level 1 trauma center.

Role of Systemic and Local Antibiotics in the Treatment of Open Fractures.

The orthopedic community has learned much about the treatment of open fractures from the tremendous work of Ramon Gustilo, Michael Patzakis, and others; however, open fractures continue to be very difficult challenges. Type III open fractures continue to be associated with high infection rates. Some combination of systemic and local antibiotics may be most appropriate in these high-grade open fractures.

High Complication Rate in Young Patients With High-Energy Intertrochanteric Femoral Fractures.

Although intertrochanteric femoral fractures in elderly patients are common injuries that have been studied extensively, little has been reported about high-energy intertrochanteric fractures in younger patients. This study examined the injury characteristics and outcomes of high-energy intertrochanteric fractures in patients younger than 65 years treated with either sliding hip screws (SHSs) or cephalomedullary nails (CMNs). A total of 37 patients younger than 65 years (mean age, 45 years) with high-energy intertrochanteric fractures and mean follow-up of 34 weeks were identified; 21 patients were treated with SHSs, and 16 patients were treated with CMNs.

Tibial Stress Fractures in Athletes.

Tibial stress fractures are common in the athlete. There are various causes of these fractures, the most common being a sudden increase in training intensity. Most of these injuries are treated conservatively; however, some may require operative intervention.

Distal Femoral Replacement for Acute Distal Femoral Fractures in Elderly Patients.

Objectives: To evaluate outcomes and complications using cemented modular distal femoral replacement in elderly patients with distal femoral fractures.

Design: Retrospective chart review, case series.

Setting: A Level 1 and Level 2 trauma center, both tertiary referral hospitals.

Nonunion of the Femur and Tibia: An Update.

Delayed union and nonunion of tibial and femoral shaft fractures are common orthopedic problems. Numerous publications address lower extremity long bone nonunions. This review presents current trends and recent literature on the evaluation and treatment of nonunions of the tibia and femur.

Morbid obesity increases the risk for systemic complications in patients with femoral shaft fractures.

Objectives: To determine whether morbidity and mortality were increased in morbidly obese patients who had reamed intramedullary nailing of closed femoral shaft fractures compared with similar patients of normal weight.

Design: Retrospective case-control study.

Setting: Level I trauma center.

Aged men display blunted biorhythmic variation of muscle performance and physiological responses.

Aging is known to disrupt the "biological clock" that governs physiological variables at rest. This study sought to determine whether aged men demonstrated biorhythmic variation in muscle performance during resistance exercise and physiological responses to that stimulus. Ten aged (75.