High Complication Rate After Percutaneous Screw Fixation for Valgus-Impacted Femoral Neck Fractures Without Sagittal Malalignment.

Objectives: To evaluate the rate of reoperation in patients without sagittal plane malalignment who underwent percutaneous screw fixation of a valgus-impacted femoral neck fracture.

Design: Retrospective case series.

Setting: Two Level 1 academic trauma centers.

The Use of the Piriformis Fossa Radiographic Landmark to Predict "In-Out-In" Placement of the Posterosuperior Femoral Neck Screw.

Objectives: To investigate the correlation between a screw's radiographic relationship to the piriformis fossa with position on CT in the clinical setting.

Methods: Intraoperative fluoroscopic images of patients treated with cannulated screw fixation of a femoral neck fracture, who also had a postoperative CT scan, were retrospectively evaluated by 4 fellowship-trained orthopaedic trauma surgeons. The posterosuperior screw on the AP fluoroscopic view was determined to be above the piriformis fossa (APF) or below the piriformis fossa (BPF).

Impact of an Opioid Stewardship Initiative Involving Early Conversion to Oral Narcotics in Postoperative Orthopaedic Patients.

The objective of this study was to determine if the implementation of an opioid stewardship initiative involving early conversion to oral opioids improves outcomes in postoperative orthopaedic patients. This single-center retrospective chart review compared adult patients undergoing lower extremity orthopaedic procedures during a specified six-month time period. The primary outcome was total opioid utilization in morphine milligram equivalence (MME) at 48-hours post-surgery.

Synovial fluid pH sensor for early detection of prosthetic hip infections.

We describe an implantable sensor developed to measure synovial fluid pH for noninvasive early detection and monitoring of hip infections using standard-of-care plain radiography. The sensor was made of a pH responsive polyacrylic acid-based hydrogel, which expands at high pH and contracts at low pH. A radiodense tantalum bead and a tungsten wire were embedded in the two ends of the hydrogel in order to monitor the change in length of the hydrogel sensor in response to pH via plain radiography.

The Use of Tranexamic Acid in Hip and Pelvic Fracture Surgeries.

Tranexamic acid (TXA) use has expanded across many surgical specialties. It has been shown to reduce blood loss, decrease transfusion rates, and, in some cases, improve mortality. Within orthopaedic surgery, its popularity has primarily grown within arthroplasty and spinal surgery.

Medial Collateral Ligament Reconstruction With Dual Adjustable-Loop Suspensory Fixation: A Technique Guide.

The purpose of this technique paper is to outline a minimally invasive technique using dual suspensory fixation with adjustable-loop devices for reconstruction of the superficial medial collateral ligament. The femoral fixation is performed through a limited approach at the anatomic origin of the medial collateral ligament, a socket is prepared, and the graft is docked using the adjustable-loop suspensory fixation. The tibial socket is prepared through a separate incision just distal to the pes anserine tendons and drilled medially to laterally perpendicular to the tibial shaft.

The Dark Side of Development: A Systems Characterization of the Negative Mentoring Experiences of Doctoral Students.

Effective mentoring promotes the development and success of graduate students. Yet mentoring, like other relationships, can have negative elements. Little knowledge exists about the problematic mentoring that graduate students experience despite its potentially detrimental impacts.

The Dislocated Hip on CT Scan: An Argument for the Initial Pelvic Radiograph in Trauma Patients.

This study evaluated the frequency in which a hip dislocation is first diagnosed by computed tomography (CT) scan. A retrospective review was conducted of orthopaedic trauma patients presenting with hip dislocation to a Level 1 trauma center over three years. We recorded whether the patient first received pelvic radiograph (PXR) or CT scan of the pelvis, if the patient underwent closed reduction of the hip prior to CT scan, and if repeat pelvis CT scan was done.

Does Traction Decrease the Need for Open Reduction in Femoral Shaft Fractures Treated Within 24 Hours?

This study evaluates whether preoperative skeletal traction reduces the need for open reduction in femoral shaft fractures treated with intramedullary nailing (IMN) within 24 hours. A retrospective review was conducted of femoral shaft fractures undergoing IMN within 1 day of admission. Primary outcome was an open reduction at the time of IMN.

Biomechanics-Hot Topics Part II.

Orthopaedic surgery and biomechanics are intimately partnered topics in medicine. Biomechanical principles are used to design implants and fashion treatment protocols. Although it would seem that biomechanical principles in the design of fixation devices and fracture repair constructs have been already finalized, there are several points of controversy remaining.

Outcomes of Low-Energy Basicervical Proximal Femoral Fractures Treated with Cephalomedullary Fixation.

Background: Basicervical peritrochanteric fractures are relatively rare, with 1.8% to 7.6% of hip fractures being identified as true basicervical fractures.

Management of Posterior Articular Depression in Tibial Plateau Fractures.

Fractures involving the posterior aspect of the tibial plateau are challenging fractures to treat. Articular depression in tibial plateau fractures is usually addressed by elevation of the fragment(s), filling the residual defect with bone graft or bone substitute, and "raft" support of the articular fracture reduction with screws through a medially and/or laterally based plate. Posterior tibial plateau articular depression presents unique challenges for obtaining and maintaining fracture reduction.

Far cortical locking screws in distal femur fractures.

Distal femur fractures routinely heal by secondary bone healing, which relies on interfragmentary motion. Periarticular locking plates are commonly used for fixation in distal femur fractures but are associated with a high nonunion rate, likely due to the stiffness of the constructs. Far cortical locking (FCL) screws are designed to allow micromotion at the near cortex while maintaining purchase in only the far cortex.

An initial appraisal of waste decomposition by microbial processes within roadside gully pots.

Despite their importance in urban drainage systems, gully pot internal processes have received little scientific study. Therefore, gully pot contents were examined to gain a basic understanding of these processes and to establish the decomposition characteristics of the contents ex situ. Moisture content, organic matter content, enzyme activity and pH were measured to investigate seasonal and geographical effects, in addition to a 5-week composting trial to determine the rate and characteristics of decomposition.

Vaginal lichen planus: preservation of sexual function in severe disease.

Lichen planus is a multisystem disease. Often genital involvement is missed or misdiagnosed. It can be rapidly progressive with high patient morbidity.

An assessment of bacterial dysbiosis in pouchitis using terminal restriction fragment length polymorphisms of 16S ribosomal DNA from pouch effluent microbiota.

Purpose: Previous studies on dysbiosis and pouchitis using conventional culture techniques have been disappointing because of inherent limitations associated with the technique. This study was designed to use terminal restriction fragment length polymorphism to evaluate patients with and without pouchitis.

Methods: Bacterial microbiota in 20 pouch patients (15 healthy and 5 with inflamed) were studied.

Prostate cancer: the new evidence base for diagnosis and treatment.

Although prostate cancer (PC) has a significant mortality, there is debate regarding the utility of PC screening. This debate continues as major studies investigating the value of population-based screening have yet to be concluded. Despite this, there is increasing evidence from preliminary reports from these series, as well as numerous others relating to outcome prediction for PC, that early detection leads to improved outcomes and a decrease in the burden of metastatic disease on our healthcare system.