Postoperative dorsal step-off predicts olecranon osteotomy union: a retrospective cohort study.

Purpose: Olecranon osteotomy has been associated with loss of reduction, nonunion, implant failure, and migration of wires. We aim to evaluate quality of reduction of the osteotomy site as a predictor of olecranon osteotomy nonunion.

Methods: One hundred and twenty-five distal humerus fractures that underwent open reduction internal fixation (ORIF) were reviewed.

Comparative outcomes of operative treatment for two and three-part proximal humerus fractures with or without ipsilateral shaft fractures and head-split patterns: intramedullary nail versus open reduction internal fixation.

Purpose: To investigate whether the outcomes, including union rates, complications, reoperations, blood loss, operative time, and range of motion, differed following intramedullary nailing (IMN) or open reduction internal fixation (ORIF) of two- and three-part proximal humerus fractures with or without ipsilateral shaft fractures and head-split patterns.

Methods: This was a retrospective multicenter study at three community centers and one level 1 trauma center. Inclusion criteria were two- and three-part proximal humerus fracture treated with either IMN or ORIF from 2015 to 2022 with at least three months of postoperative follow-up.

Utility of CT Scans for Detecting Operative Malleolar Fractures Associated With Tibial Shaft Fractures.

Objectives: The purpose of this study was to define the utility of CT scans for detecting articular extension in tibial shaft fractures and determine whether radiographic parameters can predict the presence of operative distal tibial articular fractures (DTAFs).

Design: Retrospective cohort study.

Setting: Single level I trauma center.

Emphysematous Osteomyelitis of the Pubis Associated With Necrotizing Soft Tissue Infection of the Thigh.

Emphysematous osteomyelitis (EO) is a rare condition identified through the presence of intraosseous gas. It is frequently fatal even with prompt recognition and management. We report a case of EO presenting with a necrotizing soft tissue infection of the thigh in the setting of prior pelvic radiation.

Operative Traction Technique for an Intertrochanteric Femur Fracture in a Patient with Transfemoral Amputation: A Case Report.

Case: A 53-year-old woman with a history of transfemoral amputation presented to the emergency department with an ipsilateral intertrochanteric femur fracture. Standard fracture tables that use a boot to pull traction are not helpful in these cases, which makes achieving adequate traction for reduction difficult.

Conclusion: We describe a unique technique to manipulate an amputated extremity using 2 Schanz pins attached to a weight through a traction rope.

Dual Magnetically Expandable Intramedullary Nails for Treatment of a Large Bony Defect in a Patient with Sarcoma: A Case Report.

Aim: To describe the surgical technique of performing an all-internal lengthening to address a large diaphyseal femur defect in the sarcoma patient.

Background: Various strategies exist to address large intercalary bone defects with various biomechanical and biological implications.

Case Description: A 23-year-old female with high-grade osteosarcoma of her left femur underwent wide resection and an internal reconstruction of a 12.

Comparison of outcomes and operative course between septic and aseptic nonunion in long bones.

Purpose: The treatment of nonunion of long bones is difficult particularly in the presence of infection, which often involves staged surgical management. There is limited literature to compare the post operative course and outcomes of patients treated for septic versus aseptic nonunion. Thus, the purpose of this study was to determine if a difference exists between the number of surgical procedures, time to union, and rate of successful union for these two groups.

Increase in gunshot wounds at a level 1 trauma center following the COVID19 pandemic.

Objectives: To compare the number of patients with gunshot wounds presenting to our level 1 trauma center before and during the COVID-19 pandemic with a focus on volume trends after the lifting of stay-at-home directives through August 2020.

Design: Retrospective.

Setting: Level 1 trauma center.

Acute Fixation of Displaced Intra-articular Calcaneus Fractures Is Safe Using the Sinus Tarsi Approach.

Objective: To analyze the correlation between surgical timing and outcomes for calcaneus fractures treated using a sinus tarsi approach (STA).

Setting: Single Level-1 trauma center.

Design: Retrospective.

Secrets of Success in the Management of Lower Extremity Nonunions.

The key to obtaining healing of nonunions in the lower extremity is to provide a balance of biology and stability. To achieve this goal, the surgeon must understand why the bone did not heal with the initial treatment and change the strategy to improve the outcome. Patients need to be optimized before any proposed surgery.

Comparison of Infrapatellar and Suprapatellar Approaches for Intramedullary Nail Fixation of Tibia Fractures.

Objective: To assess clinical, radiographic, and functional outcomes after intramedullary nail (IMN) fixation of tibia fractures with an infrapatellar approach compared to a suprapatellar approach.

Design: Retrospective chart review.

Setting: Level 1 trauma center.

Clinical Outcomes After Intramedullary Nailing of Intraarticular Distal Tibial Fractures: A Retrospective Review.

Unlabelled: The objective of this study was to evaluate the clinical and functional outcomes of intra-articular distal tibial fractures after intramedullary nail (IMN) and independent fixation compared with extra-articular fracture controls.

Methods: A retrospective chart review of distal tibial fractures treated with IMN was performed. Clinical outcomes were compared between fractures with and without intra-articular involvement.

Comparison of Clinical Outcomes After Intramedullary Fixation of Tibia Fractures Caused by Blunt Trauma and Civilian Gunshot Wounds: A Retrospective Review.

Objective: To assess the outcomes of patients who sustained blunt trauma tibia fractures compared with tibia fractures from civilian gunshot injuries when treated with intramedullary fixation.

Design: Retrospective chart review.

Setting: Level I trauma center.

How Can I Get This Bone to Heal?

A nonunion is a reconstructive challenge that may have a devastating effect on a patient's quality of life. To develop an individualized treatment plan, surgeons must carefully assess several factors related to the nonunion, including the involved bone, the existing implants, the presence of infection, the soft-tissue envelope, and the function of the involved extremity, as well as the status of the patient. Essential components of an individualized treatment plan for a patient with a nonunion include management of infection (if present); optimization of the systemic and local biologic environment via management of nutritional and metabolic deficiencies, systemic disease, tobacco use, and medications that interfere with bone healing as well as via supplemental procedures, such as use of biologics or bone grafting; and achievement of mechanical stability via internal or external fixation that allows for early functional active range of motion and weight bearing.

Hexapod Stacked Transport for Tibial Infected Nonunions With Bone Loss: Long-Term Functional Outcomes.

Objectives: To analyze long-term functional outcomes in patients with posttraumatic infected tibial nonunions having undergone bone transport with hexapod external fixator.

Design: Retrospective cohort study.

Setting: Level 1 trauma center.

Hexapod Frame Stacked Transport for Tibial Infected Nonunions With Bone Loss: Analysis of Use of Adjunctive Stability.

Objectives: The stacked hexapod bone transport technique is an effective treatment for infected tibial nonunions with bone loss. The purpose of this study was to evaluate the patients' risk factors and timing for requiring adjunctive stabilization.

Design: Retrospective cohort study.

Premature Consolidation with Resultant Implant Failure Using PRECICE Femoral Nail Lengthening: A Case Report.

Case: Posttraumatic limb-length discrepancies secondary to femoral malunion can be treated with a variety of external or internal lengthening systems. The PRECICE nail is an intramedullary device featuring an external remote control to activate a magnetically driven internal distraction mechanism. While this intramedullary system avoids the soft-tissue complications common to external lengthening, it has unique mechanisms of failure that are difficult to diagnose and that require a systematic approach.

Surgical Technique for Osteocutaneous Pedicle Flap Transfer for Salvage of Transtibial Amputation After Severe Lower-Extremity Injury.

Introduction: Osteocutaneous pedicle flap transfer from the foot can be used to "salvage" a transtibial amputation level when the severity of an injury precludes a transtibial amputation.

Step 1 Preoperative Assessment: If the posterior tibial artery is not palpable, obtain an angiogram to determine the vascular supply distal to the traumatic zone and to prepare for conversion to a composite free microvascular transfer.

Step 2 Remove Provisional Implants: Remove provisional stabilization implants and minimize surgery about the knee.

Osteocutaneous pedicle flap transfer for salvage of transtibial amputation after severe lower-extremity injury.

Background: A conventional transtibial amputation may not be possible when the zone of injury involves the proximal part of the tibia, or in cases of massive tibial bone and/or soft-tissue loss. The purpose of this study was to examine the outcomes of salvage of a transtibial amputation level with a rotational osteocutaneous pedicle flap from the ipsilateral hindfoot.

Methods: Fourteen patients who had an osteocutaneous pedicle flap from the ipsilateral foot were included in the study.

Free tissue transfer with distraction osteogenesis is effective for limb salvage of the infected traumatized lower extremity.

Background: Salvage of acute and chronic tibial osseocutaneous defects in the lower extremity poses a formidable problem. Although local, distant, and free tissue transfer or bone grafting alone may be adequate for repair of small wounds or osseous defects, large or complicated defects necessitate a different approach. The authors describe their experience with free tissue transfer in combination with distraction osteogenesis for complex composite osteocutaneous defects.

Tibiotalar arthrodesis using a custom blade plate.

Background: The purpose of this study was to evaluate the clinical and radiographic outcomes of patients who underwent tibiotalar arthrodesis between 1997 and 2003 for tibiotalar arthritis. The cause was predominantly posttraumatic arthritis secondary to tibial plafond fracture (n = 15) or talar body fracture (n = 2).

Methods: We retrospectively evaluated a consecutive series of 20 patients with 21 arthritic tibiotalar joints.

Results and outcomes after operative treatment of high-energy tibial plafond fractures.

Background: The purposes of this study were to evaluate the clinical and radiographic results and the functional outcomes after operative treatment of tibial plafond fractures treated with internal or external fixation.

Methods: A retrospective review identified 76 patients with 79 fractures (OTA 43-B or 43-C) of the tibial plafond. Their average age was 45 years.