Do All Fractures Need Surgery?

Common fractures managed by orthopaedic surgeons include ankle fractures, proximal humerus fractures in patients older than 60 years, humeral shaft fractures, and distal radius fractures. Recent trends indicate that surgical management is the best option for most fractures. However, there is limited evidence regarding whether most of these fractures need surgery, or whether there is a subset that could be managed without surgery, with no change in outcomes, or even possibly having improved results with lower complication rates with nonsurgical care.

Plunging Dangerously: A Quantitative Assessment of Drilling the Clavicle.

Bicortical drilling of the clavicle is associated with risk of iatrogenic damage from plunging given the close proximity of neurovascular structures. This study determined plunge depth during superior-to-inferior clavicle drilling using a standard drill vs drill-sensing technology. Two orthopedic surgeons drilled 10 holes in a fresh cadaveric clavicle with drill-sensing technology in freehand mode (functions as standard orthopedic drill) and another 10 holes with drill-sensing technology in bicortical mode (drill motor stops when the second cortex is breached and depth is measured in real time).

Examination of fluoroscopy monitor as a source of indirect bacterial contamination in orthopaedic surgery.

Background: Surgical site infection is a well-documented complication of surgery. While contact with fomites represents a recognised source of contamination, electrostatic charge can cause contamination without surface contact as shown in previous studies evaluating operating room equipment. In cases requiring fluoroscopy, an intraoperative X-ray method, it is common for a surgeon to point to the associated monitor, particularly when teaching.

Bone density of first and second segments of normal and dysmorphic sacra.

Background: Iliosacral screw fixation is safe and effective but can be complicated by loss of fixation, particularly in patients with osteopenic bone. Sacral morphology dictates where iliosacral screws may be placed when stabilizing pelvic ring injuries. In dysmorphic sacra, the safe osseous corridor of the upper sacral segment (S1) is smaller and lacks a transsacral corridor, increasing the need for fixation in the second sacral segment (S2).

Bilateral Isolated Fractures of the Sustentaculum Tali: A Case Report.

Case: This article presents a case of bilateral isolated fractures of the sustentaculum tali. Subtle radiographic findings of sustentaculum fractures on routine foot and ankle series are often difficult to detect, which can result in a delayed diagnosis. Early diagnosis and timely operative management allowed for a good short-term outcome.

Achieving Anatomic Acetabular Fracture Reduction-When is the Best Time to Operate?

Objectives: We hypothesize that earlier operative intervention for acetabular fractures improves the probability of achieving an anatomic reduction.

Design: Retrospective review.

Setting: Academic level I trauma center.