External validation of a model using health administrative data to predict acetabular fracture probability: Brief report.

Analyses using population-based health administrative data can return erroneous results if case identification is inaccurate ("misclassification bias"). An acetabular fracture (AF) prediction model using administrative data decreased misclassification bias compared to identifying AFs using diagnostic codes. This study measured the accuracy of this AF prediction model in another hospital.

Operative vs Nonoperative Treatment of Acute Unstable Chest Wall Injuries: A Randomized Clinical Trial.

Importance: Unstable chest wall injuries have high rates of mortality and morbidity. In the last decade, multiple studies have reported improved outcomes with operative compared with nonoperative treatment. However, to date, an adequately powered, randomized clinical trial to support operative treatment has been lacking.

A Dedicated Orthopaedic Trauma Room Improves Efficiency While Remaining Financially Net Positive.

Objectives: To determine the impact of dedicated orthopaedic trauma room (DOTR) implementation on operating room efficiency and finances.

Design: Retrospective cost-analysis.

Setting: Single midsized academic-affiliated community hospital in Toronto, Canada.

Distal femoral replacement or internal fixation for management of periprosthetic distal femur fractures: A systematic review.

Background: The number of periprosthetic fractures above a total knee arthroplasty continues to increase. These fractures are associated with a high risk of morbidity and mortality. Techniques for addressing these fractures include open reduction internal fixation (ORIF) and revision arthroplasty, including distal femoral replacement (DFR).

Risk of Total Hip Arthroplasty After Acetabular Fracture Fixation: The Importance of Age.

Background: Geriatric patients are the most rapidly growing cohort of patients sustaining acetabular fractures (AFs). The purpose of this study was to examine the risk of a secondary total hip arthroplasty (THA) in older patients (>60 year old) with a prior AF open reduction internal fixation (ORIF) compared with younger patients (<60 year old) with an AF ORIF on a large population level.

Methods: Using administrative health care data from 1996 to 2010 inclusive of all 202 hospitals in Ontario, Canada, all adult patients with an AF ORIF and a minimum of two year follow-up were identified and included.

Endosteal substitution with medial plate in the treatment of acute distal femur fracture (AO/OTA type A): surgical technique and case-series.

Introduction: Distal Femur fractures account for 4- 6% of all femur fractures and can be challenging to treat. The aims of this study are: (1) to describe a surgical technique using a medial distal femur endosteal plate to augment the stability of standard lateral plate fixation; (2) to report the results of a case-series of acute distal femur fractures (AO/OTA Type A/ Vancouver periprosthetic fractures Type C) treated using this technique.

Methods: This study describes the surgical steps for placement of a medial endosteal plate in combination with lateral locking plate in a cadaver model using fluoroscopy guidance.

The Impact of an Open-Book Pelvic Ring Injury on Bone Strain: Validation of a Finite Element Model and Analysis Within the Gait Cycle.

The threshold for surgical stabilization for an open-book pelvic fracture is not well defined. The purpose of this research was to validate the biomechanical behavior of a specimen-specific pelvic finite element (FE) model with an open-book fracture with the biomechanical behavior of a cadaveric pelvis in double leg stance configuration under physiologic loading, and to utilize the validated model to compare open book versus intact strain patterns during gait. A cadaveric pelvis was experimentally tested under compressive loading in double leg stance, intact, and with a simulated open-book fracture.

Influence of pelvic shape on strain patterns: A computational analysis using finite element mesh morphing techniques.

The pelvis functions to transmit upper body loads to the lower limbs and is critical in human locomotion. Semi-automated, finite element (FE) morphing techniques eliminate the need for segmentation and have shown to accelerate the generation of multiple specimen-specific pelvic FE models to enable the study of pelvic mechanical behaviour. The purpose of this research was to produce simulated human pelvic FE models representing android, gynecoid, anthropoid and platypelloid morphologies and to isolate differences in strain patterns due to anatomic shape under physiologic loading.

Management of Lower Extremity Fractures in the Elderly: A Focus on Post-Operative Rehabilitation.

Fractures in the elderly population are increasing in incidence and represent a rising burden of disease. It is difficult for the elderly population to adhere to restricted weight bearing, and immobility poses significant risks and increased morbidity. Therefore, a primary goal of fracture management in the elderly population is early post-operative weight bearing.

Association between socioeconomic deprivation and surgical complications in adults undergoing ankle fracture fixation: a population-based analysis.

Background: Few studies have investigated the outcomes of surgical fracture care among socially deprived patients despite the increased incidence of fractures and the inequality of care received in this group. We evaluated whether socioeconomic deprivation affected the complications and subsequent management of marginalized/homeless patients following surgery for ankle fracture.

Methods: In this retrospective, population-based cohort study involving 202 hospitals in Ontario, Canada, we evaluated 45 444 patients who underwent open reduction and internal fixation (ORIF) for ankle fracture performed by 710 different surgeons between Jan.

Assessing Preoperative Mobility in Total Hip Arthroplasty: A SAFE T database study.

Unlabelled: This study examined whether individuals undergoing total hip arthroplasty who are self-rated as "highly active", demonstrated higher pre-operative activity levels than others.

Methods: 483 patients were retrospectively identified; 241 were "highly active" and 242 were not. They were compared using WOMAC, self-reported activity and 6-Minute Walk Test (6MWT).

Comparing Complications and Costs of Total Hip Arthroplasty and Hemiarthroplasty for Femoral Neck Fractures: A Propensity Score-Matched, Population-Based Study.

Background: Although the prevalence of displaced femoral neck fractures in the elderly population is increasing worldwide, there remains controversy as to whether these injuries should be managed with hemiarthroplasty or total hip arthroplasty. Although total hip arthroplasties result in better function, they are more expensive and may have higher complication rates. Our objective was to compare the complication rates and health-care costs between hemiarthroplasty and total hip arthroplasty for displaced femoral neck fractures in the elderly population.

A standard universal C-arm language: Assessing its need and its likelihood of acceptance.

Intraoperative fluoroscopy has facilitated improvements in surgical procedures across various subspecialties but has resulted in increased radiation exposure to the patient and surgeon. The results of a survey administered to 447 orthopedic surgeons and radiological technologists show that there is no standard universal c-arm language, that significant confusion and miscommunication exists between surgeons and technologists because of this, that unnecessary radiation exposure occurs as a direct consequence of this miscommunication, and that the vast majority of respondents would accept a standardized language similar to the one proposed in this study. This could potentially lead to less miscommunication and radiation exposure.

Medical Costs of Delayed Hip Fracture Surgery.

Background: Waiting for hip fracture surgery is associated with complications. The objective of this study was to determine whether waiting for hip fracture surgery is associated with health-care costs.

Methods: We conducted a population-based, propensity-matched cohort study of patients treated between 2009 and 2014 in Ontario, Canada.

The impact of thermal cycling on Staphylococcus aureus biofilm growth on stainless steel and titanium orthopaedic plates.

Background: Orthopaedic implant infections are difficult to eradicate because bacteria adhering to implant surfaces inhibit the ability of the immune system and antibiotics to combat these infections. Thermal cycling is a temperature modulation process that improves performance and longevity of materials through molecular structural reorientation, thereby increasing surface uniformity. Thermal cycling may change material surface properties that reduce the ability for bacteria to adhere to the surface of orthopaedic implants.

Reporting and evaluating wait times for urgent hip fracture surgery in Ontario, Canada.

Background: Although a delay of 24 hours for hip fracture repair is associated with medical complications and costs, it is unknown how long patients wait for surgery for hip fracture. We describe novel methods for measuring exact urgent and emergent surgical wait times (in hours) and the factors that influence them.

Methods: Adults aged 45 years and older who underwent surgery for hip fracture (the most common urgently performed procedure) in Ontario, Canada, between 2009 and 2014 were eligible.

Risk of Hip Arthroplasty After Open Reduction Internal Fixation of a Fracture of the Acetabulum: A Matched Cohort Study.

Objectives: To determine what proportion of operatively treated acetabular fracture patients proceeded to total hip arthroplasty (THA), over what time period, and quantify the influence of patient, provider, and surgical factors on rates of THA.

Design: Retrospective matched cohort prognostic study using administrative data.

Setting: This study used the large population database of Ontario (population 13,125,000 in 2010), Canada.

Open Reduction and Internal Fixation Versus Acute Arthroplasty for the Management of Common Extremity Injuries: Evidence-Based Decision Making.

A considerable burden of disease is associated with the management of periarticular fractures. Increasingly, evidence-based medicine is used to define the standard of clinical care. The role of internal fixation in the management of periarticular fractures, particularly in elderly patients, has been questioned.

Practice patterns in the care of acute Achilles tendon ruptures : is there an association with level I evidence?

Aims: To determine whether the findings from a landmark Canadian trial assessing the optimal management of acute rupture of the Achilles tendon influenced the practice patterns of orthopaedic surgeons in Ontario, Canada.

Materials And Methods: Health administrative databases were used to identify Ontario residents ≥ 18 years of age with an Achilles tendon rupture from April 2002 to March 2014. The rate of surgical repair (per 100 cases) was calculated for each calendar quarter.

Association of Overlapping Surgery With Increased Risk for Complications Following Hip Surgery: A Population-Based, Matched Cohort Study.

Importance: Overlapping surgery, also known as double-booking, refers to a controversial practice in which a single attending surgeon supervises 2 or more operations, in different operating rooms, at the same time.

Objective: To determine if overlapping surgery is associated with greater risk for complications following surgical treatment for hip fracture and arthritis.

Design, Setting, And Participants: This was a retrospective population-based cohort study in Ontario, Canada (population, 13.

Association Between Wait Time and 30-Day Mortality in Adults Undergoing Hip Fracture Surgery.

Importance: Although wait times for hip fracture surgery have been linked to mortality and are being used as quality-of-care indicators worldwide, controversy exists about the duration of the wait that leads to complications.

Objective: To use population-based wait-time data to identify the optimal time window in which to conduct hip fracture surgery before the risk of complications increases.

Design, Setting, And Participants: Population-based, retrospective cohort study of adults undergoing hip fracture surgery between April 1, 2009, and March 31, 2014, at 72 hospitals in Ontario, Canada.

Symptomatic palliation with radiotherapy in extensive heterotopic ossifications.

Heterotopic ossification (HTO) is the dystrophic formation of mature lamellar bone outside the confines of normal osseous tissues. It is frequently a complication which occurs following traumatic insult, both iatrogenic and non-iatrogenic, and neurological compromise. While mild degree of disease is often asymptomatic, significant pain and mobility limitations may result in reduced quality of life in advanced cases.

Discharge destination following hip fracture: comparative effectiveness and cost analyses.

Unlabelled: This study determines outcomes and costs of similar hip fracture patients that were discharged from hospital to a rehabilitation facility or to the community within 1 year. Community patients had worse outcomes and lower costs compared to rehabilitation facility patients. This study contributes to understanding hip fracture quality of care.