Comminuted Suprasyndesmotic Ankle Fractures are Associated with a High Rate of Anterolateral Plafond Involvement.

Objectives: This study aimed to identify the rate at which the anterolateral tibial plafond is affected in comminuted suprasyndesmotic ankle fractures (AO/OTA 44C2) and to assess how its involvement affects clinical outcomes.

Methods: Design: Retrospective review.

Setting: Level 1 Trauma Center.

Open Reduction and Orthogonal Tension Band Plating of an Isolated Periprosthetic Tibial Tubercle Fracture: A Case Report.

Case: A 67-year-old woman sustained a periprosthetic tibial tubercle avulsion fracture with extensor mechanism disruption. She underwent open reduction internal fixation (ORIF) with orthogonal mini-fragment plates applied in a tension band fashion with patellar tendon suture augmentation. Radiographs, range of motion, and patient-reported outcomes were completed over 1 year.

Tranexamic Acid Administered at Time of Hospital Admission Does Not Decrease Transfusion Rates or Blood Loss for Extracapsular Hip Fractures: A Double-Blinded Randomized Clinical Trial.

Objectives: To evaluate tranexamic acid (TXA) when administered immediately on hospital presentation in patients with extracapsular peritrochanteric hip fractures to determine its effect on (1) transfusion rates, (2) estimated blood loss, and (3) complications.

Design: Prospective, double-blinded, randomized clinical trial.

Setting: Single-center, Level 1 trauma center.

Assessing the Accuracy and Reliability of the Fluoroscopic Ruler for Comminuted Femur Fractures: A Cadaveric Study.

Background: Fixation of comminuted femur fractures may result in limb length discrepancy. Intraoperative fluoroscopic measurement of the contralateral femur with a ruler is commonly performed to establish a reference for femoral length. No evidence regarding the reliability and accuracy of this technique exists.

Salvage of failed subtrochanteric fracture fixation in the elderly: revision internal fixation or hip arthroplasty?

Purpose: This study aimed to compare reoperation rate and clinical outcomes between revision open reduction and internal fixation and hip arthroplasty following failed subtrochanteric fracture fixation.

Methods: A retrospective review was conducted of patients > 50 years old treated for failed fixation of subtrochanteric fractures with revision ORIF or hip arthroplasty from 2003 to 2023. Primary outcomes included rate of fracture union and reoperations after initial salvage therapy.

Can Large Language Models (LLMs) Predict the Appropriate Treatment of Acute Hip Fractures in Older Adults? Comparing Appropriate Use Criteria With Recommendations From ChatGPT.

Background: Acute hip fractures are a public health problem affecting primarily older adults. Chat Generative Pretrained Transformer may be useful in providing appropriate clinical recommendations for beneficial treatment.

Objective: To evaluate the accuracy of Chat Generative Pretrained Transformer (ChatGPT)-4.

Cannulated Screws or Hemiarthroplasty for Femoral Neck Fractures: Is There a Mortality Difference?

Objectives: To determine the difference in mortality and reoperation rate between femoral neck fractures (FNFx) treated with cannulated screw (CS) fixation or hemiarthroplasty (HA).

Design: Retrospective study.

Setting: Institutional registry data from a single Level I trauma center.

Impact of Intraoperative Femoral Fractures During Cemented Hemiarthroplasty for Femoral Neck Fractures.

Background: There have been several studies on intraoperative femoral fractures (IFFs) during primary total hip arthroplasty, but it is not well understood how this complication affects the patient population undergoing cemented hemiarthroplasty. This study aimed to analyze the impact of IFFs sustained during cemented hemiarthroplasty for the treatment of femoral neck fractures.

Methods: A retrospective review was conducted of all patients who were treated for Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association 31B fractures with cemented hemiarthroplasty between January 1, 2000 and December 31, 2021, at a single academic level 1 trauma center.

Approach to Tibial Shaft Nonunions: Diagnosis and Management.

The tibia is the most common long bone at risk for nonunion with an annual incidence ranging from 12% to 19%. This topic continues to be an area of research as management techniques constantly evolve. A foundational knowledge of the fundamental concepts, etiology, and risk factors for nonunions is crucial for success.

Closed Reduction Technique for Acetabular Fractures with Femoral Head Protrusion and Concomitant Superolateral Impaction: A Case Report.

Case: Closed reduction of acetabular fractures with femoral head protrusion and superolateral femoral head impaction may be challenging because the intact acetabular roof may block anatomic reduction with traditional maneuvers. We report the use of a 5-step technique for this unique pattern: medializing force to disengage the femoral head, axial traction to clear the intact ilium, lateralizing force to center the head underneath the acetabular roof, confirmation of femoral head stability, and skeletal traction placement.

Conclusion: Acetabular fractures with femoral head protrusion and concomitant superolateral impaction may be reduced with an initial medializing force followed by axial and lateralizing forces.

A coronoid-centric classification system of proximal trans-ulnar fracture-dislocations has almost perfect intraobserver and interobserver agreement.

Background: Fracture-dislocations of the elbow, particularly those that involve a fracture through the proximal ulna, are complex and can be difficult to manage. Moreover, current classification systems often cannot discriminate between Monteggia-variant injury patterns and trans-olecranon fracture-dislocations, particularly when the fracture involves the coronoid. The Mayo classification of proximal trans-ulnar fracture-dislocations categorizes these fractures into 3 types according to what the coronoid is still attached to: trans-olecranon fracture-dislocations (the coronoid is still attached to the ulnar metaphysis); Monteggia-variant fracture-dislocations (the coronoid is still attached to the olecranon); and ulnar basal coronoid fracture-dislocations (the coronoid is not attached to either the olecranon or the ulnar metaphysis).

Risk Factors for Secondary Revision After Finger Amputations.

Background: Digit amputations are relatively simple and are often performed in the setting of trauma or infection. However, it is not uncommon for digit amputations to undergo secondary revision due to complications or patient dissatisfaction. Identifying factors associated with secondary revision may alter treatment strategy.

Demographics and Characteristics of Orthopaedic Surgery Residency Program Directors: A Cross-sectional Review.

Unlabelled: To date, there has been a paucity of research evaluating the demographics, characteristics, and surgical training of orthopaedic residency program directors (PDs).

Purpose: To determine the objective characteristics of orthopaedic residency PDs by analyzing their demographic characteristics, academic backgrounds, institutional histories, research productivity, and professional leadership affiliations.

Methods: Data for each PD were collected by searching publicly available , LinkedIn, Healthgrades, Doximity, and/or institutional biographies and consolidated into a database.

Immediate Fixation of Acetabular Fractures Through an Anterior Approach Does Not Increase Morbidity or Mortality.

Introduction: Acetabular fractures requiring an anterior approach have historically been delayed, allowing a stable clot to form before creating large surgical exposures. The purpose of this study was to determine whether immediate fixation of acetabular fractures within 24 hours using an anterior approach demonstrates notable difference in blood loss, length of stay (LOS), complications, or mortality compared with acetabular fractures treated after 24 hours.

Methods: Ninety-three patients were optimized for surgery within 24 hours of injury.

Iliac Crest Allograft with Plate Osteosynthesis for a Bone-Patellar Tendon-Bone Anterior Cruciate Ligament Donor-Site Fracture: A Case Report.

Case: A 20-year-old man sustained a comminuted bone-patellar tendon-bone donor-site fracture 17 days after a contralateral anterior cruciate ligament revision reconstruction. Successful fixation was achieved by using a tricortical iliac crest allograft bone plug with mesh plate osteosynthesis. At 6 months of follow-up, the patient had full range of motion without pain.

Computed tomography provides effective detection of traumatic arthrotomy of the elbow.

Background: Failure to identify a traumatic arthrotomy of the elbow (TAE) can lead to septic arthritis with devastating complications. The gold standard for TAE detection remains controversial, and evidence is limited. While multiple clinical and cadaveric studies have validated the use of computed tomography (CT) to detect traumatic arthrotomies about the knee, other studies have called into question whether the use of CT to detect traumatic arthrotomy is applicable to the elbow.

Patella Fracture Fixation With Novel Wagon Wheel Construct Versus Tension-Band Construct: A Technical Trick.

Internal fixation of patella fractures remains technically challenging. Cannulated screws with an anterior tension band have been associated with high rates of implant prominence, and fracture comminution can make appropriate application of a tension band impractical. We present the results of a novel technique using a transtendinous/transligamentous mini-fragment plate positioned peripherally around the patella with radially directed screws: termed the wagon-wheel (WW) construct.

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).

Cephalomedullary Nailing of Unstable Geriatric Intertrochanteric Fractures on a Traction Table Combined With Percutaneous Reduction Techniques Is Safe and Results in a Low Rate of Cutout.

Objectives: To describe a reproducible technique for reduction assessment and percutaneous reduction of unstable intertrochanteric fractures treated with a cephalomedullary nail on a traction table.

Design: Retrospective cohort study.

Setting: Level-1 trauma center.

Type III Open Tibia Fractures Treated With Single-Stage Immediate Medullary Nailing and Attempted Primary Closure Yield Low Rates of Flap Coverage.

Objective: The purpose of this study was to determine whether type III open high-energy tibia fractures treated with immediate intramedullary nailing (IMN) and primary closure yield low rates of flap coverage.

Methods: Patients with high-energy type IIIA open tibia (OTA/AO42/43) fractures treated with IMN over a 10-year period at a level 1 academic center with at least 90 days of in-person postoperative follow-up were included. Single-stage reamed IMN with acute primary skin closure using Allgower-Donati suture technique was utilized in patients without notable skin loss.

Octogenarian and Nonagenarians Are at a Higher Risk for Experiencing Adverse 30-Day Outcomes Following ORIF of Ankle Fractures.

Introduction: Despite an increasing number of elderly individuals undergoing surgical fixation for ankle fractures, few studies have investigated peri-operative outcomes and safety of surgery in an octogenarian and nonagenarian population (age >80 years).

Materials And Methods: The 2012-2017 American College of Surgeons database was queried for patients undergoing open reduction internal fixation for isolated uni-malleolar, bi-malleolar and tri-malleolar ankle fractures. The study cohort was divided into 3 comparison groups (age <65 years, 65-75 and >80).

Management of a Broken PRECICE Femoral Nail at an Ununited Distraction Osteogenesis Site: A Case Report.

Case: A 20-year-old man with a history of right lower extremity fibular hemimelia previously treated with PRECICE femoral nail lengthening presented with a broken magnetic nail and a displaced fracture through an ununited distraction osteogenesis site. Using a combination of techniques, we removed the broken implant while maintaining the achieved limb length and preserving the native biology without bone grafting.

Conclusion: The unique challenges associated with the removal of a broken PRECICE femoral nail are described, with a technique for implant removal that preserves the achieved length, the innate biology of the distraction osteogenesis site, and promoting union without bone grafting.

Factors Influencing Surgeon's Choice of Procedure for Anterior Shoulder Instability: A Multicenter Prospective Cohort Study.

Purpose: To investigate preoperative factors associated with selection of surgical treatment for anterior shoulder instability.

Methods: Patient demographics, initial physical examinations, and patient-oriented outcome questionnaires were collected prospectively from 26 shoulder surgeons at 10 sites. Symptom duration, number of dislocations, sport, history of prior stabilization procedure, Hill-Sachs/glenoid bone loss, pain level, and failure of conservative treatment were recorded.