Iatrogenic Sciatic Nerve Injury in Posterior Acetabular Surgery: Surgeon More Predictive Than Position.

Objectives: To identify factors that contribute to iatrogenic sciatic nerve palsy during acetabular surgery through a Kocher-Langenbeck approach and to evaluate if variation among individual surgeons exists.

Design: Retrospective cohort.

Setting: Level I trauma center.

Femoral Head Fractures: Evaluation, Management, and Outcomes.

Fractures of the femoral head typically occur after high-energy trauma. Radiographs and cross-sectional imaging are used to appropriately classify and identify associated injuries or morphologic characteristics that may influence management. Identification of the radiographic and clinical hallmarks of an irreducible variant is critical to optimizing the patient's outcome.

Trimodal wireless intramuscular device detects muscle pressure, flow, and oxygenation changes in porcine model of lower extremity compartment syndrome.

Purpose: Compartment syndrome remains difficult to diagnose early in its clinical course. Pressure transducer catheters have been used to directly measure intracompartmental pressure (ICP), but this method is unreliable, with a false positive rate of 35%. We have previously used intramuscular near infrared spectroscopy to detect changes in tissue oxygen saturation (StO) in response to increasing ICP using a novel implantable probe.

Early Versus Delayed Definitive Fixation Relative to Fasciotomy Closure in High-Energy Tibial Plateau Fractures With Compartment Syndrome.

Objectives: To evaluate the timing of definitive fixation of tibial plateau fractures relative to fasciotomy closure with regard to alignment and articular reduction.

Design: Retrospective case series.

Setting: Four Level I trauma centers.

Effect of Computerized Tomography on Assessment and Surgical Planning for Olecranon Fractures.

Objectives: (1) Determine effects of computed tomography (CT) on reproducibility of olecranon fracture classification. (2) Determine effects of CT utilization on interobserver agreement regarding management of olecranon fractures. (3) Evaluate factors associated with articular impaction.

Comparison of clinical and radiographic outcomes of arthroscopic-assisted percutaneous fixation versus open reduction internal fixation of lateral tibial plateau fractures.

Purpose: Treatment for tibial plateau fractures continues to evolve but maintains primary objectives of anatomic reduction of the joint line and a rapid recovery course. Arthroscopic-assisted percutaneous fixation (AAPF) has been introduced as an alternative to traditional open reduction internal fixation (ORIF). The purpose of the study is to compare clinical and radiographic outcomes in patients with low-energy Schatzker type I-III tibial plateau fractures treated with AAPF versus ORIF.

The Effect of Social Deprivation on Fracture-Healing and Patient-Reported Outcomes Following Intramedullary Nailing of Tibial Shaft Fractures.

Background: Social deprivation is a state marked by limited access to resources due to poverty, discrimination, or other marginalizing factors. We investigated the links between social deprivation and orthopaedic trauma, including patient-reported outcomes, radiographic healing, and complication rates following intramedullary nailing of tibial shaft fractures.

Methods: We retrospectively reviewed 229 patients who underwent intramedullary nailing of tibial shaft fractures at our Level-I trauma center.

Radiographic Assessment of Ankle Fracture Displacement: A Validation Study.

Background: Ankle fracture displacement is an important outcome in clinical research examining the effectiveness of surgical and rehabilitation interventions. However, the assessment of displacement remains subjective without well-described or validated measurement methods. The aim of this study was to assess inter- and intrarater reliability of ankle fracture displacement radiographic measures and select measurement thresholds that differentiate displaced and acceptably reduced fractures.

Acute Dislocations of the Sternoclavicular Joint: A Review Article.

Acute dislocations of the sternoclavicular joint are uncommon injuries, and it is difficult for physicians to develop expertise in treating these injuries because of their infrequent nature. No level I evidence currently exists for these injuries, but several retrospective studies and surgical techniques have been described. For acute injuries, current recommendations include early treatment with closed reduction.

Tibia Antibiotic Intramedullary Nail.

This video depicts the materials and steps for creating an antibiotic cement spacer in the form of an intramedullary nail and demonstrates how to insert the nail into a tibia. The indication for this patient was a history of a type 3B open tibia fracture 6 months before treated with an intramedullary nail that subsequently developed an infected nonunion.

Application of Negative Pressure Wound Therapy.

The video depicts the materials and steps for applying negative pressure wound therapy. The clinical case involves a patient who had sustained a thigh Morel-Lavallee lesion that developed overlying skin necrosis and drainage that was treated with surgical debridement and the application of negative pressure wound therapy.

Factors influencing management of bilateral femur fractures: A multicenter retrospective cohort of early versus delayed definitive Fixation.

Introduction: The purpose of our study was to evaluate the factors that influence the timing of definitive fixation in the management of bilateral femoral shaft fractures and the outcomes for patients with these injuries.

Methods: Patients with bilateral femur fractures treated between 1998 to 2019 at ten level-1 trauma centers were retrospectively reviewed. Patients were grouped into early or delayed fixation, which was defined as definitive fixation of both femurs within or greater than 24 hours from injury, respectively.

The influence of arthroscopy on the classification and treatment of tibial plateau fractures.

Introduction: Arthroscopically-assisted reduction and percutaneous fixation of tibial plateau fractures is associated with fewer adverse events, better knee motion, and better Rasmussen functional scores compared to open reduction internal fixation in a number of non-randomized studies. The purpose of this study was to measure the influence of arthroscopy on the interobserver reliability in classification, treatment, and evaluation of intra-articular pathology and fracture reduction for fractures of the tibial plateau.

Methods: Surgeons were invited to participate in this online survey study.

Compartment Syndrome: Evaluation of Skeletal Muscle Ischemia and Physiologic Biomarkers in Controlled Conditions Within Ex Vivo Isolated Muscle Bundles.

Objectives: To identify potential physiologic markers of muscle ischemia to serve as diagnostic indicators of compartment syndrome. We hypothesize that muscle bundles in hypoxic conditions will elicit decreases in potential hydrogen (pH) and increases in lactate and potassium that correlates with decreased muscle twitch forces.

Methods: We performed an ex vivo evaluation of individual skeletal muscle bundles obtained from a swine's diaphragm that were exposed to hypoxic conditions and compared with control groups.

Patient Reported Outcomes: The Foundation of Value.

As we transition from volume-based to value-based health care, orthopedic surgeons must understand the role of outcomes in measuring value. Patient-reported outcomes (PROs) offer a number of advantages in orthopedic trauma compared with traditional clinical and radiographic results while also being an important indicator of the patient's perception of their condition. Patient-Reported Outcomes Measurement Information System, developed and funded by the National Institutes of Health, has a number of features that make PRO date collection less burdensome for providers and patients.