Limb Rotation in Lower Extremity Fractures.

Fractures of the tibia and femur are common. Rotation of the limb can affect the outcome of the injury, both in the immediate term and the long term. Because plain radiographs are two dimensional, rotation is hard to assess radiographically.

The devastating effects of humeral nonunion on health-related quality of life.

Background: Humeral nonunion is estimated to occur at a rate of 1.1%-25% depending on the fracture location and pattern, mechanism of injury, patient compliance with the immobilization protocol and patient's nutritional status and medical comorbidities. Fracture nonunion can cause chronic pain and limited range of motion and may hinder normal function.

Trauma fellowship impact on trends and complications of operatively treated clavicle fractures in recently trained orthopedic surgeons.

Purpose: The purpose of this study was to evaluate whether fellowship training affected trends and complications of operative clavicle fracture treatment in newly trained orthopedic surgeons.

Methods: The American Board of Orthopedic Surgery (ABOS) database was utilized to identify cases of open treatment of clavicle fractures submitted by ABOS Part-II Board Certification candidates. From 2005 to 2017, 3148 candidates performed at least one open clavicle fracture treatment.

Efficacy of PRECICE Nail in Treatment of Adult Patients With Posttraumatic Femoral Leg Length Discrepancy.

Posttraumatic, limb length discrepancy in adults is a challenge to treat, and multiple treatment protocols over the years have shown varying levels of success and complications. Before the introduction of the PRECICE nail in 2011, our preferred method of limb lengthening used an Ilizarov or Taylor Spatial frame. To assess the PRECICE nail, we evaluated the accuracy and complications during treatment in a series of skeletally mature patients with posttraumatic femoral limb length discrepancy.

Utility of Common Biomarkers for Diagnosing Infection in Nonunion.

Objectives: To evaluate the diagnostic utility of leukocyte count (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) for distinguishing between septic and aseptic nonunions.

Design: A single-gate (cohort) design was used, using 1 set of eligibility criteria applied to a consecutive sample of nonunions.

Setting: Private quaternary referral center.

Treatment of Periprosthetic Nonunions of the Lower Extremity.

Multiple studies have reported nonunion rates of 3% to 17% following peri-prosthetic fractures. Determining management strategies based on the available literature is difficult because existing studies are small and involve heterogeneous treatments and multiple surgeons. The purpose of this study was to describe a consecutive series of patients who presented to the authors' clinic with a periprosthetic nonunion of the lower extremity and to report the methods used to achieve limb salvage and the associated complications.

Immediate Soft-Tissue Reconstruction for Chronic Infected Tibia Nonunions Treated with an Ilizarov Frame.

There are multiple options available for the management of large tibial defects. The Ilizarov frame is one of the most widely used techniques due to the physiological bone growth and the symmetrical distribution of axial forces permitting adequate bone distribution. However, disadvantages still remain including obtaining additional soft-tissue access for defect coverage.

Socio-demographic factors impact time to discharge following total knee arthroplasty.

Aim: To determine social, logistical and demographic factors that influence time to discharge in a short stay pathway (SSP) by following total knee arthroplasty (TKA).

Methods: The study included primary TKA's performed in a high-volume arthroplasty center from January 2016 through December 2016. Potential variables associated with increased hospital length of stay (LOS) were obtained from patient medical records.

Principles of Nonunion Management: State of the Art.

A substantial proportion of fractures can present with nonunion, and the management of nonunion continues to present a challenge for orthopaedic surgeons. A variety of biological, mechanical, patient, and injury factors can contribute to the occurrence of nonunion, and often the cause of nonunion may be multifactorial. Successful management often requires assessment and treatment of more than one of these factors.

High Rate of Union for Aseptic Distal Tibial Nonunions in Adults Treated With Slow Gradual Compression via Circular External Fixation.

Objective: To evaluate the healing rate of aseptic nonunions of the distal third of the tibia treated with Ilizarov slow gradual compression and deformity correction.

Design: Retrospective cohort study.

Setting: Tertiary referral center.

Subtubercle Osteotomy for Medial Compartment Osteoarthritis of the Knee Using Ilizarov Technique: Survival Analysis and Clinical Outcomes.

Background: High tibial osteotomy with acute correction and internal fixation can be used to correct malalignment and malorientation and reduce symptoms in patients with medial compartment osteoarthritis of the knee. To address the inadequacies of this technique, we performed a series of subtubercle tibial osteotomy (STO) procedures using circular ring fixation to correct knee varus malalignment and joint malorientation. The purpose of this study was to analyze the ability of this technique to delay subsequent knee arthroplasty and decrease symptoms.

Precise Measurement of the Outer Diameters of Antibiotic-Laden Cement Nails Produced by Various Sized Thoracostomy Catheter Molds.

Objectives: At our institution, custom-made antibiotic-laden cement nails (ACNs) fabricated during surgery using a thoracostomy catheter as a mold are commonly used to treat long-bone infection. As the outer diameter of the nails produced has not previously been described, we designed a study to measure the outer diameter of ACNs fashioned using commercially available and commonly utilized thoracostomy catheters of various sizes.

Methods: Six thoracostomy catheters from 2 different manufactures (Argyle PVC Thoracic Catheters; Covidien Ltd and Atrium PVC Thoracic Catheters; Atrium Medical Corporation), ranging from 20 French to 40 French, were utilized in this study.

Debilitating Effects of Femoral Nonunion on Health-Related Quality of Life.

Objective: The purpose of this study was to report the extent of the effects of femoral nonunion on health-related quality of life.

Design: Retrospective cohort.

Setting: Tertiary referral center.

The Biological Basis for Nonunions.

Fracture nonunion is a failure of the biological processes of fracture-healing. Critical cellular events in fracture-healing include the inflammatory response, differentiation and proliferation of progenitor cells, formation of fibrocartilage callus, angiogenesis and subsequent mineralization of the callus, vascular union (restoration of normal medullary circulation), and conversion of woven bone to lamellar bone. All critical events are closely regulated and coordinated by numerous cytokines and growth factors, which are expressed in complex spatial and temporal patterns throughout the repair process.

Treatment of Infected Forearm Nonunions With Large Complete Segmental Defects Using Bulk Allograft and Intramedullary Fixation.

Purpose: The purpose of this study is to report the results of a series of infected forearm nonunions treated from 1998 to 2012 using a staged reconstruction technique.

Methods: At a median of 42 months follow-up, 7 patients who had an average segmental defect of 4.9 cm (range, 2.

Addition of a Medial Locking Plate to an In Situ Lateral Locking Plate Results in Healing of Distal Femoral Nonunions.

Background: Nonunion of the distal femur after lateral plating is associated with axial malalignment, chronic pain, loss of ambulatory function, and decreased knee ROM. The addition of a medial locking plate with autogenous bone grafting can provide greater stability to allow bone healing and may be used to achieve union in these challenging cases.

Questions/purposes: We wished to determine (1) the proportion of patients who achieve radiographic signs of osseous union for distal femoral nonunions with an in situ lateral plate after treatment with addition of a medial locking plate and autogenous bone grafting, and (2) the frequency and types of complications associated with this treatment.

Management of Aseptic Tibial and Femoral Diaphyseal Nonunions Without Bony Defects.

An evidence-based description of aseptic tibial and femoral diaphyseal nonunions without segmental defects is based on a systematic search of MEDLINE. Aseptic nonunion of the femoral or tibial diaphysis without segmental defects and with an in situ nail, treated with reamed exchange nailing or augmentative plating and bone grafting, has consistently high union rates. Aseptic nonunion without segmental defects and with in situ plate and screw fixation is best managed with revision plate and screw fixation and autogenous bone graft.

Time Trade-Off as a Measure of Health-Related Quality of Life: Long Bone Nonunions Have a Devastating Impact.

Background: Long bone nonunions have an important impact on a patient's quality of life. The purpose of this study was to compare long bone nonunions with use of the Time Trade-Off direct measure to compute utility scores and to determine which nonunion anatomic location had the lowest health-related quality of life. The Time Trade-Off assesses the percentage of a patient's remaining life that the patient would be willing to trade for perfect health.

Results of a systematic approach to exchange nailing for the treatment of aseptic femoral nonunions.

Objectives: To evaluate the radiographic and clinical outcomes of a systematic approach to exchange nailing for the treatment of aseptic femoral nonunions previously treated with an intramedullary nail.

Design: Retrospective cohort.

Setting: Tertiary referral center.

Results of a systematic approach to exchange nailing for the treatment of aseptic tibial nonunions.

Objectives: The purpose of this study was to evaluate the effectiveness of a systematic approach to exchange nailing for the treatment of aseptic tibial nonunion.

Design: Retrospective cohort.

Setting: Tertiary referral center.

The devastating effects of tibial nonunion on health-related quality of life.

Background: Tibial nonunion is disabling, but to our knowledge no quantitative evaluation of its effect on health-related quality of life has been reported.

Methods: We evaluated 243 tibial shaft fracture nonunions in 237 consecutive patients (seventy-nine female [age, 49.4 ± 14.

Stakeholders in outcome measures: review from a clinical perspective.

Modern interest in patient-reported outcomes measures (PROMs) in orthopaedics dates back to the mid-1980s. While gradual growth of activity in this area has occurred over the past 25 years, the extent to which this research methodology is applied in clinical practice to improve patient care is unclear. WHERE ARE WE NOW?: Historically, clinical research in orthopaedics has focused on the technical success of treatment, and objective indicators such as mortality, morbidity, and complications.

Challenges in outcome measurement: clinical research perspective.

Comparative effectiveness research evaluates treatments as actually delivered in routine clinical practice, shifting research focus from efficacy and internal validity to effectiveness and external validity ("generalizability"). Such research requires accurate assessments of the numbers of patients treated and the completeness of their followup, their clinical outcomes, and the setting in which their care was delivered. Choosing measures and methods for clinical outcome research to produce meaningful information that may be used to improve patient care presents a number of challenges.

Percutaneous autologous bone marrow injection in the treatment of distal meta-diaphyseal tibial nonunions and delayed unions.

Objective: To report the outcomes of percutaneous autologous bone marrow injection for nonunion or delayed union of the distal tibial metaphysis in patients with prior plating.

Design: Consecutive case series.

Setting: Tertiary center.