Discrimination, reliability, sensitivity, and specificity of metric-based assessment of an unstable pertrochanteric 31A2 intramedullary nailing procedure performed by experienced and novice surgeons.

Introduction: Identifying objective performance metrics for surgical training in orthopedic surgery is imperative for effective training and patient safety. The objective of this study was to determine if an internationally agreed, metric-based objective assessment of video recordings of an unstable pertrochanteric 31A2 intramedullary nailing procedure distinguished between the performance of experienced and novice orthopedic surgeons.

Materials And Methods: Previously agreed procedure metrics (i.

The Prevalence of Metabolic and Endocrine Disturbances on Fracture Nonunion.

Objective: This study aims to determine the prevalence of metabolic disturbance in all fracture nonunion cases and identify the most common endocrine abnormalities seen using a simple screening algorithm.

Methods: A retrospective review study was performed evaluating patients who underwent operative intervention for nonunion from January 2010 to December 2018 at 2 level-1 trauma centers. Preoperative laboratory values were recorded for a 9-test "nonunion panel.

Biomechanics of Osteoporotic Fracture Care: Advances in Locking Plate and Intramedullary Nail Technology.

Osteoporotic fractures are extremely common and will continue to increase. Methods of internal fixation must address challenges presented by architectural changes of weakened bone. The goals of surgery are to provide mechanically stable internal fixation with minimal biologic insult that provides rapid rehabilitation and early mobilization.

Tibial Shaft and Pilon Fractures With Associated Syndesmotic Injury: A Matched Cohort Assessment.

Objective: To determine the outcomes of pilon and tibial shaft fractures with syndesmotic injuries compared with similar fractures without syndesmotic injury.

Design: Retrospective case-control study.

Setting: Level 1 trauma center.

Indications for cement augmentation in fixation of geriatric intertrochanteric femur fractures: a systematic review of evidence.

Introduction: Achieving durable mechanical stability in geriatric intertrochanteric proximal femur fractures remains a challenge. Concomitant poor bone quality, unstable fracture patterns, and suboptimal reduction are additional risk factors for early mechanical failure. Cement augmentation of the proximal locking screw or blade is one proposed method to augment implant anchorage.

Treating the Orthopaedic Trauma Knowledge Gap: Quantification of Orthopaedic Resident Knowledge Gaps and Validation of a Multimodal Course to Address the Deficiencies.

Objectives: To determine whether knowledge-based deficiencies are adequately addressed at the AO North America Basic Principles of Fracture Management course.

Design: Pretest, posttest.

Setting: Eighteen national trauma courses.

AO international consensus panel for metrics on a closed reduction and fixation of a 31A2 pertrochanteric fracture.

Background: The foundations of an effective and evidence-based training program are the metrics, which characterize optimal performance.

Purposes: To develop, operationally define, and seek consensus from procedure experts on the metrics that best characterize a reference approach to the performance of a closed reduction and internal fixation of a 31A2 unstable pertrochanteric fracture with a cephalomedullary nail with distal locking through the proximal guide.

Methods: A Metrics Group consisting of 3 senior orthopaedic surgeons, a surgeon/medical scientist, an education expert and a behavioural scientist deconstructed the performance of the selected fixation procedure and defined performance metrics.

Resident Selection Beyond the United States Medical Licensing Examination.

The resident application process has matured over the decades to become an efficient system. An unforeseen consequence of this efficiency is the massive number of applications that each orthopaedic surgery residency program must sort through to arrive at a manageable rank list. The most widely used filter in today's application cycle is an applicant's performance on the United States Medical Licensing Examination Step 1.

The value of preoperative planning.

"Better to throw your disasters into the waste paper basket than to consign your patients to the scrap heap" has been a proverb of Jeff Mast, one of the greatest fracture and deformity surgeons in the history of our specialty. Stated slightly more scientifically, one of the major values of simulation is that it allows one to make mistakes in a consequence-free environment. Preoperative planning is the focus of this article.

Iliosacral screw placement: are uniplanar changes realistic based on standard fluoroscopic imaging?

Background: With the aim of improving the understanding of iliosacral screw placement, two hypotheses were tested: (1) standard intraoperative inlet and outlet images are not based on orthogonal coordinates, and (2) therefore making starting point and aim changes by moving perpendicular to the c-arm beam will displace the guide wire on the other intraoperative radiographic view.

Methods: This is a prospective case series with review of intraoperative data from consecutive patients treated at a University Level I trauma center. The study group included ten consecutive patients with nondysmorphic upper sacral segments and unstable posterior pelvic ring injuries that required surgical treatment.

Acetabular fracture reductions in the obese patient.

Objectives: To evaluate the radiographic and computed tomographic reduction qualities after acetabular fracture repair in obese and nonobese patients.

Design: Retrospective review.

Setting: University medical center.

Lateral ankle radiographs: do we really understand what we are seeing?

Objectives: To evaluate the validity of using lateral intraoperative fluoroscopic imaging to assess the reduction of the tibial plafond articular surface, two hypotheses were tested: 1) the distal tibial subchondral shadow on the lateral ankle radiograph is created equally by the medial, central, and lateral portions of the distal tibia; and (2) displacement of a 5-mm width osteochondral fragment is consistently recognizable on lateral fluoroscopic imaging.

Methods: Six human fresh-frozen tibial plafond cadaveric specimens were sagitally sectioned in 5-mm increments after removal of the anterior soft tissue and stabilization of the position of the ankle through external fixation. To test the first hypothesis, a perfect lateral radiograph was taken after sectioning the specimens.

Periarticular tibial fracture treatment in the obese population.

Lambotte's 7 steps of fracture treatment have stood the test of time. Incision, preparation of the bone ends, reduction, temporary fixation, permanent fixation, closure, and dressing are modified to suit the needs of each fracture and each patient. One specific patient characteristic, obesity, has provided complex challenges in fracture care.

Radiographic quantification and analysis of dysmorphic upper sacral osseous anatomy and associated iliosacral screw insertions.

Objective: To quantify upper sacral dysmorphic osseous anatomy and assess its impact on second sacral segment iliosacral screw insertion.

Design: Retrospective evaluation of a prospective trauma database.

Setting: Regional Level I trauma center.

The clamshell osteotomy: a new technique to correct complex diaphyseal malunions: surgical technique.

Background: The treatment of complex diaphyseal malunions is challenging, requiring extensive preoperative planning and precise operative technique. We have developed a simpler method to treat some of these deformities.

Methods: Ten patients with complex diaphyseal malunions (including four femoral and six tibial malunions) underwent a clamshell osteotomy.

The clamshell osteotomy: a new technique to correct complex diaphyseal malunions.

Background: The treatment of complex diaphyseal malunions is challenging, requiring extensive preoperative planning and precise operative technique. We have developed a simpler method to treat some of these deformities.

Methods: Ten patients with complex diaphyseal malunions (including four femoral and six tibial malunions) underwent a clamshell osteotomy.

Femoroacetabular impingement: do outcomes reliably improve with surgical dislocations?

Femoroacetabular impingement is a motion-based concept of conflict that occurs secondary to morphologic abnormalities of the proximal femur and/or acetabulum. Creating impingement-free motion through restoration of normal morphology serves as the goal of joint-preserving procedures. We retrospectively reviewed the short-term functional and radiographic outcomes of 46 patients (48 hips) with femoroacetabular impingement treated with a surgical dislocation and restoration of offset.

Operative experience of pelvic fractures in the obese.

Background: Disruptions of the pelvic ring may be a significant short- or long-term source of morbidity and mortality. In the obese, temporary stabilization and definitive fixation of the injured pelvis is a much more difficult undertaking, requiring more surgeon expertise and larger surgical approaches. Complications that arise as a result of the operative fixation of pelvic ring injuries may significantly minimize any potential long-term benefits conferred by attempts at fixation.

Acetabular fracture patterns and their associated injuries.

Objectives: Characterize relationships between acetabular fractures patterns and visceral organ injuries.

Design: Retrospective review.

Setting: : University medical center.

Targeted sustained delivery of tobramycin at the site of a femoral osteotomy.

Complex fractures are difficult to manage because of the increased risk of secondary infection. Traditional treatments include debridment and local administration of antibiotics. Local antibiotic therapy is a safe technique resulting in high local concentration of antibiotics with minimal systemic levels.

Screening for extermity arterial injury with the arterial pressure index.

Certain extremity injuries presenting to the ED or Trauma Unit warrant increased suspicion for underlying arterial trauma. Such injuries include knee dislocations, displaced medial tibial plateau fractures and other displaced bicondylar fractures around the knee, open or segmental distal femoral shaft fractures, floating joints, gunshot wounds in proximity to neurovascular structures, or mangled extremities. Once the diagnosis of arterial trauma is made, a multi-disciplinary approach is warranted.

Supracondylar femur nonunion associated with previous vascular repair: importance of vascular exam in preoperative planning of nonunion repair.

One case of a Gustilo type 3C open OTA 33A-1 supracondylar femur fracture with superficial femoral artery injury that underwent reverse saphenous vein graft repair and open reduction and internal fixation with a retrograde femoral nail is reviewed. The fracture progressed to a hypertrophic nonunion despite 2 bone-grafting procedures and a nail dynamization. Upon referral for revision of the nonunion, a vascular examination revealed a well-perfused extremity with slightly diminished pedal pulses.