A Unique Mode of Failure in the Noncontact Bridging Periprosthetic Plating System.

Although lateral locking plates are often a preferred and successful fixation construct for the treatment of periprosthetic proximal and distal femur fractures, specific complications and modes of failure have been associated and well-described with their use. We present two cases of implant failure in the Non-Contact Bridge Periprosthetic Plating System (Zimmer Biomet) in which a nonlocked screw fretted through the annular seating of the plate. One case demonstrates failure in the setting of a proximal femur periprosthetic fracture, whereas the other demonstrates failure in the setting of a distal femur periprosthetic fracture.

Early Ambulation After Hip Fracture Surgery Is Associated With Decreased 30-Day Mortality.

Introduction: Hip fractures frequently present in complicated patients and are fraught with high morbidity and mortality rates. Postoperatively, delayed ambulation has been identified as a factor associated with increased mortality, although its magnitude has yet to be quantified. Therefore, this article aims to evaluate mortality after hip fracture surgery because it relates to early postoperative ambulation, taking into account preexisting comorbidity burden.

Immediate Weight-Bearing Protocol for the Determination of Ankle Stability in Patients With Isolated Distal Fibular Fractures.

Objective: To evaluate an alternative protocol for allowing immediate weight-bearing (WB) as tolerated in a functional walking boot in patients with a medial clear space (MCS) of less than 4 mm on nonstressed initial radiographs with subsequent WB radiographs at 1-week follow-up to determine if this can differentiate stable from unstable distal fibular fractures.

Design: Retrospective case series.

Setting: Level 1 trauma center.

Is It Safe to Prep the External Fixator In Situ During Second-Stage Pilon Surgical Treatment?

Objective: To evaluate the infection rate of our protocol of prepping the external fixator in situ during definitive second-stage pilon fracture open reduction internal fixation.

Design: Retrospective clinical investigation.

Setting: Academic Level 1 Trauma Center.

Suture Button Fixation Versus Syndesmotic Screws in Supination-External Rotation Type 4 Injuries: A Cost-Effectiveness Analysis.

Background: In stress-positive, unstable supination-external rotation type 4 (SER IV) ankle fractures, implant selection for syndesmotic fixation is a debated topic. Among the available syndesmotic fixation methods, the metallic screw and the suture button have been routinely compared in the literature. In addition to strength of fixation and ability to anatomically restore the syndesmosis, costs associated with implant use have recently been called into question.

Distal humerus atrophic nonunion in a child with osteogenesis imperfecta.

Unlabelled: Atrophic nonunion of the distal humerus in children with osteogenesis imperfecta is a vexing and disabling problem. Traditional treatments, including casting, intramedullary nailing, plating and bone grafting have not been universally successful. We report on a case of successful treatment of one atrophic nonunion of the distal humerus in ad 2 year 10 month old child with type III OI who had failed more traditional treatments.

A paradigm shift in the surgical reconstruction of extra-articular distal humeral fractures: single-column plating.

Objectives: The study aimed (1) to examine if there are equivalent results in terms of union, alignment and elbow functionally comparing single- to dual-column plating of AO/OTA 13A2 and A3 distal humeral fractures and (2) if there are more implant-related complications in patients managed with bicolumnar plating compared to single-column plate fixation.

Design: This was a multi-centred retrospective comparative study.

Setting: The study was conducted at two academic level 1 trauma centres.

Distal Humeral Fracture Fixation with an Extensor Mechanism-on Approach.

Introduction: Open treatment of extra-articular and intra-articular distal humeral fractures can be effectively accomplished through an extensor mechanism-on approach.

Step 1 Preoperative Planning: Assess all images for multiplane fracture lines involving the capitellum or trochlea.

Step 2 Operative Setup: Verify with fluoroscopy that the patient and arm positions allow for adequate imaging of the distal part of the humerus.

Outcomes following distal humeral fracture fixation with an extensor mechanism-on approach.

Background: Distal humeral fractures have traditionally been managed with surgical approaches that disrupt the extensor mechanism. We hypothesized that an extensor mechanism-on approach for operative fixation of distal humeral fractures with parallel or orthogonal plate constructs would allow excellent healing, a motion arc of the elbow exceeding 100°, and maintenance of extensor mechanism strength.

Methods: Distal humeral open reduction and internal fixation (ORIF) was performed with either orthogonal or parallel plate constructs in seventy-nine elbows.

Evaluation of popliteal artery injury risk with locked lateral plating of the tibial plateau.

Objectives: This study was undertaken to determine if there is increased likelihood of popliteal artery injury as one places a fixed-angle lateral proximal tibia locking plate with posterior plate lift off and or anterior plate translation from the ideal position.

Methods: A Synthes (Synthes USA, West Chester, PA) 3.5-mm and 4.

Functional outcomes of Denis zone III sacral fractures treated nonoperatively.

Objectives: The purpose of this study is to report the outcomes of nonoperative treatment in patients with Denis Zone III sacral fractures at a minimum of 2 years follow up.

Design: Retrospective review of prospectively collected data of a consecutive series of patients.

Setting: Level I trauma center.

Distal tibia nonunions.

Although tibia metaphyseal nonunion is rare, its treatment is often complex. The merits of related management techniques are discussed. These techniques include: intramedullary nailing, fine wire fixation, and blade plate reconstruction, which is the method preferred by the authors.

The radiographic acromiohumeral interval is affected by arm and radiographic beam position.

Objective: The objective was to determine whether arm and radiographic beam positional changes affect the acromiohumeral interval (AHI) in radiographs of healthy shoulders.

Materials And Methods: Controlling for participant's height and position as well as radiographic beam height and angle, from 30 right shoulders of right-handed males without shoulder problems four antero-posterior (AP) radiographic views each were obtained in defined positions. Three independent, blinded physicians measured the AHI to the nearest millimeter in 120 randomized radiographs.

Anterior plate supplementation increases ankle arthrodesis construct rigidity.

Background: The success of ankle arthrodesis for the treatment of post-traumatic ankle arthritis depends on achieving and maintaining rigid fixation of the prepared tibiotalar interface. The purpose of this study was to examine the biomechanical effect of anterior plate supplementation of a popular three-screw fusion construct.

Methods: Six fresh-frozen cadaver ankles were prepared and instrumented with three partially threaded screws compressing the tibiotalar interface.

Interobserver and intraobserver reliability of two classification systems for intra-articular calcaneal fractures.

Background: For a fracture classification to be useful it must provide prognostic significance, interobserver reliability, and intraobserver reproducibility. Most studies have found reliability and reproducibility to be poor for fracture classification schemes. The purpose of this study was to evaluate the interobserver and intraobserver reliability of the Sanders and Crosby-Fitzgibbons classification systems, two commonly used methods for classifying intra-articular calcaneal fractures.

The relationship of proximal locking screws to the axillary nerve during antegrade humeral nail insertion of four commercially available implants.

Objective: The purpose of this study was to determine the proximity of proximal interlocking mechanisms in 4 current antegrade humeral nails to the axillary nerve and its branches.

Design: Cadaveric study.

Setting: Anatomy laboratory.

Functional outcome after blade plate reconstruction of distal tibia metaphyseal nonunions: a study of 11 cases.

Objectives: To present the functional outcome of a cohort of 11 patients prospectively followed before and after blade plate reconstruction of a distal tibia metaphyseal nonunion.

Design: Prospective case series.

Setting: University hospital tertiary referral center.

Injury to the tarsometatarsal joint complex.

Tarsometatarsal joint complex fracture-dislocations may result from direct or indirect trauma. Direct injuries are usually the result of a crush and may involve associated compartment syndrome, significant soft-tissue injury, and open fracture-dislocation. Indirect injuries are often the result of an axial load to the plantarflexed foot.