Pilon fractures: Consensus and controversy.

Pilon fractures are complex injuries that require an individualized approach to treatment to avoid complications and achieve good outcomes. Staged open reduction internal fixation remains the gold standard for most cases to achieve anatomic articular reduction while minimizing soft tissue complications and infection. Careful preoperative planning based on computed tomography dictates the surgical approach for reduction.

Suprapatellar Tibial Nailing: Future or Fad?

Over the last hundred years, there have been significant advancements in the way the Orthopaedic community treats tibial fractures. More recently, the focus of Orthopaedic trauma surgeons has been comparing the different techniques of insertion for tibial nails, specifically suprapatellar (SPTN) versus infrapatellar. The existing literature is convincing that there does not appear to be any clinically significant differences between suprapatellar and infrapatellar tibial nailing, with some apparent benefits of SPTN.

Implant-related complications in patients with opioid use disorder undergoing primary shoulder arthroplasties: a matched-controlled analysis.

Background: The purpose of this study was to investigate whether patients undergoing primary shoulder arthroplasty with opioid use disorder have higher rates of (1) implant-related complications; (2) in-hospital lengths of stay; (3) readmission rates; and (4) costs of care.

Methods: Opioid use disorder patients undergoing primary shoulder arthroplasty were queried and matched in a 1:5 ratio to controls by age, sex, and medical comorbidities within the Medicare database. The query yielded 25,489 patients with ( = 4253) and without ( = 21,236) opioid use disorder.

Comparison study of patient demographics and risk factors for infections following primary total hip arthroplasty for femoral neck fractures.

Introduction: While studies have shown favorable outcomes in the treatment of femoral neck fractures with the utilization of total hip arthroplasty (THA), adverse events, such as infections, can still occur. Therefore, the aims of this study were to 1) compare baseline demographics and 2) identify risk factors associated with developing either surgical site infections (SSIs) or peri-prosthetic joint infections (PJIs).

Materials And Methods: A retrospective analysis of patients who underwent primary THA for femoral neck fractures were queried from the Medicare database.

No difference between lag screw and helical blade for cephalomedullary nail cut-out a systematic review and meta-analysis.

Introduction: Cephalomedullary nail (CMN) cut-out is a severe complication of treatment of intertrochanteric femur fractures. This study aimed to identify modifiable risk factors predictive of implant cut-out including: CMN proximal fixation type (lag screw vs. helical blade), tip-apex distance (TAD), reduction quality, nail length, screw location, and surgeon fellowship training.

A matched-control study on the effects of depressive disorders following open reduction and internal fixation for acetabular fractures.

Introduction: The World Health Organization (WHO) postulates that depressive disorders (DD) will be the leading cause of morbidity and mortality by 2030. Studies evaluating the association of DD following open reduction and internal fixation (ORIF) for the treatment of acetabular fractures are limited. Therefore, the purpose of this matched-control study was to determine whether DD patients undergoing ORIF for acetabular fractures have higher rates of: (1) in-hospital lengths of stay (LOS); (2) readmissions; (3) medical complications; and (4) costs of care.

Comparison of Patient Demographics and Patient-Related Risk Factors for Infections After Primary Total Hip Arthroplasty for Acetabular Fractures.

Introduction: In the proper age group, there is evidence that total hip arthroplasty (THA) has superior outcomes for the treatment of acetabular fractures compared with open reduction and internal fixation. Studies comparing patient demographics and identifying risk factors for either surgical site infections (SSIs) or periprosthetic joint infections (PJIs) are limited. Therefore, the purpose of this study was to (1) compare baseline demographics of patients who did and did not develop infections and (2) identify risk factors associated with developing either SSIs or PJIs.

The Psychological Effects of Musculoskeletal Trauma.

Musculoskeletal injuries comprise a large percentage of hospital admissions for adults and often contribute to persistent daily pain as an illness; opioid dependence; disability; and complaints of increased depression, anxiety, and symptoms of post-traumatic stress disorder. The prevalence of depression and post-traumatic stress disorder after orthopaedic trauma has been found to be considerably greater than the general adult cohort. Soon after sustaining a fracture, psychological factors can predict pain and disability many months after injury, even after controlling for injury severity.

Novel Technique for Reduction of Ankle Valgus Malunion and Chronic Talus Subluxation during Hindfoot Nailing.

In recent years, there has been a significant increase in the incidence and severity of ankle fractures in the elderly. We present a case of an elderly patient with significant medical comorbidities and social issues who sustained an unstable ankle fracture that led to a severe malunion secondary to refusal for surgery and noncompliance with weight-bearing precautions. By choosing an intramedullary fixation method that can be inserted through a biologically advantageous surgical exposure, we can permit early mobilization, create a stable plantigrade foot for ambulation, and alleviate the expected noncompliance with weight-bearing precautions in this patient.

Effect of weekend admission on geriatric hip fractures.

Background: The care discrepancy for patients presenting to a hospital on the weekend relative to the work week is well documented. With respect to hip fractures, however, there is no consensus about the presence of a so-called "weekend effect". This study sought to determine the effects, if any, of weekend admission on care of geriatric hip fractures admitted to a large tertiary care hospital.

Impact of Pediatric Subspecialty Training on Perioperative Complications in Adolescent Idiopathic Scoliosis Surgery.

This was a retrospective study of data prospectively collected from 2012 to 2016 from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. The objective was to evaluate the effect of pediatric fellowship training on 30-day perioperative morbidity and mortality following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Several pathways exist in North America by which physicians acquire the clinical and technical skills to manage AIS surgically.

Complications and Readmissions After Total Hip Replacement in Octogenarians and Nonagenarians.

Introduction: As the US population ages, the need for total hip arthroplasty (THA) is predicted to increase by 174% by 2030. The purpose of our study was to examine the rate and risks of 30-day complications and unplanned readmission in patients over the age of 80 years old.

Materials And Methods: The National Surgical Quality Improvement Project database for the years 2008 to 2014 was queried for patients over the age of 80 undergoing THA.

Does Care at a Trauma Center Affect Geriatric Hip Fracture Patients?

Introduction: With respect to care setting, there are mixed results in the literature with respect to the role of trauma centers in management of isolated geriatric hip fractures. During a transition from a Level 3 to a Level 1 trauma center, significant protocol changes were implemented that sought to standardize and improve the care of hip fracture patients. The objective of this study was to determine the effects of this transition on the management, efficiency, morbidity, mortality, and discharge of geriatric hip fracture patients.

Patient outcomes for the Internal Joint Stabilizer of the Elbow (IJS-E).

Background: Recently, the Internal Joint Stabilizer of the Elbow (IJS-E) was developed as an internal dynamic fixator for use in the setting of traumatic elbow instability. This study reviews the patients who had an IJS-E placed at our institution. Specifically, postoperative complications, postoperative functional outcomes, and need for subsequent procedures were reviewed.

Isolated Distal Ulna Fracture With Distal Radioulnar Joint Dislocation: A Novel Fracture Pattern.

Galeazzi fractures composed of a middle to distal third radius fracture with dislocation and/or instability at the distal radioulnar joint (DRUJ) have been well described for decades. However, the inverse scenario has seldom if ever been described in the literature. We explore the case of a 25-year-old active patient who experienced a traumatic distal ulna fracture with dislocation of the DRUJ without a distal radius fracture.

Complications and Readmissions After Total Knee Replacement in Octogenarians and Nonagenarians.

Introduction: From 2000 to 2010, the cohort of patients aged 85 to 94 years had the fastest growth rate increasing in size by approximately 30%. The need for total knee arthroplasty (TKA) continues to increase with a larger percentage of patients older than 80 years requiring TKA. The purpose of our study was to examine the rate and risks of 30-day complications and unplanned readmission in patients older than 80 years.

Self-Reduction of Displaced Bucket-Handle Medial Meniscal Tear in a 71-Year-Old Patient: A Case Report.

Background: Bucket-handle meniscal tears are rare in geriatric patients. Displaced bucket-handle meniscal tears are usually treated operatively. Due to the rarity of these tears in elderly patients and conflicting evidence regarding the use of arthroscopy versus conservative treatment, it is valuable to report the clinical presentation, treatment, and outcome of these injuries in elderly patients.

Visiting Educational Scholarship Training Program at the University of Miami, Miller School of Medicine: A Global Opportunity to Learn.

The Visiting Educational Scholarship Training Program, started by the University of Miami's Division of Plastic and Reconstructive Surgery, was designed to uphold the institution's founding mission: the education of our future medical leaders as well as the promotion of health of our local, regional, national, and international communities. It offers the opportunity for international medical students and training physicians to be educated and get exposure to the field of plastic surgery in a United States training institution.