Bicondylar tibial plateau fracture dislocations with an intact anterolateral cortical rim: A surgical technique.

A displaced medial tibial plateau fracture with central and lateral impaction, but an intact anterolateral cortical rim, is an uncommon variant of bicondylar tibial plateau fracture that presents a number of challenges. Without a lateral metaphyseal fracture line to work through, it is challenging to address central and lateral impaction. Previously published techniques for addressing this fracture pattern describe an intra-articular osteotomy of the lateral plateau to aid visualization and reduction, or use a posterolateral approach to the proximal tibia with or without an osteotomy of the proximal fibula.

Complications of Morbid Obesity in the Treatment of Acetabular Fractures: Re-evaluating Outcomes a Decade Later.

Objectives: To determine the rate of perioperative complications between morbidly obese (body mass index greater than 40 kg/m2) and nonmorbidly obese patients undergoing operative treatment of acetabular fractures across 2 periods (2000-2005 and 2012-2019).

Design: Retrospective, case-control study.

Setting: Level I academic trauma center.

The Clamshell Osteotomy for Diaphyseal Malunion in Deformity Correction and Fracture Surgery.

Diaphyseal malunion poses a great challenge for the orthopedic surgeon, and an inundation of morbidity for the patient. Diaphyseal malunion can cause altered gait, adjacent joint osteoarthritis and body dissatisfaction. This problem is fraught with complications without surgical intervention.

Barriers to Increasing Diversity in Orthopaedics: The Residency Program Perspective.

Background: There are little data to explain why the surgical subspecialty of orthopaedic surgery struggles with improving the racial/ethnic composition of its workforce. The current work sought to determine what orthopaedic residency program directors and coordinators believe are the barriers to improving diversity at their own programs.

Methods: Between November 17, 2018, and April 1, 2019, a 17-question survey was electronically distributed to the program directors and coordinators of 155 allopathic orthopaedic surgery residency programs.

Contouring Plates in Fracture Surgery: Indications and Pitfalls.

Effective fracture surgery requires contouring orthopaedic implants in multiple planes. The amount of force required for contouring is dependent on the amount and type of material contained within the plane to be altered. The type of contouring used depends on the desired plate function; for example, buttress mode often requires some degree of undercontouring, whereas compression plating may require prebending.

What are the Risk Factors for Deep Infection in OTA/AO 43C Pilon Fractures?

Objectives: To determine the risk factors for deep infection in OTA/AO 43C pilon fractures.

Design: Retrospective, case-control study.

Setting: Single institution, Level 1 trauma center.

Treatment of Distal Femur Fractures With the DePuy-Synthes Variable Angle Locking Compression Plate.

Objectives: To determine the failure rate of the DePuy-Synthes variable angle locking compression curved condylar plate (VA-LCP) and quantify failure modes.

Design: Retrospective review.

Setting: Level I Trauma Center.

Risk Factors for Kidney Dysfunction With the Use of Gentamicin in Open Fracture Antibiotic Treatment.

Objectives: To evaluate all patients who received gentamicin for open fracture treatment and determine the incidence of, and risk factors for, kidney injury in this population.

Design: Retrospective, case control.

Setting: Single institution; Level 1 trauma center.

Intraoperative Evaluation of the Anatomic Lateral Distal Femoral Angle and Its Variation due to Positioning.

Background/purpose: Preoperative evaluation of the contralateral anatomic lateral distal femoral angle (aLDFA) at our institution is used to judge coronal plane alignment. In our study, we investigated 4 different techniques for obtaining an anteroposterior intraoperative fluoroscopic image of the distal femur to determine which technique provides (1) the greatest interobserver reliability; (2) the lowest variability from the previously published population mean; and (3) the lowest side-to-side variability.

Methods: Inclusion criteria included lower extremity injuries needing fixation that required intraoperative fluoroscopy with an intact femur and an intact extensor mechanism (N = 100).

Management of Pelvic and Acetabular Fractures in the Obese Patient.

Acetabular and pelvic ring injuries in obese patients are difficult to treat. Obese patients require great attention to detail during the trauma evaluation to prevent medical and anesthetic complications in the perioperative period. Radiographic evaluation is often compromised by modalities available and loss of resolution with plain film imaging.

Obesity in the Polytrauma Patient.

The rates of obesity continue to increase in the United States and the overall impact of obesity on health care spending and patient outcomes after trauma is considerable. The unique physiology of the obese places them at higher risk for complications, including infection, failure of fixation, nonunion, multiorgan failure, and death. These physiologic differences and overall patient size can make orthopedic care in obese patients with trauma more difficult, but appropriate initial resuscitation, careful preoperative planning, meticulous surgical technique, diligent postoperative medical management, and specialized rehabilitation give these patients their best opportunity for a good outcome.

Objective Methodology to Assess Meaningful Research Productivity by Orthopaedic Residency Departments: Validation Against Widely Distributed Ranking Metrics and Published Surrogates.

The mission of any academic orthopaedic training program can be divided into 3 general areas of focus: clinical care, academic performance, and research. Clinical care is evaluated on clinical volume, patient outcomes, patient satisfaction, and becoming increasingly focused on data-driven quality metrics. Academic performance of a department can be used to motivate individual surgeons, but objective measures are used to define a residency program.

Endosteal Substitution With an Intramedullary Rod in Fractures of the Femur.

Background: Morbid obesity and segmental fracture/bone loss are challenging problems in the treatment of fractures and nonunions of the distal femur. The use of an intramedullary rod as an endosteal substitute for a deficient medial cortex along with a lateral locked plate is 1-tool to combat these problems. This article describes the technique used and its results at a single Level 1 trauma center.

Intraosseous Plating for the Management of Cortical Defects.

The management of fractures with segmental bone loss or abundant comminution on the far cortex is often complicated by deformity or frank hardware failure. Using plate constructs that rely on off-axis loading may not be sufficient to support the limb until healing occurs. There are a number of techniques to mitigate this problem, notably the use of intramedullary nails and bicolumnar plating of the fracture.

Failure of Patellar Plating with Mini-Fragment Implants: A Case Report.

Case: A 40-year-old woman presented to the emergency department with a comminuted fracture of the patella with separation of the bone fragments. The patient underwent an open reduction and osteosynthesis using medial and lateral 2.0-mm nonlocking plates, which subsequently led to pain in the anterior and posterior aspects of the knee.

Stability of the Syndesmosis After Posterior Malleolar Fracture Fixation.

Background: We sought to define the rate of syndesmotic instability after anatomic reduction of the posterior malleolus when posterior stabilization of a trimalleolar or trimalleolar equivalent ankle fracture was chosen vs when a supine position and initially conservative management of the posterior elements was chosen.

Methods: The types of syndesmotic and posterior malleolar fixation used to treat adult patients with ankle fractures involving the posterior malleolus at our level I trauma center were retrospectively assessed (N = 198). Specifically, both bimalleolar and trimalleolar fractures were included.

Extent and Morbidity of Lateralization of a Trochanteric Fixation Nail Blade.

This study examined the incidence and risk factors associated with lateral helical blade migration and trochanteric pain with the trochanteric fixation nail. A retrospective review was performed of 141 cases of pertrochanteric femur fracture treated with a trochanteric fixation nail at a level I trauma center over a period of 42 months. Exclusion criteria included follow-up of less than 60 days, preexisting osteonecrosis of the femoral head, and prophylactic trochanteric fixation nail treatment.

Technical Considerations in the Treatment of Syndesmotic Injuries Associated With Ankle Fractures.

Malleolar ankle fractures associated with syndesmotic injuries are common. Diagnosis of the syndesmotic injury can be difficult and often requires intraoperative fluoroscopic stress testing. Accurate reduction and stable fixation of the syndesmosis are critical to maximize patient outcomes.

Modifier 22 for acetabular fractures in morbidly obese patients: does it affect reimbursement?

Background: Modifier 22 in the American Medical Association's Current Procedural Terminology (CPT®) book is a billing code for professional fees used to reflect an increased amount of skill, time, and work required to complete a procedure. There is little disagreement that using this code in the setting of surgery for acetabulum fractures in the obese patient is appropriate; however, to our knowledge, the degree to which payers value this additional level of complexity has not been determined.

Questions/purposes: We asked whether (1) the use of Modifier 22 increased reimbursements in morbidly obese patients and (2) there was any difference between private insurance and governmental payer sources in treatment of Modifier 22.

Skin dimpling after a closed proximal humerus fracture.

Background: Skin dimpling, also known as skin puckering, is a rare occurrence after closed proximal humerus fractures. This finding is suggestive of incarceration of the skin at the fracture site and may lead to necrosis and conversion to an open fracture.

Objectives: Our goal is to describe our experience with skin dimpling after a proximal humerus fracture to increase awareness and recognition of this clinical presentation in the Emergency Department (ED).

Is obesity protective against wound healing complications in pilon surgery? Soft tissue envelope and pilon fractures in the obese.

Open treatment of pilon fractures is associated with wound healing complications. A traumatized, limited soft tissue envelope contributes to wound healing complications. Obese patients have larger soft tissue envelopes around the ankle, theoretically providing a greater area for energy distribution and more accommodation to implants.

A novel way to prevent lost scalpel blades during percutaneous placement of iliosacral screws.

Percutaneously placed implants and reduction tools are now commonplace in orthopaedic traumatology. Significant strides toward reducing fractures and maintaining that reduction without additional harm to the soft tissue envelope have been realized. The majority of these percutaneous techniques begin with a simple "stab" incision through the skin into the deeper tissue planes beneath.

Complications of acetabular fracture surgery in morbidly obese patients.

Objectives: To compare the early complications with operative treatment of acetabular fractures in morbidly obese (body mass index >or=40) patients when compared with all other patients.

Design: Retrospective review.

Setting: University medical center.

Operative fixation of acetabular fractures in the pregnant patient.

Objective: To describe in utero radiation exposures in pregnant patients undergoing acetabular fracture repair.

Design: Retrospective case series.

Setting: University-affiliated regional trauma center.