Use of single agent Cefotetan for Gustilo-Anderson type III open fracture prophylaxis.

Introduction: The prophylactic intravenous antibiotic regimen for Gustilo-Anderson Type III open fractures traditionally consists of cefazolin with an aminoglycoside plus penicillin for gross contamination. Cefotetan, a second-generation cephalosporin, offers a wide spectrum of activity against both aerobes and anaerobes as well as against Gram-positive and Gram-negative bacteria. Cefotetan has not been previously established within orthopedic surgery as a prophylactic intravenous agent.

Increased risk of hip fracture mortality associated with intraoperative hypotension in elderly hip fracture patients is related to under resuscitation.

Background: As the US and world population ages, hip fractures are increasingly more common. The mortality associated with these fractures remains high both in the immediate postoperative period and at one year. Perioperative resuscitation in this population is of key interest to prevent organ injury and mortality.

Cyclic Damage Accumulation in the Femoral Constructs Made With Cephalomedullary Nails.

The purpose of this study was to evaluate the risk of peri-prosthetic fracture of constructs made with cephalomedullary (CM) long and short nails. The nails were made with titanium alloy (Ti-6Al-4V) and stainless steel (SS 316L). Biomechanical evaluation of CM nail constructs was carried out with regard to post-primary healing to determine the risk of peri-implant/peri-prosthetic fractures.

Variability of orthopedic physician fracture location identification: Implications for bone stimulator treatment.

Introduction: Aseptic non-union is a significant complication in approximately 5% of long-bone fractures. External bone stimulation treatment is often attempted before more invasive surgical interventions. Bone stimulators can have favorable results, but have a limited 1.

The Role of Far Cortical Endosteal Fixation for the Treatment of Medial Malleolus Fractures: A Biomechanical Study.

The traditional method for fixation of medial malleolus fractures has been with partially threaded (PT) lag screws extending beyond the physeal scar. The purpose of this study was to evaluate the biomechanical strength of an innovative method of fixation for medial malleolus fractures using a fully threaded (FT) lag screw that extends to the far endosteal cortex. Medial malleolus fractures were simulated in 12 matched cadaver pairs.

A biomechanical cadaver comparison of suture button fixation to plate fixation for pubic symphysis diastasis.

Objectives: To determine whether suture button fixation of the pubic symphysis is biomechanically similar to plate fixation in the treatment of partially stable pelvic ring injuries.

Methods: Twelve pelvis specimens were harvested from fresh frozen cadavers. Dual-x-ray-absorptiometry (DXA) scans were obtained for all specimens.

Gun barrel view of the anterior pelvic ring for percutaneous anterior column or superior pubic ramus screw placement.

Background: Traditionally, operative fixation of pelvic and acetabular injuries involves complex approaches and significant complications. Accelerated rehabilitation, decreased soft tissue stripping and decreased wound complications are several benefits driving a recent interest in percutaneous fixation. We describe a new fluoroscopic view to guide the placement of screws within the anterior pelvic ring.

Epidemiology of Fracture Nonunion in 18 Human Bones.

Importance: Failure of bone fracture healing occurs in 5% to 10% of all patients. Nonunion risk is associated with the severity of injury and with the surgical treatment technique, yet progression to nonunion is not fully explained by these risk factors.

Objective: To test a hypothesis that fracture characteristics and patient-related risk factors assessable by the clinician at patient presentation can indicate the probability of fracture nonunion.

Adherence to Preoperative Cardiac Clearance Guidelines in Hip Fracture Patients.

Objectives: To identify if preoperative cardiac consultations are made in accordance with the American College of Cardiology (ACC) Foundation and American Heart Association (AHA) guidelines and the delays in care after unnecessary consults.

Design: Retrospective review.

Setting: Level 1 trauma center.

Scapula fractures: interobserver reliability of classification and treatment.

Objectives: There is substantial variation in the classification and management of scapula fractures. The first purpose of this study was to analyze the interobserver reliability of the OTA/AO classification and the New International Classification for Scapula Fractures. The second purpose was to assess the proportion of agreement among orthopaedic surgeons on operative or nonoperative treatment.

Timing of C-arm drape contamination.

Background: Surgical site infection remains a concern in orthopedic surgery, and contamination of C-arm covers is a potentially modifiable risk factor.

Methods: A single-cohort study was conducted using 30 consecutive patients undergoing operative fracture fixation. Cultures were obtained from the C-arm cover after initial draping and every 20 min thereafter.

The protective effect of locking screw placement on nonlocking screw extraction torque in an osteoporotic supracondylar femur fracture model.

Objective: To examine the impact of number and position of locking screws in the diaphyseal portion of an osteoporotic distal femoral fracture model with hybrid fixation.

Methods: Four groups containing 5 osteoporotic bone models were used with varying combinations of diaphyseal screw fixation: 4 nonlocking screws (control); 1 locking screw adjacent to the osteotomy and 3 nonlocking screws; 1 locking screw in the most proximal screw hole of the plate and 3 nonlocking screws; and 2 locking screws at opposite ends of the diaphyseal fixation with 2 nonlocking screws in between. Fixation in the distal articular segment was identical in all constructs.

Repeated freeze-thaw cycles do not alter the biomechanical properties of fibular allograft bone.

Background: Allograft tissues can undergo several freeze-thaw cycles between donor tissue recovery and final use by surgeons. However, there are currently no standards indicating the number of reasonable freeze-thaw cycles for allograft bone and it is unclear how much a graft may be degraded with multiple cycles.

Questions/purposes: We therefore asked whether (1) the mechanical properties of fibular allograft bone would remain unchanged with increasing numbers of freeze-thaw cycles and (2) histologic alterations from increased numbers of freeze-thaw cycles would correspond to any mechanical changes.

Mechanical evaluation of fourth-generation composite femur hybrid locking plate constructs.

Locking compression plates are routinely used for open reduction and internal fixation of fractures. Such plates allow for locking or non-locking screw placement in each hole. A combined use of both types of screw application for stabilization of a fracture is commonly applied and referred to as hybrid internal fixation.

The effects of magnetic resonance imaging on surgical staples: an experimental analysis.

Background: Surgical staples are commonplace in repairing surgical incisions. Staples allow for expeditious closure and removal compared with suture materials. However, there are clinical concerns when obtaining a magnetic resonance imaging (MRI) scan with staples present.

Biomechanical comparison of a proximal humeral locking plate using two methods of head fixation.

Hypothesis: Locking plates have emerged as the implant of choice for stabilization of proximal humeral fractures. The biomechanical properties of a locked plating system using smooth pegs vs threaded screws for fixation of the humeral head were compared to test the hypothesis that there would be no biomechanical difference between pegs and threaded screws.

Materials And Methods: Sixteen pairs of fresh frozen cadaveric humeri were randomized to have a surgical neck gap osteotomy stabilized with a locked plate using threaded screws (n=8) or smooth pegs (n=8).

Use of the Reamer-Irrigator-Aspirator for bone graft harvest: a mechanical comparison of three starting points in cadaveric femurs.

Objectives: The mechanical behavior of cadaveric femurs after intramedullary reaming using the Reamer-Irrigator-Aspirator (RIA) for autogenous bone graft harvest has not been fully described. We hypothesized that reamed femurs, regardless of starting point, would adequately withstand cyclic loading simulating postoperative single-leg stance.

Methods: Twenty-one cadaveric pairs were randomly assigned to one of three groups based on starting point: Group 1 (trochanteric), Group 2 (piriformis fossa), and Group 3 (retrograde).

Overview of the locking compression plate and its clinical applications in fracture healing.

Open reduction and internal fixation of fractures involves the use of metallic implants to support bone reduction. This procedure is often used in situations in which adequate alignment and stability of the bone cannot be achieved using nonsurgical methods such as casting. The locking compression plate is a contemporary implant that allows for both conventional screw placement (using nonlocking screws) and locking screw placement (where screw heads lock into the plate at a predetermined angle).

Bladder incarceration following anterior external fixation of a traumatic pubic symphysis diastasis treated with immediate open reduction and internal fixation.

Anterior pelvic ring disruptions are often associated with injuries to the genitourinary structures with the potential for considerable resultant morbidity. Herniation of the bladder into the symphyseal region after injury with subsequent entrapment upon reduction of the symphyseal diastasis has seldom been reported in the literature. We report such a case involving bladder herniation and subsequent entrapment after attempted closed reduction with anterior pelvic external fixation immediately treated with open reduction and internal fixation along with a review of the literature.

An alternative direction for proximal locking in retrograde femoral nails.

Lateral-to-medial proximal interlocking screw insertion for retrograde femoral nails avoids potential neurovascular injury while maintaining stable interlocking mechanics.

Time-dependent contamination of opened sterile operating-room trays.

Background: There are no clear guidelines for how long a sterile operating-room tray can be exposed to the open environment before the contamination risk becomes unacceptable. The purpose of this study was to determine the time until first contamination and the rate of time-dependent contamination of sterile trays that had been opened in a controlled operating-room environment. We also examined the effect of operating-room traffic on the contamination rate.

Safe zone for anterior cortical perforation of the ulna during tension-band wire fixation: a magnetic resonance imaging analysis.

Placing K-wires obliquely through the anterior ulnar cortex is a common modification of traditional olecranon tension-band wiring. Wire tip protrusion, however, risks injury to adjacent neurovascular structures and may impede forearm rotation. This study examines the proximity of neurovascular structures to the anterior proximal ulnar cortex.