Short-term clinical outcomes of subway-related amputations.

Introduction: In city hospitals, subway-related traumatic amputations are a frequent pattern of injury, however there is a paucity of literature on this specific injury pattern. The purpose of this study was to describe the epidemiology of subway-related traumatic amputations, as well as compare them to non-subway traumatic amputations.

Patients And Methods: Retrospective review was performed at a single Level-1 trauma center in a metropolitan area.

An Eponymous History of Hemostatic, Tissue, and Reduction Clamps in Orthopedic Surgery.

Eponyms are widely used in the field of orthopedic surgery, including for surgical instruments. Although their use is at times controversial, an appreciation of the history behind eponymous terms allows one to both recognize the shortcomings of the past and simultaneously be inspired by ingenious inventors. The primary purpose of this review is to provide a historical perspective of clamps and forceps commonly used in orthopedic surgery, to better appreciate the evolution of their use over time, and to inspire innovation to constantly improve upon surgical instrumentation as the field of orthopedic surgery advances.

Quadriceps muscle quality and quantity following tibial plateau fracture repair.

Purpose: To investigate the qualitative and quantitative changes seen in quadriceps muscles [QM] following tibial plateau fracture and surgery.

Methods: A consecutive series of patients with an isolated tibial plateau fracture presenting to a single academic center were enrolled and prospectively followed. Bilateral knee MRIs were performed preoperatively and 3 and 12 months postoperatively to assess quantity and quality of the quadriceps muscles.

Risk factors for delayed return to work following tibial shaft fracture surgery.

Purpose: To determine when patients return to work following operative repair of tibial shaft fractures (TSF) and what risk factors are associated with a delayed return to work (RTW), defined as greater than 180 days after operative repair.

Methods: Retrospective chart review was performed on a consecutive series of TSF patients who underwent operative repair. Time to RTW was based on documented work-clearance communications from the operating surgeon.

Pneumothorax After Superior Plating of Clavicle Fractures: Are the Concerns Warranted?

Purpose: The primary goal of this study was to determine the anatomic relationship between the clavicle and the apical lung segment. The secondary goal was to determine the incidence of pneumothorax (PTX) in patients who underwent clavicle ORIF to analyze the utility of postoperative chest radiographs.

Methods: Six hundred thirty-one patients with a midshaft clavicle fracture who underwent superior plating at a single institution were identified.

Infected humeral shaft nonunion treatment with the induced membrane technique and a novel fixation construct: a case report.

Case: A 51-year-old woman with an infected left humeral shaft recalcitrant nonunion presented 3 years after initial injury. This case report focuses on the staged treatment of a 17-centimeter (cm) humeral shaft nonunion with the induced membrane technique (IMT) using a unique fixation construct of dual locked plating around a humeral nail to provide long-lasting fixation and allow for bone graft consolidation.

Conclusion: Large segmental bone loss of the humerus can be treated with the IMT using nail-plate fixation constructs that allow for early mobilization, increased time for bone graft consolidation before hardware failure, and less frequent follow-up.

Eponyms for the Description and Classification of Calcaneus Fractures.

There are several eponyms used in the assessment and management of calcaneus fractures. However, the origin of these eponyms is no longer widely known. Named for orthopaedic surgeons who made substantial contributions to the management of calcaneus fractures as well as the field of orthopaedic surgery, understanding the context of how these descriptors were derived helps give context to their use in the present day.

A Good Tip-Apex Distance Does Not Make Up For a Poor Reduction in Intertrochanteric Hip Fractures Treated with an Cephalomedullary Nail: The Utility of the Neck-Shaft Angle in Preventing Fixation Failure.

Purpose: Determine if any fracture characteristics or radiographic parameters were predictive of fixation failure [FF] within 1 year following cephalomedullary nailing for intertrochanteric fractures.

Methods: A consecutive series of intertrochanteric hip fracture patients (AO/OTA 31A) treated with a cephalomedullary nail were reviewed. Pre-fixation (neck-shaft angle [NSA], distance from ischial tuberosities to greater and lesser trochanters, integrity of lesser trochanter, and fracture angulation) and post-fixation (post-fixation NSA, posteromedial cortex continuity, lag screw position, tip to apex distance [TAD], and post-fixation angulation and translation) radiographic parameters were measured by blinded independent reviewers.

Cut-Through versus Cut-Out: No Easy Way to Predict How Single Lag Screw Design Cephalomedullary Nails Used for Intertrochanteric Hip Fractures Will Fail?

Purpose: This study aims to compare patients in whom fixation failure occurred via cut-out (CO) or cut-through (CT) in order to determine patient factors and radiographic parameters that may be predictive of each mechanism.

Materials And Methods: This retrospective cohort study includes 18 patients with intertrochanteric (IT) hip fractures (AO/OTA classification 31A1.3) who underwent treatment using a single lag screw design intramedullary nail in whom fixation failure occurred within one year.

Angiotensin Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors Have No Significant Relationship With Postoperative Arthrofibrosis After Shoulder Arthroscopy.

Purpose: To determine the effect of perioperative angiotensin II receptor blocker (ARB) or angiotensin-converting enzyme inhibitors (ACEi) on postoperative arthrofibrosis, as defined by requiring manipulation under anesthesia (MUA) or new diagnosis of adhesive capsulitis (AC) following arthroscopic shoulder procedures.

Methods: Patients were retrospectively identified using Current Procedural Terminology surgical billing codes to identify patients who underwent any shoulder arthroscopic procedure at a single urban academic institution from 2012 to 2020 with a minimum 2-year follow-up. Patients were excluded if <30 years old at time of surgery, as these patients rarely use ARB and ACEi medications, or if they had pre-existing AC.

Does a Modified Frailty Index Predict 30-day Complications After Long-Bone Nonunion or Malunion Surgery?

Objective: To assess the ability of a modified frailty index (mFI-5) score, which includes the presence of congestive heart failure, hypertension, chronic obstructive pulmonary disease, diabetes, and nonindependent functional status, and to identify patients at increased risk of complications after surgical treatment of long-bone nonunions/malunions.

Design: Retrospective.

Setting: Hospitals participating in the 2005-2018 American College of Surgeons National Surgical Quality Improvement Program.

Electric scooter injuries: Incidence and injury patterns at a level I trauma center.

Purpose: Electric scooters (e-scooters) have become an increasingly popular mode of public transportation in recent years. As the incidence of related injuries rises, it is important to understand specific fracture patterns unique to e-scooters and electric bikes (e-bikes) to help guide management. The purpose of this study was to review the prevalence and describe specific fracture patterns of e-scooter and e-bike related injuries at the busiest level 1 trauma center in the borough of Manhattan.

Transfusion Thresholds Can Be Safely Lowered in the Hip Fracture Patient: A Consecutive Series of 1,496 Patients.

Introduction: The purpose of this study is to identify optimal threshold hemoglobin (Hgb) and hematocrit (Hct) laboratory values to transfuse hip fracture patients.

Methods: A consecutive series of hip fracture patients were reviewed for demographic, clinical, and cost data. Patients receiving an allogeneic transfusion of packed red blood cells (pRBCs) were grouped based on last Hct or Hgb (H&H) value before first transfusion.

Perilunate Dislocations: Current Treatment Options.

➢: Approximately 25% of all patients who sustain perilunate dislocations present in a delayed fashion.

➢: While management of acute injuries is relatively well-described, treatment of chronic injuries can be complex and there is a paucity of scientific evidence to guide management.

➢: Treatment options include open reduction internal fixation, proximal row carpectomy, scaphoid or lunate excision with or without arthrodesis, and total wrist arthrodesis, although indications vary based on chronicity of injury and patient factors.

Intra-articular fracture patterns associated with tibial shaft fractures: more than just the posterior malleolus.

Background: The association of tibial shaft fractures (TSFs) with posterior malleolar fractures is well described. The purpose of this study was to identify specific radiographic parameters that are predictive of any pattern of associated distal intra-articular fractures in TSFs.

Methods: All TSFs presenting over a 6-year period were identified.

Risk Factors for Wound Complications Following Conversion TKA after Tibial Plateau Fracture.

Introduction: The purpose is to investigate the incidence of wound complications for total knee arthroplasty (TKA) following tibial plateau open reduction and internal fixation (ORIF).

Materials And Methods: A prospective arthroplasty registry was queried for patients with CPT codes for primary TKA, tibial plateau ORIF, removal of hardware (ROH), and diagnosis of post-traumatic arthritis. Patients were included if they had undergone tibial plateau ORIF and subsequent TKA.

Delayed Versus Primary Closure of Diaphyseal Forearm Fractures in Adults: Short-Term Soft Tissue Outcomes.

Introduction: The purpose of this study was to investigate the effect of delayed closures, whether delayed primary closure (DPC) or split-thickness skin grafting (STSG), of operatively treated forearm fractures on short-term soft tissue outcomes.

Methods: In this retrospective cohort comparative study of two academic-level one trauma centers from 2010 to 2020, adult patients with diaphyseal forearm fractures who underwent open reduction and internal fixation (ORIF) were either closed primarily at index surgery, or underwent delayed closure, either with DPC or with a STSG. Primary outcome measures were soft-tissue outcomes as measured by wound healing (delayed healing, dehiscence, or skin breakdown) and fracture-related infection (FRI) at time of final follow-up.

Fracture obliquity angle and distance from plafond: novel radiographic predictors of posterior malleolar involvement in tibial shaft fractures.

Background: The purpose of this study was to identify specific radiographic parameters that are predictive of associated PM fractures in TSFs.

Methods: All TSFs presenting over a 6-year period were identified. A review of plain radiographs and CT scans included: identification of an isolated PM fracture, AO/OTA classification, measurements of the fracture obliquity angle (FOA), absolute and relative distance from distal extent of fracture to plafond (DFP and DFP%), and presence and level of associated fibular fractures.