Injury metrics are altered in spica-casted versus non-casted child ATDs in side-impact collisions with door intrusion.

There is little data defining safe transport protocols for spica-casted children. A single earlier study demonstrated the presence of a body cast alters kinematics and injury metrics during simulated side-impact crashes. Since then, the National Highway Transportation Safety Administration (NHTSA) proposed a new side-impact test protocol for evaluating child restraints.

Frontal Crash Injury Metrics Are Below Mandated Limits for a Spica Casted Child Dummy in Currently Available Restraints.

Background: There is a paucity of data defining safe transport protocols for children treated with hip spica casting. Although restraint devices for casted children are available, all federally mandated testing uses a noncasted anthropomorphic test device (ATD or crash dummy). The purpose of this study was to evaluate current restraint options in simulated frontal crash testing using a casted pediatric ATD to determine injury risk to the head, cervical spine, chest, and pelvis.

The Return on Investment of Orthopaedic Fellowship Training: A Ten-year Update.

Background: Over 90% of graduating orthopaedic residents now pursue fellowship training, and only 15% of practicing orthopaedic surgeons now characterize themselves as generalists. Fellowship training has significant financial effects due to both opportunity cost of that year of training and changes in compensation throughout one's career. The purpose of this study was to estimate the financial return on investment by pursuing additional training in an orthopaedic fellowship versus general practice.

Optimizing Hybrid Plate Fixation with a Locked, Oblique End Screw in Osteoporotic Fractures.

Background: The end screw in a fracture plate creates the greatest resistance to bending. For osteoporotic fractures treated with plates, there is some question as to the optimal screw insertion technique for the screw farthest from the fracture. A locked, oblique end screw was previously shown to increase resistance to periprosthetic fracture.

Temporal Variation in Ankle Fractures and Orthopedic Resident Program Planning in an Urban Level 1 Trauma Center.

Previous studies have described the mechanism of ankle fractures, their seasonal variation, and fracture patterns but never in conjunction. In addition, the cohorts previously studied were either not from trauma centers or were often dominated by low-energy mechanisms. The present study aimed to describe the epidemiology of ankle fractures presenting to an urban level 1 trauma center.

The New Surgical Technique for Improving Total Knee and Hip Arthroplasty Outcomes: Patient Selection.

Background: Inclusion of patient satisfaction scores in setting reimbursements has been suggested by health care policy makers to contain cost and improve outcomes. The Short Form 36 Health Survey (SF-36) score provides a health-related quality of life (HRQoL) measure of arthroplasty outcome. Although previous work identified factors that influence this score for hip and knee arthroplasty patients, they did not focus on how a surgeon might use this information in a clinical setting.

Acute Disassembly and Dissociation of a Dual-Mobility Next-Generation Prosthesis.

The use of bipolar components in hip surgery was introduced more than 40 years ago with the rationale of a dual-mobility hip implant. This design used a small femoral head that would decrease the rate of wear because of the smaller surface area but would still provide implant stability because of the larger outer shell that articulated with the acetabulum, decreasing dislocation rates. In April 2011, the E1 Active Articulation Hip System (Biomet, Warsaw, Indiana) was introduced to the orthopedic market.

Ankle fracture patterns in drivers are associated with femoral fracture, higher BMI, and advanced age.

Objective: Despite advances in vehicle safety systems, motor vehicle crashes continue to cause ankle fractures. This study attempts to provide insight into the mechanisms of injury and to identify the at-risk population groups.

Methods: A study was made of ankle fractures patients treated at an urban level 1 trauma center following motor vehicle crashes, with a concurrent analysis of a nationally representative crash data set.

Nine year follow-up of a ceramic-on-ceramic bearing total hip arthroplasty utilizing a layered monoblock acetabular component.

Introduction: Early ceramic bearing systems in total hip arthoplasty (THA) sought to provide long term wear improvement over traditional metal on polyethylene systems. However, previous designs exhibited fractures of the ceramic acetabular liner, leading to the development of the Implex Hedrocel ceramic bearing THA system where the ceramic liner was supported on a layer of polyethylene intended to transition liner loads to the metal shell, a so-called "sandwich" design. Unfortunately, the device trial was stopped to further enrollment when liner fractures were reported.

Analysis of the basic science section of the orthopaedic in-training examination.

Since 1963, the Orthopaedic In-Training Examination (OITE) has been administered to orthopedic residents to assess residents' knowledge and measure the quality of teaching within individual programs. The OITE currently consists of 275 questions divided among 12 domains. This study analyzed all OITE basic science questions between 2006 and 2010.

Development of an interlocked nail for segmental defects in the rabbit tibia.

Previous animal models have been developed to study intramedullary nailing for challenging segmental defects in the tibia. In large animals, interlocked nail fixation created a stable environment suitable to study new bone growth technologies placed in the defect. To our knowledge, there are no comparable interlocked tibial defect models for the rabbit in which new technologies could be evaluated.

Mycobacterium bovis infection of total hip arthroplasty after intravesicular bacille Calmette-Guérin therapy.

Bacille Calmette-Guérin (BCG) is a live, attenuated strain of Mycobacterium bovis. Intravesicular BCG therapy is the most effective treatment for superficial bladder cancer. The most common complication of this treatment is cystitis; there is a wide range of other complications.

Streptococcus bovis infection of total hip arthroplasty in association with carcinoma of colon.

Streptococcus bovis is normally found in the gastrointestinal tract of the human population. The association between Streptococcus bovis and bowel neoplasia has been frequently reported. This report presents two cases of total hip arthroplasty with Streptococcus Bovis infection at 18 and 11 years after arthroplasty.

Evaluation of transdermal steroids for trapeziometacarpal arthritis.

Purpose: One conservative treatment for trapeziometacarpal joint arthritis is the delivery of steroids transdermally. In prior transdermal studies on the elbow and foot, there are mixed reports of success. It appears that the benefits of the treatment might be limited to short-term relief (approximately one week).

Do scores of the USMLE Step 1 and OITE correlate with the ABOS Part I certifying examination?: a multicenter study.

Background: The US Medical Licensing Examination (USMLE) and Orthopaedic In-Training Examination (OITE) are commonly used to select medical students or residents, respectively. Knowing how well these examinations predict performance on the American Board of Orthopaedic Surgery (ABOS) Part I certifying examination is important to provide evaluations for medical students and residents. Previous studies comparing the OITE scores with the ABOS Part 1 scores have been limited to one program.

Casting technique and restraint choice influence child safety during transport of body casted children subjected to a simulated frontal MVA.

Background: Hip spica casts (or body casts) are commonly applied to young pediatric trauma and hip dysplasia patients. The greatest hip stability in the cast is achieved via fixed hip flexion or abduction and fixed knee flexion. Unfortunately, this fixed position causes difficulties in restraining children for transport because the child cannot typically accommodate their body to the child car seat geometry.

The split-line pattern of the distal femur: A consideration in the orientation of autologous cartilage grafts.

Purpose: To identify the surface collagen orientations of the distal femur and create a generic cartilage split-line map that could be used as a reference guide for the proper alignment of autogenous cartilage transplants.

Type Of Study: Anatomic, cadaveric study.

Methods: Eight fresh cadaveric knee joints were used to determine the collagen fiber orientation of the superficial layer of the articular cartilage of the distal femur.