Acute compartment syndrome in patients with tibia fractures transferred for definitive fracture care.

We sought to determine if patients evaluated at an outside institution for a tibia fracture and transferred to a referral hospital for fracture management were at risk for having acute compartment syndrome (ACS) on arrival. We conducted a database search for cases in which patients were referred for definitive fixation of tibia fractures, and on initial evaluation at our institution were diagnosed with ACS that necessitated fasciotomy. Incidence, demographics, fracture type, early complications, and factors that predict ACS were evaluated.

Temporary joint-spanning external fixation before internal fixation of open intra-articular distal humeral fractures: a staged protocol.

Introduction: This study determined outcomes after temporary joint-spanning external fixation before internal fixation of open intra-articular distal humeral fractures.

Materials And Methods: A retrospective case analysis was done of all patients who were treated between 2000 and 2008 in 3 level I trauma centers with temporary joint-spanning external fixation before internal fixation of an open intra-articular distal humeral fracture. Healing rates, complications, Disabilities of Arm, Shoulder and Hand (DASH), and Smith and Cooney outcome scores were documented.

Locked plating of the proximal humerus using an endosteal implant.

Purpose: To report on the use of a supplemental medial endosteal implant to prevent varus collapse and screw cutout in proximal humerus fractures treated with a laterally placed locking plate.

Methods: Twenty-seven patients meeting study inclusion criteria were included in the study. Follow-up averaged 63.

Functional and radiographic outcomes of intertrochanteric hip fractures treated with calcar reduction, compression, and trochanteric entry nailing.

Objectives: Shortening after intertrochanteric hip fractures with sliding constructs is an increasingly recognized problem by the orthopaedic community. It often results in a limb length discrepancy causing maladaptation of the abductor lever arm. Functional limitations can also result from altered hip biomechanics and negatively influence patient outcomes.

The anterolateral approach to the proximal humerus for nonunions and delayed unions.

Nonunions of proximal humerus fractures can be disabling as a result of pain, deformity and instability, and are often found in geriatric patients with poor bone quality. There are relatively few studies examining the treatment of nonunions of the proximal third of the humerus and the ideal treatment and surgical approach remains unclear. This case series reports the successful use of the anterolateral acromial approach for treatment of the symptomatic proximal third humerus nonunions in a geriatric group of patients with clear challenges as a result of patient comorbidities and bone quality.

Dual plating for fractures of the distal third of the humeral shaft.

In this study, we present a novel method for performing dual plating of extra-articular fractures of the distal third of the humerus. Since 2006, we have treated 15 such fractures with dual plates from a single posterior midline incision. In the first part of the study, we provide the surgical protocol we have used in addressing these fractures.

Management of nonunions of the proximal humeral diaphysis.

It has been reported that the majority of nonunions of the humeral shaft evaluated are within the proximal one-third of the diaphysis. We are not aware of any reported series of humeral nonunions dealing specifically with the proximal diaphysis. We therefore sought to identify patients with a humeral shaft nonunion from an orthopaedic trauma service database, determine the frequency of those within the proximal one-third and review our treatment strategy and resulting clinical outcomes for these difficult fractures.

Outcomes of length-stable fixation of femoral neck fractures.

Introduction: The most common implants for treating unstable femoral neck fractures are sliding constructs, which allow postoperative collapse. Successful healing, typically, is a malunion with a shortened femoral neck. Functional sequelae resulting from altered femoral neck biomechanics have been increasingly reported.

The use osteochondral allograft in the treatment of a severe femoral head fracture.

This study reviews the second case in the literature involving the use of frozen osteochondral allograft to reconstruct a femoral head fracture-dislocation. The case involved significant, unreconstructable damage to the weightbearing area of the femoral head in an 18-year-old male. Clinical and diagnostic imaging follow up at 46 months revealed that despite magnetic resonance imaging and radiographic evidence of progressive arthrosis in the hip, including subchondral cystic change in the femoral head and localized cartilage loss in the acetabulum and femoral head, the patient had excellent function with no complications (Harris hip score 100, hip dysfunction and osteoarthritis outcome score 62, musculoskeletal function assesment score 22, SF-36 score 81).

Functional outcomes after syndesmotic screw fixation and removal.

Objectives: Ankle fractures with a syndesmotic injury have historically been treated with syndesmotic screw fixation. We compared range of motion and functional outcomes' scores to assess patient benefit from syndesmotic screw and plate removal.

Design: Level IV--case series.

Predictable healing of femoral neck fractures treated with intraoperative compression and length-stable implants.

Objectives: A healed, yet shortened, femoral neck has historically been deemed a success in fracture treatment. This, however, comes at the price of diminished physical function and quality of life. We analyzed the outcomes of our treatment algorithm, which attempts to minimize postoperative shortening of femoral neck fractures and determined which preoperative factors were associated with femoral neck shortening and failure of surgical fixation.

Complications of recombinant human BMP-2 for treating complex tibial plateau fractures: a preliminary report.

Unlabelled: Bone morphogenic proteins (BMPs) are potent osteoinductive agents. Their use in fracture surgery is still being studied and the clinical indications are evolving. Heterotopic bone after BMP use in spine surgery is a known complication.

Osteochondral lesions of talus associated with ankle fractures.

Background: Residual ankle pain and stiffness is not uncommon after ankle fractures. Proposed etiologies include ligamentous instability, joint arthrosis and osteochondral injuries. We studied the incidence of osteochondral lesions of the talus (OCLT) with various ankle fracture patterns and assessed their impact on functional outcome.