Acetabular Fractures: A Problem-Oriented Approach.

The main goals of acetabular fracture management are to restore the congruity and stability of the hip joint. These goals are the same for all patients who have an acetabular fracture, regardless of the morphology or etiology of the fracture. Nevertheless, certain acetabular fracture types and several patient factors pose management challenges for surgeons.

Obesity Increases Early Complications After High-Energy Pelvic and Acetabular Fractures.

Elevated body mass index has been identified as a potential risk factor for complications in operatively treated pelvic trauma. Although obesity is an independent risk factor for morbidity and mortality following high-energy blunt force trauma, there is little information on the immediate complications following isolated pelvic and acetabular fractures in obese patients with trauma. The authors hypothesized that obesity (body mass index ≥30 kg/m(2)) is a risk factor for complications in both operative and nonoperative pelvic and acetabular fractures.

The effect of body mass index on posttraumatic transfusion after pelvic trauma.

The impact of body mass index (BMI) on posttraumatic blood transfusion after pelvic trauma is not well known. We conducted a retrospective review of trauma registry data over a 5-year period. Patients were stratified by BMI as normal: less than 25 kg/m(2), overweight: 25 to 29.

Current management of posterior wall fractures of the acetabulum.

The general goals for treating an acetabular fracture are to restore congruity and stability of the hip joint. These goals are no different from those for the subset of fractures of the posterior wall. Nevertheless, posterior wall fractures present unique problems compared with other types of acetabular fractures.

Unstable pertrochanteric femoral fractures.

Background: Fractures in the trochanteric region of the femur are classified as AO/OTA 31-A, as they are extracapsular (). This report analyzes the relatively rare 31-A3 fracture, which has also been referred to as an "intertrochanteric femur fracture with subtrochanteric extension," "reverse obliquity intertrochanteric femur fracture," "unstable intertrochanteric femur fracture," or a "subtrochanteric femur fracture." The A3 fracture is characterized by having a fracture line exiting the lateral femoral cortex distal to the vastus ridge.

Hot topics in biomechanically directed fracture fixation.

The evolution of locking plates and modern nail constructs provides the orthopaedic trauma surgeon with a myriad of options with regard to implant selection for common fractures. There is a significant amount of biomechanical literature comparing modern constructs with those conventionally used. A basic understanding of this literature is required to make informed decisions with regard to implant selection in the management of these injuries.

External fixation versus ORIF for distal intra-articular tibia fractures.

Tibia plafond fractures have historically demonstrated high complication rates. The purpose of this study was to assess the outcomes of tibia plafond fractures following treatment with definitive external fixation vs delayed open reduction and internal fixation (ORIF). Sixty patients were enrolled in a prospective cohort trial at 1 Level I trauma center.

Preoperative skeletal versus cutaneous traction for femoral shaft fractures treated within 24 hours.

Objectives: To compare the advantages and disadvantages of preoperative cutaneous traction versus skeletal traction in adults with diaphyseal femur fractures amenable to fixation within 24 hours.

Design: Randomized prospective trial.

Setting: Level I trauma center in a major metropolitan area.

Bone morphogenetic protein-2 compared to autologous iliac crest bone graft in the treatment of long bone nonunion.

This retrospective study investigated the effect of recombinant human bone morphogenetic protein-2 (rhBMP-2) mixed with cancellous allograft on fracture healing compared to iliac crest autograft in the treatment of long bone nonunion. Eighty-nine patients with 93 established long bone nonunions treated between January 2002 and June 2004 at a single academic Level I trauma center were evaluated. Patients with clinical and radiographic evidence of failed fracture union underwent nonunion debridement, revision of fixation, and implantation at the nonunion site of either rhBMP-2 or the standard treatment autologous iliac crest bone graft.

The surgical treatment of acetabular fractures.

The goals of treating an acetabular fracture are to restore the congruity and stability of the hip joint. Some fracture types may not require surgery for a satisfactory outcome, but a displaced fracture in the weight-bearing area of the acetabulum generally should be treated with open reduction and internal fixation. The surgery is complex and demanding, and the fracture reduction must be anatomic to obtain the best result.

Utilization of the less-invasive stabilization system internal fixator for open fractures of the proximal tibia: a multi-center evaluation.

Background: Locked plating has become popular and has clear biomechanical advantages when compared with conventional plating. When combined with minimally invasive surgical techniques, locked plating may cause substantially less iatrogenic tissue damage when compared with conventional plating. These characteristics may make locked plating an attractive option for treating open fractures of the tibial plateau and proximal tibia for which coverage over the plate can be obtained.

Subcellular localization of IRS-1 in IGF-I-mediated chondrogenic proliferation, differentiation and hypertrophy of bone marrow mesenchymal stem cells.

Bone marrow derived mesenchymal stem cells (BM-MSC) can differentiate into chondrocytes. Understanding the mechanisms and growth factors that control the MSC stemness is critical to fully implement their therapeutic use in cartilage diseases. The activated type 1 insulin-like growth factor receptor (IGF-IR), interacting with the insulin receptor substrate-1 (IRS-1), can induce cancer cell proliferation and transformation.

Long-term functional outcomes after intra-articular distal femur fractures: ORIF versus retrograde intramedullary nailing.

This retrospective study evaluated the long-term clinical, functional, and radiographic outcomes of traditional open reduction internal fixation (ORIF) versus limited open reduction with retrograde intramedullary nailing for supracondylar-intercondylar distal femur fractures (Arbeitsgemeinschaft für Osteosynthesefragen [AO] 33-C type). Twenty-three fractures were followed in 22 patients for a mean follow-up of 80 months. The rate of subsequent bone-grafting procedures (67% vs 9%) and malunion (42% vs 0%) were significantly higher in ORIF compared to the less invasive retrograde intramedullary nailing treatment.

Treatment of acute distal femur fractures above a total knee arthroplasty: systematic review of 415 cases (1981-2006).

Background: There is no consensus on the best treatment for periprosthetic supracondylar fracture.

Material And Methods: We systematically summarized and compared results of different fixation techniques in the management of acute distal femur fractures above a total knee arthroplasty (TKA). Several databases were searched (Medline, Cochrane library, OTA and AAOS abstract databases) and baseline and outcome parameters were abstracted.

Plating of femoral shaft fractures: open reduction and internal fixation versus submuscular fixation.

Background: The standard treatment for femoral shaft fractures is intramedullary nailing. However, there are indications for which plating can be performed either openly or in a submuscular manner.

Methods: Between June 1996 and May 2002, two fellowship-trained orthopedic trauma surgeons treated 40 acute diaphyseal femoral fractures in 37 patients with use of plating techniques.

Predicting blood loss in isolated pelvic and acetabular high-energy trauma.

Objective: To quantify transfusion requirements in patients with isolated acetabular or pelvic fractures and correlate these requirements with fracture classification.

Design: Retrospective review of 382 patients with isolated pelvic and/or acetabular fractures.

Setting: Academic Level I Trauma Center.

Shortening after femoral neck fracture fixation: is there a solution?

When using parallel screws for treatment of femoral neck fractures, shortening of the femoral neck might occur. Given the high revision surgery rates associated with parallel screws, we developed a questionnaire to explore (1) surgeons' viewpoints on difficulties in the fixation of femoral neck fractures, (2) their perception of the clinical importance of femoral neck shortening after internal fixation, and (3) their opinions regarding the ideal fixation device. Two hundred three surgeons responded.

Operative treatment of acute distal femur fractures: systematic review of 2 comparative studies and 45 case series (1989 to 2005).

Background: The incidence of distal femur fractures is approximately 37 per 100,000 person-years. Typically, distal femur fractures are caused by a high-energy injury mechanism in young men or a low-energy mechanism in elderly women. Managing these fractures can be a challenging task.

Recombinant human bone morphogenetic protein-2 in open tibial fractures. A subgroup analysis of data combined from two prospective randomized studies.

Background: The use of recombinant human bone morphogenetic protein-2 (rhBMP-2) to improve the healing of open tibial shaft fractures has been the focus of two prospective clinical studies. The objective of the current study was to perform a subgroup analysis of the combined data from these studies.

Methods: Two prospective, randomized clinical studies were conducted.

Treatment of scapula fractures: systematic review of 520 fractures in 22 case series.

Background: Fractures of the scapula account for 3% to 5% of all fractures of the shoulder girdle and make up less than 1% of all broken bones. Scapula fractures typically occur after high-energy trauma, and approximately 90% of the patients have associated injuries.

Objective: (1) To determine the incidences of nonoperative and operative treatment of different scapula fracture types, (2) to systematically stratify the reported results of nonoperatively and operatively treated scapula fractures on the basis of different fracture types and to summarize functional results, and (3) to quantify infection and secondary surgical procedure rates after operative treatment.

Biomechanical evaluation of the less invasive stabilization system and the 95-degree angled blade plate for the internal fixation of distal femur Fractures in human cadaveric bones with high bone mineral density.

Background: The less invasive stabilization system (LISS) is an internal fixator that utilizes unicortical locked screws for fixation of distal femur fractures. A question is whether locked unicortical screw fixation is sufficient, when compared with a standard implant such as a blade plate.

Methods: Eight matched pairs of fresh-frozen cadaveric femora were instrumented with either the LISS or a 95-degree blade plate.

Evidence-based resources and search strategies for orthopaedic surgeons.

Identification of information on a specific topic of interest can be a difficult and time-consuming task. The key to successful and time-efficient article identification is to use easily accessible, complete, and most up-to-date information sources and to perform a focused search that minimises hits without missing relevant articles. Pre-appraised articles and databases allowing "pre-filtering" techniques for high level evidence are useful for a quick search for the best available evidence.

CASE REPORTS: malignant fibrous histiocytoma of bone arising in chronic osteomyelitis.

This case report shows the importance of frozen section and/or permanent section pathology for diagnosis of tumorous conditions in patients with chronic osteomyelitis. According to published reports, a coincidence of malignant fibrous histiocytoma of bone and post-fracture osteomyelitis has occurred in only four patients. Our report details the treatment of 51-year-old man with a fracture 15 years previously and subsequent chronic osteomyelitis of the left distal femur.

Functional outcome after treatment of lower-extremity nonunions.

Background: The results for nonunion surgery usually have been judged in terms of bony union, time to union, infection rate, range of motion for the adjacent joints, and muscle strength. The goal of this study was to assess the improvement of patient-oriented physical and mental functional outcomes.

Methods: The functional status of 23 patients with nonunion of the lower extremity was assessed using the Short-Form Health Survey (SF-36) questionnaire.