Safety of immediate open reduction and internal fixation of geriatric open fractures of the distal radius.

Introduction And Aim: There is a paucity of literature regarding outcomes of open fractures of the distal radius. No study has detailed this injury or treatment strategy in the geriatric population. The purpose of this study was to determine the safety of immediate open reduction and internal fixation of geriatric open fractures of the distal radius.

The evolution of damage control orthopedics: current evidence and practical applications of early appropriate care.

This article summarizes the evolution of literature and practice related to fracture care in polytrauma patients. Particular emphasis is given to the management of femoral shaft fractures and the concept of damage control in these complex patients. The application of these guidelines in common clinical practice is also discussed.

Perioperative supplemental oxygen to reduce surgical site infection after open fixation of high-risk fractures: a randomized controlled pilot trial.

Background: Higher concentrations of fraction of inspired oxygen (FIO2) have been shown to be associated with lower risk for surgical site infection in multiple studies outside the domain of orthopedic surgery. We evaluated the efficacy of high FIO2 administered during the perioperative period to reduce the rate of surgical site infection after open fixation of lower-extremity fractures at high risk of infection.

Methods: We conducted a randomized controlled, parallel design, double-blind study.

Early application of airway pressure release ventilation may reduce mortality in high-risk trauma patients: a systematic review of observational trauma ARDS literature.

Background: Adult respiratory distress syndrome is often refractory to treatment and develops after entering the health care system. This suggests an opportunity to prevent this syndrome before it develops. The objective of this study was to demonstrate that early application of airway pressure release ventilation in high-risk trauma patients reduces hospital mortality as compared with similarly injured patients on conventional ventilation.

Does a trochanteric lag screw improve fixation of vertically oriented femoral neck fractures? A biomechanical analysis in cadaveric bone.

Background: We assessed the biomechanical performances of a trochanteric lag screw construct and a traditional inverted triangle construct in the treatment of simulated Pauwels type 3 femoral neck fractures.

Methods: An inverted triangle construct (three 7.3-mm cannulated screws placed in inverted triangle orientation) and a trochanteric lag screw construct (two 7.

Are bilateral femoral fractures no longer a marker for death?

Objectives: To determine whether previously reported high mortality rates associated with bilateral femoral fractures have decreased over time.

Design: Retrospective review.

Setting: Urban academic trauma center.

Do locking screws work in plates bent at holes?

Objectives: To assess whether plate bending at a hole significantly changes the biomechanical properties of a locked screw.

Methods: Coronal plane bends of 5-, 15-, or 45-degree angles were placed in 3.5-mm locking compression plates with the apex at a locking hole.

Articular cartilage thickness at the distal radius: a cadaveric study.

Purpose: Articular stepoffs that occur after fracture and are greater in size than the thickness of the articular surface seem to result in arthritis. The thickness of a joint's cartilage may, therefore, set the limit for acceptable stepoff when treating fractures. The goal of our study was to determine the thickness of the articular cartilage at the distal radius.

How often does open reduction and internal fixation of geriatric acetabular fractures lead to hip arthroplasty?

Objectives: We hypothesized that open reduction and internal fixation (ORIF) of displaced acetabular fractures in geriatric patients result in a low rate of conversion to hip arthroplasty and satisfactory hip-specific validated outcome scores at medium-term follow-up.

Design: Retrospective review.

Setting: Level I trauma center.

Predictive model for surgical site infection risk after surgery for high-energy lower-extremity fractures: development of the risk of infection in orthopedic trauma surgery score.

Background: Current infection risk scores are not designed to predict the likelihood of surgical site infection after orthopedic fracture surgery. We hypothesized that the National Nosocomial Infections Surveillance (NNIS) System and the Study on the Efficacy of Nosocomial Infection Control (SENIC) scores are not predictive of infection after orthopedic fracture surgery and that risk factors for infection can be identified and a new score created (Emerg Infect Dis. 2003;9:196-203).

Magnetic resonance imaging for the evaluation of ligamentous injury in the pelvis: a prospective case-controlled study.

Objectives: Management of external rotation pelvic ring disruptions is based on which ligaments are disrupted within the pelvis. We hypothesized that magnetic resonance imaging (MRI) can evaluate the ligaments of the pelvic ring and differentiate injured from uninjured pelves.

Design: Prospective cohort study.

How much vertical displacement of the symphysis indicates instability after pelvic injury?

Background: Measures of pubic symphyseal widening are used by at least two classification systems as determinants of injury grade. Recent work has challenged the commonly used parameter of 2.5 cm of pubic symphysis as an accurate marker of pelvic injury grade and has suggested a role of rotation in the flexion-extension plane as a determinant of pelvic stability.

Do traction radiographs of distal radial fractures influence fracture characterization and treatment?

Background: Our center evaluates all distal radial fractures with traction radiographs before splinting. Although investigations of various imaging modalities to evaluate distal radial fractures have been presented in the literature, to our knowledge the use of traction radiographs has not been well described. We hypothesized that the addition of traction radiographs to standard radiographs increases interobserver and intraobserver reliability for injury descriptions, affects the choice of treatment plan, and decreases the perceived need for computed tomography.

Fracture of the distal radius with radial artery injury: injury description and outcome of vascular repair.

Introduction: The ideal treatment of an isolated radial artery injury that is associated with a fracture of the distal radius is unknown. Our purposes were to assess the incidence of this injury pattern and to describe the outcomes of our treatment protocol. We hypothesised that combined routine repair of the artery during operative treatment results in a satisfactory outcome.

Does sleep deprivation impair orthopaedic surgeons' cognitive and psychomotor performance?

Background: Sleep deprivation may slow reaction time, cloud judgment, and impair the ability to think. Our purpose was to study the cognitive and psychomotor performances of orthopaedic trauma surgeons on the basis of the amount of sleep that they obtained.

Methods: We prospectively studied the performances of thirty-two orthopaedic trauma surgeons (residents, fellows, and attending surgeons) over two four-week periods at an urban academic trauma center.

Diagnosis of femoral neck fracture associated with femoral shaft fracture: blinded comparison of computed tomography and plain radiography.

Objective: Femoral neck fractures that are associated with femoral shaft fractures have historically been associated with high rates of missed diagnosis. Despite the potentially serious consequences of a missed femoral neck fracture, little work has been conducted to rigorously evaluate the ability of commonly used imaging studies to detect such fractures. Our hypothesis was that axial-view computed tomography is superior to plain radiography at detecting femoral neck fractures.

Reprioritization of research for combat casualty care.

Since the beginning of the conflicts in Iraq and Afghanistan more than a decade ago, much has been learned with regard to combat casualty care. Although progress has been significant, knowledge gaps still exist. The seventh Extremity War Injuries symposium, held in January 2012, reviewed the current state of knowledge and defined knowledge gaps in acute care, reconstructive care, and rehabilitative care in order to provide policymakers information on the areas in which research funding would be the most beneficial.

Evolution of orthopaedic reconstructive care.

The patterns and severity of injury sustained by service members have continuously evolved over the past 10 years of combat in Iraq and Afghanistan. The 2010 surge of combat troops into Afghanistan, combined with a transition to counterinsurgency tactics with an emphasis on dismounted operations, resulted in increased exposure of US service members to improvised explosive devices and a new pattern of injury termed dismounted complex blast injury. This constellation of injuries typically includes multiple extremity injuries, high bilateral transfemoral amputations, amputated or mangled upper extremities, open pelvis fractures, and injury to the perineal and/or genital regions.

Combined pelvic ring disruption and acetabular fracture: associated injury patterns in 40 patients.

Objectives: Combined pelvic ring disruptions and acetabular fractures are thought to be uncommon. Our objectives were to characterize concomitant injury patterns and to compare them with historically observed rates for each injury in isolation.

Design: Retrospective review comparing a study group with historical controls.

Predrilling does not improve the pullout strength of external fixator pins: a biomechanical study.

Objectives: External fixator pins are thought to have improved pullout strength if inserted into both cortices and if pilot holes are drilled. We tested these hypotheses and investigated effects of osteoporosis and pin location on pin pullout strength.

Methods: Self-drilling external fixator pins were inserted using 4 techniques: 1) predrilled bicortically inserted, 2) not predrilled bicortically inserted, 3) not predrilled unicortically inserted, and 4) technique 2 with far cortex disengaged to test holding power of near cortex in isolation.

Embolization of pelvic arterial injury is a risk factor for deep infection after acetabular fracture surgery.

Objective: To determine whether embolization of pelvic arterial injuries before open reduction and internal fixation (ORIF) of acetabular fractures is associated with an increased rate of deep surgical site infection.

Methods: Retrospective review of patients who underwent ORIF of acetabular fractures at our institution from 1995 through 2007 (n = 1440). We compared patients with acetabular fractures who underwent angiography and embolization of a pelvic artery (n = 12) with those who underwent angiography but did not undergo embolization (n = 14).

Does early fixation of posterior wall acetabular fractures lead to increased blood loss?

Objective: Controversy exists regarding the ideal timing of acetabular fracture surgery. Surgery within the first 24 hours might put patients at risk for increased blood loss; however, early treatment might facilitate fracture reduction and patient mobilization. The purpose of this study was to determine whether early surgery for posterior wall acetabular fractures results in higher intraoperative blood loss.

Geriatric trauma: demographics, injuries, and mortality.

Objectives: To identify injuries that elderly sustain during high-energy trauma and determine which are associated with mortality.

Design: Retrospective review of prospectively collected database.

Setting: Academic trauma center.

A biomechanical comparison of a locking plate, a nail, and a 95° angled blade plate for fixation of subtrochanteric femoral fractures.

Objective: To compare the biomechanical performance of a cephalomedullary nail (CMN), a proximal femoral locking plate, and a 95° angled blade plate in a comminuted subtrochanteric fracture model.

Methods: A comminuted subtrochanteric femoral fracture model was created with a 2-cm gap below the lesser trochanter in 15 pairs of human cadaveric femora confirmed to be nonosteoporotic. The femora were randomized to treatment with one of the previously mentioned 3 devices.

Are certain fractures at increased risk for compartment syndrome after civilian ballistic injury?

Background: Compartment syndrome after ballistic fracture is uncommon but potentially devastating. Few data are available to help guide clinicians regarding risk factors for developing compartment syndrome after ballistic fractures. Our primary hypothesis was that ballistic fractures of certain bones would be at higher risk for development of compartment syndrome.