Injection drug use is associated with repeat irrigation and debridement in native joint septic arthritis.

Background And Objective: Septic arthritis is an orthopaedic emergency that requires prompt irrigation and debridement (I&D). Some patients require a repeat I&D, which poses excessive burden on the patient and provider. The goal of this study was to identify possible risk factors for repeat I&D in the setting of native septic arthritis.

Prevalence of pelvic CT angiography (CTA) and angiographic embolization in geriatric patients with pelvic ring fractures presenting to two level I trauma centers.

Objectives: Hemorrhage in osteoporotic pelvic ring fractures is a rare, but serious complication. Most bleeding comes from the bone or venous plexuses, but arterial injury does occur. The purpose of this study was to characterize a large geriatric pelvic fracture cohort and determine the prevalence of pelvic CT angiography (CTA) and subsequent need for arterial embolization.

Effect of Antibiotic Administration Before Joint Aspiration on Synovial Fluid White Blood Cell Count in Native Joint Septic Arthritis.

Background: This study was performed to assess the impact of preaspiration antibiotics on synovial fluid analysis and timing of operative treatment in native-joint septic arthritis.

Methods: We performed a retrospective record review of adult patients from an urban level 1 trauma center with native joint septic arthritis in 2015-2019, identified by means of codes from the ( and ). Univariate and multivariate analyses were performed to determine whether antibiotics were associated with lower synovial fluid white blood cell counts (WBCs), the percentage of polymorphonuclear neutrophil (PMNs), and rate of culture positivity.

Predictors of Hardware Removal in Orthopaedic Trauma Patients Undergoing Syndesmotic Ankle Fixation With Screws.

Background: Indications for removal of syndesmotic screws are not fully elucidated. This study aimed to determine factors related to elective syndesmotic screw removal.

Methods: Patients who underwent fixation of ankle syndesmotic injuries were included.

Heterotopic Ossification Remodeling After Acetabular Surgery: A Natural History Case Report.

Case: A 30-year-old woman presented with a transverse plus posterior wall acetabular fracture and underwent operative fixation through a Kocher-Langenbeck approach. Shared decision was made for no heterotopic ossification (HO) prophylaxis. The patient developed symptomatic HO and was scheduled for resection, which was delayed because of the pandemic.

How to place a cephalomedullary screw when visualization is obscured by the jig in peritrochanteric hip fractures using "peek radiographs.".

Lag screw positioning can be difficult to discern intraoperatively on lateral fluoroscopic imaging during intramedullary fixation of proximal femur fractures in some nailing systems due to the drill guide handle obstructing the view. We have described a method of obtaining non-obstructed lateral-oblique "peek" views that reliably assist in obtaining adequate tip-apex distance (TAD) measurements when using intramedullary fixation for these fractures. The purpose of this study was (1) to describe an intraoperative radiographic technique to obtain non-obscured views for appropriate center-center placement of the lag screw(s) within the femoral head during jig-aided cephalomedullary nailing of peritrochanteric hip fractures and (2) to present a case series detailing the radiographic results using this technique.

Not All Proximal Humerus Fractures Do Well Without Surgery: Anterior Translation Predicts the Need for Surgery.

Objectives: To evaluate the effect of translation on a large series of low-energy proximal humerus fractures initially treated nonoperatively.

Design: Retrospective multicenter analysis.

Setting: Five level-one trauma centers.

Is Patellar Instability a Contraindication to Semiextended Tibial Nailing?: A Case Report.

Case: We report a 40-year-old woman with undiagnosed patellofemoral instability that worsened 8 months after intramedullary nailing of a distal left tibia fracture in the semiextended position through a partial medial parapatellar approach. Patella stability and asymptomatic knee function were restored after IM nail removal, medial patellofemoral ligament repair, and left tibial tubercle transposition.

Conclusion: The optimal surgical approach for tibial IM nailing in patients with chronic patellar instability has not been described.

Incidence of Complications and Revision Surgery After High Tibial Osteotomy: A Systematic Review.

Background: High tibial osteotomy (HTO) is a well-recognized procedure for its effectiveness in treating symptomatic early knee arthritis and malalignment. Although there are numerous systematic reviews evaluating the management and outcomes after HTO, there are few investigations on complications of this procedure.

Purpose: To systematically review the literature to determine the incidence of intraoperative and postoperative complications associated with medial opening wedge and lateral closing wedge HTOs.

Impingement and perforation of the anterior femoral cortex in cephalomedullary nailing: Systematic review and surgical techniques.

Background: Anterior femoral cortical impingement and perforation are known risks of cephalomedullary nailing. The incidence of and risk factors for these findings have not been fully established in the literature. The purpose of this review was to answer: (1) What is the incidence of anterior femoral cortical impingement and perforation associated with cephalomedullary nailing of proximal femur fractures? (2) How does incidence vary by nail radius of curvature (ROC)? (3) What populations are at increased risk of impingement and perforation? (4) What surgical techniques prevent their occurrence?

Hypothesis: Our hypothesis was that impingement would be a relatively common finding following cephalomedullary nailing, and perforation would be much less frequent but still an appreciable risk.

Is fixation of the medial malleolus necessary in unstable ankle fractures?

Introduction: It is unclear whether the medial malleolus in unstable bi- and tri- malleolar ankle fractures without medial talar displacement should be addressed surgically. This study reviews a fixation protocol for the medial malleolar component of unstable bi- or tri- malleolar ankle fractures.

Materials And Methods: Two hundred fifty-seven patients who sustained bi- (AO/OTA 44-B2) or tri- (AO/OTA 44-B3) malleolar ankle fractures between January 2005 and August 2019 at two Level 1 trauma centers were retrospectively identified.

Anterior Compartment Neurovascular Bundle Entrapment in a Minimally Displaced Distal Tibial Fracture: A Case Report.

Case: A 29-year-old woman presented with a low-energy, minimally displaced pilon fracture with progressive pain and paresthesias in the affected foot, ultimately requiring open reduction and internal fixation. Intraoperatively, the deep peroneal nerve and anterior tibial artery and vein were entrapped within the fracture. After freeing the bundle and fixing the fracture, the paresthesias improved and ultimately resolved.

Patient Perceptions of Telehealth Orthopedic Services in the Era of COVID-19 and Beyond.

The coronavirus disease 2019 (COVID-19) pandemic necessitated an unprecedented increase in the use of telehealth services in orthopedics. Patient attitudes toward and satisfaction with virtual orthopedic services remain largely unexplored. A prospective study of all orthopedic patients at a tertiary academic medical center who had a telehealth appointment between April 1, 2020, and May 5, 2020, was performed to assess patients' experience with a validated 21-item telehealth satisfaction questionnaire.

Public perceptions and disparities in access to telehealth orthopaedic services in the COVID-19 era.

Background: We used online crowdsourcing to explore public perceptions and attitudes towards virtual orthopaedic care, and to identify factors associated with perceived difficulty navigating telehealth services during the COVID-19 pandemic.

Methods: A modified version of the validated Telemedicine Satisfaction and Usefulness Questionnaire was completed by 816 individuals using crowd-sourcing methods. Multivariable logistic regression modelling was used to determine population characteristics associated with perceived difficulty using telehealth technology.

Inflammatory and Coagulative Considerations for the Management of Orthopaedic Trauma Patients With COVID-19: A Review of the Current Evidence and Our Surgical Experience.

Mounting evidence suggests that the pathogenesis of coronavirus disease 2019 (COVID-19) involves a hyperinflammatory response predisposing patients to thromboembolic disease and acute respiratory distress. In the setting of severe blunt trauma, damaged tissues induce a local and systemic inflammatory response through similar pathways to COVID-19. As such, patients with COVID-19 sustaining orthopaedic trauma injuries may have an amplified response to the traumatic insult because of their baseline hyperinflammatory and hypercoagulable states.

Hospital Stays and Medical Expenses Increase Nationwide Among Patients With Septic Arthritis of the Shoulder Who Inject Drugs.

The authors determined the proportion of patients nationwide with septic arthritis of the shoulder who inject drugs, evaluated differences in hospitalization outcomes and charges between patients with and without injection drug use (IDU), and quantified demographic trends among patients with IDU from 2000 to 2013. Nationally representative data of patients with a principal discharge diagnosis of shoulder septic arthritis were obtained from the Nationwide Inpatient Sample 2000-2013. Using published algorithms, the authors classified septic arthritis of the shoulder as related or unrelated to IDU.

Magnetic Resonance Imaging of Trauma Patients Treated With Contemporary External Fixation Devices: A Multicenter Case Series.

Objectives: To report the safety and clinical outcomes of placing current magnetic resonance imaging (MRI) components inside and outside the MRI bore during MRIs.

Design: Retrospective case series.

Setting: Four trauma centers (3 Level I and 1 Level II), from January 2005 to January 2015.

Functional Outcomes of Elderly Patients With Nonoperatively Treated Acetabular Fractures That Meet Operative Criteria.

Objectives: To report functional outcomes of displaced acetabular fractures treated nonoperatively in the geriatric patient population.

Design: Retrospective case series.

Setting: Two Level I trauma centers.

Balancing Life and Work in a 2-Physician Relationship: Redefining the "Power Couple".

Balancing the requirements of work and personal life can be a struggle. It is challenging to do on your own, but even more difficult when partnered with someone with similar career goals. Often times, career choices are prioritized over personal ones, which puts stress on interpersonal relationships and time spent with our partner.

Effect of surgical treatment on mortality after acetabular fracture in the elderly: a multicenter study of 454 patients.

Objectives: Controversy exists regarding the effect of operative treatment on mortality after acetabular fracture in elderly patients. Our hypothesis was that operative treatment would confer a mortality benefit compared with nonoperative treatment even after adjusting for comorbidities associated with death.

Design: Retrospective study.

Semi-extended nailing of metaphyseal tibia fractures: alignment and incidence of postoperative knee pain.

Objectives: To review a large series of tibial metaphyseal fractures treated with nailing in semi-extension (20-30 degrees) using a superomedial portal. To report on the quality and maintenance of reduction. To compare knee pain at final follow-up with a group nailed in hyperflexion (>90 degrees) with a standard inferior incision and parapatellar approach.

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.

Knee pain correlates with union after tibial nailing.

Objectives: The purpose of this study is to evaluate the change in quantitatively scored knee pain during union.

Design: This is a retrospective review of prospectively collected data over a 15-year period.

Setting: Academic medical center.