Single-Incision Fasciotomy Decreases Infection Risk Compared with Dual-Incision Fasciotomy in Treatment of Tibial Plateau Fractures With Acute Compartment Syndrome.

Objectives: Comparison of surgical site infection (SSI) rates in tibial plateau fractures with acute compartment syndrome treated with single-incision (SI) versus dual-incision (DI) fasciotomies.

Design: Retrospective cohort study.

Setting: Two, Level-1, academic, trauma centers.

Type III Open Tibia Fractures Treated With Single-Stage Immediate Medullary Nailing and Attempted Primary Closure Yield Low Rates of Flap Coverage.

Objective: The purpose of this study was to determine whether type III open high-energy tibia fractures treated with immediate intramedullary nailing (IMN) and primary closure yield low rates of flap coverage.

Methods: Patients with high-energy type IIIA open tibia (OTA/AO42/43) fractures treated with IMN over a 10-year period at a level 1 academic center with at least 90 days of in-person postoperative follow-up were included. Single-stage reamed IMN with acute primary skin closure using Allgower-Donati suture technique was utilized in patients without notable skin loss.

Mathematically Directed Single-Cut Osteotomy.

A mathematically directed osteotomy (MDO) is a surgical planning technique for correcting long bone deformities. Using a mathematically derived osteotomy plane, the single-cut correction simultaneously addresses angular deformity, axial malrotation, and minor shortening. This review describes an MDO's indications for use, defines its input and output variables, includes the required graphs for osteotomy planning, and provides intraoperative tips and tricks for successful execution.

Simultaneous Posterolateral and Posteromedial Approaches for Fractures of the Entire Posterior Tibial Plafond: A Safe Technique for Effective Reduction and Fixation.

Objective: To determine the short-term results of surgical treatment with dual posterolateral and posteromedial approaches for fractures of the entire posterior tibial plafond and secondarily to identify common fracture characteristics.

Design: Retrospective.

Setting: Single academic Level 1 trauma center.

It's All About the Timing: When Do I Take This Injury to the Operating Room?

Over time, what was considered urgent or emergent in orthopaedic trauma has been revisited, and as awareness of factors associated with outcomes has increased, priorities have changed. There are multiple procedures performed urgently in the belief that early intervention allowed for better outcomes for the injury and the patient. Classic examples of conditions for which urgent intervention has been implemented include open fractures, femoral neck fractures in the young adult, talus fractures, and compartment syndrome.

Contemporary Strategies in Pilon Fixation.

The treatment of tibial pilon fractures has evolved substantially over the past decades due to ever-increasing high-energy injuries. Open reduction and internal fixation of these intra-articular fractures requires an appreciation for a number of basic principles: respect the soft tissues, understand the fracture pattern, use safe surgical approaches, and provide stability that allows for early motion of the ankle. Surgical strategy should be customized based on the fracture pattern, access needed for fracture visualization and reduction, and status of the soft tissues.

Pilon Fractures in Patients Older Than 60 Years of Age: Should We Be Fixing These?

Objectives: To compare complications after operatively treated pilon fracture between elderly patients (≥60 years) and younger patients (<60 years).

Design: Retrospective comparative study.

Setting: Two Level-1 academic trauma.

Risk Factors for Tibial Plafond Nonunion: Medial Column Fixation May Reduce Nonunion Rates.

Objectives: To identify the incidence and risk factors for development of tibial plafond nonunion.

Design: Retrospective comparative study.

Setting: Two Level 1 academic trauma centers.

Syndesmosis and Syndesmotic Equivalent Injuries in Tibial Plafond Fractures.

Objectives: To identify the incidence and fracture characteristics associated with syndesmotic injury in tibial plafond fractures and report the incidence of posttraumatic osteoarthrosis (PTOA).

Design: Retrospective comparative study.

Setting: Two level-1 academic trauma centers.

Trends in Orthopedic Fracture and Injury Severity: A Level I Trauma Center Experience.

The purpose of this study was to define the trends in fracture complexity and overall injury severity of orthopedic trauma patients at a level I trauma center. A retrospective review of a prospectively collected trauma database was performed to determine the Injury Severity Score (ISS) and AO/OTA classification of the most common fractures among all patients presenting from 1995 to 1999 and from 2008 to 2012. Inclusion criteria were lower extremity fractures of the femur and tibia and pelvic fractures within the years of interest.

Biomechanical Analysis of the Proximal Femoral Locking Compression Plate: Do Quality of Reduction and Screw Orientation Influence Construct Stability?

Objectives: To investigate biomechanically in a human cadaveric model the failure modes of the proximal femoral locking compression plate and explore the underlying mechanism.

Methods: Twenty-four fresh-frozen paired human cadaveric femora with simulated unstable intertrochanteric fractures (AO/OTA 31-A3.3) were assigned to 4 groups with 6 specimens each for plating with proximal femoral locking compression plate.

Intertrochanteric Osteotomy for Femoral Neck Nonunion: Does "Undercorrection" Result in an Acceptable Rate of Femoral Neck Union?

Objectives: To analyze the radiographic outcomes of intertrochanteric osteotomy for the treatment of femoral neck nonunion with "undercorrection" of the Pauwels angle and relative preservation of the proximal femoral anatomy.

Design: Retrospective cohort study.

Setting: Level-1 trauma center.

Buttress Plating Versus Anterior-to-Posterior Lag Screws for Fixation of the Posterior Malleolus: A Biomechanical Study.

Objectives: The preferred method of fixation for posterior malleolus fractures remains controversial, and practices vary widely among surgeons. The purpose of this study was to compare anterior-to-posterior (AP) lag screws with posterior buttress plating for fixation of posterior malleolus fractures in a human cadaveric model.

Methods: Posterior malleolus fractures involving 30% of the distal tibial articular surface were created in 7 pairs of fresh frozen cadaveric ankles.

Coronal Plane Small-Fragment Fixation in Supracondylar Intercondylar Femur Fractures.

Supracondylar intercondylar distal femur fractures are devastating injuries that frequently have a concurrent coronal plane fracture, which mandates dedicated operative fixation. The purpose of this study was to determine whether small-fragment cortical lag screws oriented in the sagittal plane were sufficient to stabilize coronal plane fractures associated with supracondylar intercondylar distal femur fractures. The authors evaluated short-term radiographic outcomes in 56 coronal plane fractures in 44 knees (27 [61.

Technical Considerations in the Treatment of Syndesmotic Injuries Associated With Ankle Fractures.

Malleolar ankle fractures associated with syndesmotic injuries are common. Diagnosis of the syndesmotic injury can be difficult and often requires intraoperative fluoroscopic stress testing. Accurate reduction and stable fixation of the syndesmosis are critical to maximize patient outcomes.

How much articular displacement can be detected using fluoroscopy for tibial plateau fractures?

Introduction: While there is conflicting evidence regarding the importance of anatomic reduction for tibial plateau fractures, there are currently no studies that analyse our ability to grade reduction based on fluoroscopic imaging. The purpose of this study was to determine the accuracy of fluoroscopy in judging tibial plateau articular reduction.

Methods: Ten embalmed human cadavers were selected.

What is the underlying mechanism for the failure mode observed in the proximal femoral locking compression plate? A biomechanical study.

Purpose: Recently, several cases of clinical failure have been reported for the Proximal Femoral Locking Compression Plate (PF-LCP). The current study was designed to explore biomechanically the underlying mechanism and to determine whether the observed failure was due to technical error on insertion or to implant design.

Methods: A foam block model simulating an unstable intertrochanteric fracture was created for 3 study groups with 6 specimens each.

Salvage of an infected periprosthetic failed fracture fixation in a nonagenarian.

Infected nonunions resulting in segmental bone loss are a devastating complication for patients and a difficult problem for surgeons. Adequate soft tissue coverage, return of mobility, fracture stability, and long-term freedom from infection are all important goals of treatment. Although there are numerous published studies that provide some treatment guidelines, there are patients who require unique and individualized solutions.

Open reduction and intramedullary stabilisation of subtrochanteric femur fractures: A retrospective study of 56 cases.

Subtrochanteric femur fractures commonly present with predictable displacement because of the deforming muscle forces acting upon the proximal femur. For this reason, successful closed reduction and femoral nailing can be a technically demanding procedure. Open reduction prior to nail placement has been advocated to improve and maintain anatomic fracture alignment.

Risk factors for failure of locked plate fixation of distal femur fractures: an analysis of 335 cases.

Objectives: Locked plating has become a standard method to treat supracondylar femur fractures. Emerging evidence indicates that this method of treatment is associated with modest failure rates. The goals of this study were to determine risk factors for complications and to provide technical recommendations for locked plating of supracondylar femur fractures.

Bicortical fixation of medial malleolar fractures.

Medial malleolar fractures occur commonly and are often treated surgically. For any given fracture, treatment depends on the fracture configuration, and the clinical scenario. Multiple fixation options exist, including cortical or cancellous screws, tension band wiring, plates and screws, and even suture anchors according to some reports.

Development and validation of the new international classification for scapula fractures.

Objectives: Multiple scapula classification systems exist in the literature and were developed using a consensus approach with one or several experts agreeing on a classification without stringent validation. None have gained widespread acceptance. A decision was made by the OTA classification committee and the AO Classification Advisory Group to collaborate on the development of a new validated classification system capable of addressing the limitations of the existing systems.

Oblique distraction external pelvic fixation.

Simple anterior pelvic external fixation is a safe and effective strategy for reduction of pelvic ring deformity as well as the provisional or definitive stabilization of selected patterns of pelvic ring disruption. A two-pin oblique anterior pelvic deformity correction frame is a unique frame configuration designed to reduce and stabilize lateral compression pelvic ring disruptions associated with flexion/internal rotation hemipelvic deformities. In a small case series, we demonstrate that the oblique distraction external fixation frame alone or in combination with internal fixation is a simple and safe strategy for reduction and stabilization of unstable multiplanar hemipelvic deformities associated with partial posterior ring stability.

A fragment-specific approach to Type IID Monteggia elbow fracture-dislocations.

Objectives: To describe the pattern of injury, surgical technique, and outcomes of Monteggia Type IID fracture dislocations.

Design: Retrospective review of prospectively collected clinical and radiographic patient data in an orthopaedic trauma database.

Setting: Level I university-based trauma center.