Pilon fractures: Consensus and controversy.

Pilon fractures are complex injuries that require an individualized approach to treatment to avoid complications and achieve good outcomes. Staged open reduction internal fixation remains the gold standard for most cases to achieve anatomic articular reduction while minimizing soft tissue complications and infection. Careful preoperative planning based on computed tomography dictates the surgical approach for reduction.

Use of a Retrograde Guidewire to Direct an Antegrade Femoral Nail.

Antegrade intramedullary nailing for the treatment of diaphyseal femur fractures may present challenges in obtaining appropriate positioning of the distal tip of the nail. Known mismatch between the radius of curvature of commonly used nails and the anatomic bow of the femur may result in impingement or perforation of the anterior cortex of the distal femur. Additionally, some unique scenarios may arise that complicate traditional antegrade wire passage.

Bicondylar Tibial Plateau Fractures: What Predicts Infection?

Objectives: The purpose of this study was to identify the patient, injury, and treatment factors associated with infection of bicondylar plateau fractures and to evaluate whether center variation exists.

Design: Retrospective review.

Setting: Eighteen academic trauma centers.

Avulsion Fractures of the Calcaneal Tuberosity: A Single-Center Review of Outcomes and Complications.

Objectives: The goal of this investigation was to determine the incidence of complications and revision surgery after calcaneal tuberosity avulsion fractures, to describe experience with different fixation constructs, and to compare revision surgery rates between tuberosity and tongue-type fractures of the calcaneus.

Design: This was a retrospective study at a single level 1 trauma center between 2001 and 2019, including patients with calcaneal tuberosity avulsion fractures compared with patients with calcaneal tongue-type fractures.

Results: Twenty-nine tuberosity fractures (23 surgical and six nonsurgical) and 37 tongue-type fractures (29 surgical and eight nonsurgical) were treated during the study period.

Open Ankle Fractures: What Predicts Infection? A Multicenter Study.

Objective: To identify the patient, injury, and treatment factors associated with an acute infection during the treatment of open ankle fractures in a large multicenter retrospective review. To evaluate the effect of infectious complications on the rates of nonunion, malunion, and loss of reduction.

Design: Multicenter retrospective review.

Pilon Fracture: Preventing Complications.

Fractures of the distal tibial plafond (ie, pilon) comprise a broad range of injury mechanisms, patient demographics, and soft-tissue and osseous lesions. Patients often present with considerably comminuted fracture patterns and notable soft-tissue compromise. Surgical intervention must be performed with respect for the exceedingly vulnerable soft-tissue envelope and with a properly executed technique.

Staged Prone/Supine Fixation of High-Energy Multicolumnar Tibial Plateau Fractures: A Multicenter Analysis.

Purpose: We present a surgical strategy to manage multicolumnar tibial plateau fracture variants by addressing the predominant posterior fragment employing a Lobenhoffer approach in the prone position followed by supine patient repositioning for anterolateral column access.

Design: Multicenter retrospective analysis.

Setting: Three academic Level 1 trauma centers.

Surgical Exposure Trends and Controversies in Extremity Fracture Care.

Surgical exposures for the management of extremity fractures continue to evolve. Strategies to achieve satisfactory articular reconstitution require surgeons to have an appreciation and understanding of various conventional and contemporary surgical approaches. The recent literature has witnessed a surge in studies on surgical approaches for the fixation of extremity fractures.

Healing Time and Complications in Operatively Treated Atypical Femur Fractures Associated With Bisphosphonate Use: A Multicenter Retrospective Cohort.

Objectives: The purpose of this study was to characterize demographics, healing time, and complications of a large series of operatively treated atypical femur fractures.

Design: Retrospective multicenter review.

Setting: Seventeen academic medical centers.

Staged Fixation of Tibial Plateau Fractures: Strategies for the Posterior Approach.

A critical assessment of radiographic and clinical outcomes after complex articular fractures of the proximal tibia demonstrates several aspects worthy of reevaluation and potential modification. These include a refined understanding of fracture pathoanatomy, injury classification, operative exposure, surgical timing, and preferred fixation constructs in addition to implant design modifications. Evolving trends include increasing appreciation of the importance of the fracture morphology in the axial plane and the role that the fracture pattern has on the choice of surgical approach.

Determination of Radiographic Healing: An Assessment of Consistency Using RUST and Modified RUST in Metadiaphyseal Fractures.

Objective: To determine the reliability of the Radiographic Union Scale for Tibia (RUST) score and a new modified RUST score in quantifying healing and to define a value for radiographic union in a large series of metadiaphyseal fractures treated with plates or intramedullary nails.

Design: Healing was evaluated using 2 methods: (1) evaluation of interrater agreement in a series of radiographs and (2) analysis of prospectively gathered data from 2 previous large multicenter trials to define thresholds for radiographic union.

Intervention: Part 1: 12 orthopedic trauma surgeons evaluated a series of radiographs of 27 distal femur fractures treated with either plate or retrograde nail fixation at various stages of healing in random order using a modified RUST score.

Treatment and complications in orthopaedic trauma patients with symptomatic pulmonary embolism.

Objectives: The purpose of this study is to characterize the presentation, size, treatment, and complications of pulmonary embolism (PE) in a large series of orthopaedic trauma patients who developed PE after injury.

Methods: We reviewed the records of orthopaedic trauma patients who developed a PE within 6 months of injury at 9 trauma centers and 2 tertiary care facilities.

Results: There were 312 patients, 186 men and 126 women, average age 58 years.

Locked and minimally invasive plating: a paradigm shift? Metadiaphyseal site-specific concerns and controversies.

Metadiaphyseal fractures of long bones are associated with considerable deforming forces, tenuous soft-tissue envelopes, and, often, severely compromised osseous integrity. Contemporary methods to fix complex metadiaphyseal fractures must achieve a balance between the biomechanical and biologic environments. The advent of precontoured locking plates inserted with evolving minimally invasive techniques may achieve both goals.