From the Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA (Wadhwa, Goodnough, Finlay, DeBaun, Bishop, and Gardner), the Department of Orthopaedic Surgery, Santa Clara Valley Medical Center, San Jose, CA (Hecht and Lucas), and the Department of Orthopaedic Surgery, University of Washington Harborview Medical Center, Seattle, WA (Campbell).
Published: September 2021
AI Article Synopsis
Article Abstract
Introduction: Olecranon fractures are common in the elderly. Articular impaction is encountered occasionally, but the incidence and outcomes after treatment of this injury pattern have not been well characterized.
Methods: We evaluated a cohort of geriatric olecranon fractures to determine the incidence of articular impaction and describe a technique for open reduction and internal fixation.
Results: Of the 63 patients in our series, 31 had associated intraarticular impaction (49.2%). Patients with articular impaction did not have significantly different rates of postoperative complications (11/31, 35.5% versus 10/31, 32.3%; P = 1.00) or revision surgery (10/31, 32.3% versus 8/31, 25.8%; P = 0.780) compared with those without articular impaction.
Conclusion: Articular impaction is a common feature of geriatric olecranon fractures. Surgeons must maintain a high index of suspicion and have a surgical plan in place for managing this component of the injury.
Background Context: Primary spondylodiscitis occurs through the hematogenous spread of a pathogen entering the body via a point of entry. The infection's origin often remains unclear. During dental procedures or through minor traumas, oral bacteria can enter the bloodstream and disseminate throughout the body.
Impactions of the articular surface are relevant prognostic parameters in the treatment of acetabular fractures. Posterior marginal impactions and acetabular dome impactions may occur depending on the direction of the force vectors during trauma. Posterior marginal impactions are mainly observed in posterior fracture dislocations, while acetabular dome impactions are frequently seen in the elderly with the hip joint in extension during trauma.
The lunotriquetral intercarpal ligament (LTIL) is an important structure that equalizes the forces on the lunate imparted through the scapholunate intercarpal ligament. The extension moment of the triquetrum balances the flexion force of the scaphoid, positioning the lunate for efficient load transfer from the hand to the wrist. In contrast to the scapholunate intercarpal ligament, the LTIL is strongest volarly, with the most critical region being associated with the volar ulnocapitate ligament.
Purpose: To define the pathoanatomy of the anterior column-posterior hemitransverse (ACPHT) subtype of acetabulum fractures and assess the morphologic variation therein.
Methods: Retrospective cohort study including 50 patients age greater than 60 with an ACPHT acetabular fracture managed operatively over an 11-year period at an ACS Level 1 Trauma center. Cross-sectional CT images were reviewed for anterior column/wall comminution, anterior column fracture exit point, completeness of the anterior column and posterior column fractures, articular impaction and quadrilateral surface continuity with the posterior column.
Objectives: To identify characteristics that contribute to surgical complexity in pilon fractures and to develop a machine learning (ML) Pilon Surgical Difficulty Score (PSDS) based on these factors.
