New versus Old: 95 Degree Angled Blade Plate versus Distal Femoral Locking Plate. A Randomized Clinical Trial.
Surgical management for displaced distal femur fractures is the standard of care. Implant selection is based upon fracture pattern, medial comminution, and bone quality. Options include non-locking plates, such as the condylar buttress plate; the 95 ° angled blade plate (ABP); the Less Invasive Stabilization System (LISS)™ plate; and various locking plates. [1-9] Locking plates differ from conventional plates, as the screws are machine-threaded and rigidly secure the screw plate interface to create a fixed angle device with multiple points o f contact in the epiphyseal segment. (Source: Injury)
Source: Injury - November 26, 2020 Category: Orthopaedics Authors: Brendan M. Patterson, Mary A. Breslin, Leanne K. Wadenpfuhl, Heather A. Vallier Source Type: research

Orthopedic Trauma Guidance – Case #10: Midshaft Clavicle Fracture – Nonoperative versus Operative care
A 31yo man fell from his bike and sustained a closed mid-shaft clavicle fracture. He was otherwise unhurt. (Source: Injury)
Source: Injury - November 24, 2020 Category: Orthopaedics Authors: James RA Smith, Joep Kitzen, Richard Buckley Source Type: research

Role of preoperative posterior tilt on the outcomes of internal fixation of non-displaced femoral neck fractures: a systematic review and meta-analysis
Femoral neck fractures are traditionally classified as non-displaced or displaced fractures, which is based on anteroposterior (AP) radiographs of the fracture as first described by Garden [1]. The standard treatment of care for non-displaced (Garden I/II) femoral neck fractures is currently internal fixation whereas displaced (Garden III/IV) fractures have a high risk of non-union [1] or avascular necrosis of the femoral head (AVN) [2] and are therefore often treated with hemiarthroplasty or total hip arthroplasty [3-5]. (Source: Injury)
Source: Injury - November 23, 2020 Category: Orthopaedics Authors: Jelle P. van der List, Salih El Saddy, C.J. Vos, Olivier P.P. Temmerman Source Type: research

The safety and accuracy of the fluoroscopic imaging during Proximal femoral fixation: A Computerized 3D Reappraisal of the Joint Penetration Risk
Cut out of the femoral head screw, and joint penetration are two catastrophic complications in proximal femoral fracture fixation. Insufficient penetration of the screw into the femoral head will decrease its stability resulting in fixation failure1,2. On the other hand, the insertion of the screw too close to the joint line will increase the risk of screw migration and joint penetration3. In the literature, cut out is reported as one of the most common mechanical failure modes with a complication risk as high as 12% for intertrochanteric fracture fixation15. (Source: Injury)
Source: Injury - November 23, 2020 Category: Orthopaedics Authors: Lercan Aslan, Omer Subasi, Mehmet Demirhan, Aksel Seyahi, Ismail Lazoglu Source Type: research

Determination of Outcomes of Complex Upper End Tibial Fractures in Squatting and Cross Leg Sitting South Asian Population.
Upper end tibial fractures include the metaphyses and articular surface of proximal tibia [1]. Plateau fractures involving the proximal articular surface of tibia constitute around 1% of all extremity fractures in adults [2]. These fractures have a bimodal distribution, with high velocity injuries occurring in young and active individuals while elderly and metabolically insufficient population can have these fractures due to simple falls [1-3]. There can be varying degrees of depression and displacements involving the lateral, medial or both the plateaus and moreover, the injuries due to high velocity trauma are often comp...
Source: Injury - November 23, 2020 Category: Orthopaedics Authors: Rakesh Goyal, Shakti A Goel, Nishant Bhatia Source Type: research

Computed tomographic measurements of the psoas muscle as a predictor of mortality in hip fracture patients: Muscle attenuation helps predict mortality in hip fracture patients
Hip fracture is a musculoskeletal trauma that occurs in a large proportion of elderly patients. which tend to have comorbidity compared to young patients might occur patients ’ morbidity, mortality and medical burden for both caregivers and health systems. The number of hip fractures in the United States has doubled in 20 years, with 340,000 hip fractures in 2000, and the medical cost has reached 9 billion dollars [1, 2]. The 1-year mortality rate among elderly patient s is generally 20%–30% [3-5]. (Source: Injury)
Source: Injury - November 23, 2020 Category: Orthopaedics Authors: Sung Jin Bae, Sun Hwa Lee Source Type: research

Classification of femur trochanteric fracture: Evaluating the reliability of Tang classification
Hip fracture is one of the most common types of fractures in humans, particularly in the elderly. The aging of the population has led to a significant increase in the number of patients with hip fractures worldwide, with the largest number of patients occurring in Asia [1]. Hip fractures mostly occur after accidental falls in patients with osteoporosis [2]. The prevalence of hip fractures is 18% in women and 6% in men [1]. (Source: Injury)
Source: Injury - November 21, 2020 Category: Orthopaedics Authors: Bo Yin, Yuanming He, Dong Wang, Junlin Zhou Source Type: research

The rationale behind implant coatings to promote osteointegration, bone healing or regeneration
Bone adapts to the mechanical requirements throughout life. It is subject to permanent modeling, which enables the repair of microfractures and the adaptation to changes in mechanical demands. In the case of degenerative or traumatic disturbance of the bone, the function of the bone is usually supported by implants, which can be permanent or temporary. In addition to metallic implants, biomaterials are also used to promote bone regeneration in the case of bony defects. The requirements for implants and materials used in trauma and orthopedic surgery differ depending on the indication: (Source: Injury)
Source: Injury - November 20, 2020 Category: Orthopaedics Authors: Kai Borcherding, Gerhard Schmidmaier, Gunther O. Hofmann, Britt Wildemann Source Type: research

Remote Delivery of the Satellite Virtual Fracture Clinic - a Pilot Report of the First 500 Cases
The virtual fracture clinic (VFC) has proven to be a safe, patient-focused, cost-effective means of delivering trauma care [1]. Virtualising the fracture clinic was initially conceptualised by the Glasgow Royal Infirmary in 2011, and subsequently introduced to the Irish Healthcare System in 2016 [1, 2]. VFC pathways have been repeatedly validated and demonstrate reproducible functional outcomes complimented by high levels of patient satisfaction [3-6]. (Source: Injury)
Source: Injury - November 20, 2020 Category: Orthopaedics Authors: Andrew J. Hughes, Darren P. Moloney, Caroline Fraser, Joan Dembo, Louise O'Brien, Marie Corcoran, Michelle Crowley, Breda Conlon, Eoin Sheehan Source Type: research

A novel translation system for circular external fixation to correct translational bony deformities
Translational deformities are nonangular, bony displacements of the long axis of one segment of the limb in relation to the axis of the other segment [1] (Figure 1a- example of a translation deformity). The axes are often parallel or near parallel, and the angle between them, if greater than zero, is located far from the apex of the deformity. These deformities are often characterized by anterior-posterior translation or medial-lateral translation. [2] Axial translation refers to the fracture site being short or long. (Source: Injury)
Source: Injury - November 20, 2020 Category: Orthopaedics Authors: Guilherme Pelosini Gaiarsa, Paulo Roberto dos Reis, Kodi Edson Kojima, Walter Hamilton de Castro Targa, Austin T. Fragomen Tags: Technical Note Source Type: research

Loop Anchor Tension Band Technique for Patella Fractures Lowers the Rate of Kirschner Migration
Patella fractures account for approximately 1% –2% of all skeletal injuries [1]. They can lead to severe functional impairment due to the patella's pivotal role in the extensor mechanism of the knee. Patella fractures are diagnosed based on injury mechanism, physical examination, and radiological findings. Currently, restoration of the extenso r mechanism of the knee is the most important task for orthopaedic surgeons. Numerous treatment options have been developed, such as tension band wiring, screw fixation, cerclage wiring, transosseous suture, and retention wiring [1]. (Source: Injury)
Source: Injury - November 18, 2020 Category: Orthopaedics Authors: Shu-Hsin Yao, Shu-Fan Lin, Chang-Hao Lin, Chun-Ho Chen Source Type: research

Experimental agents to improve fracture healing: utilizing the WNT signaling pathway
Bone tissue has the rare capability of scarless self-repair after injury. However, because successful fracture healing requires tight interactions of many cell types and signaling molecules, any disruption of this highly coordinated processes can result in delayed healing or even non-union formation [1]. The rate of fracture healing complications in orthopedic patients is reported to be 5 –20% [2, 3]. Reasons for impaired bone healing are manifold and include inappropriate mechanical stabilization, infection, impaired blood supply, comorbid diseases, advanced age, hormone and nutrition status of the patient, pharmaco...
Source: Injury - November 17, 2020 Category: Orthopaedics Authors: Melanie Haffner-Luntzer Source Type: research

Scaphoid non-union during covid-19 pandemic: Need for a smart strategy
The Covid-19 pandemic has changed our lives as hand surgeons. Working within the hospitals, we are almost completely devoted to trauma and emergency surgery [1]. (Source: Injury)
Source: Injury - November 16, 2020 Category: Orthopaedics Authors: Giulio Fioravanti Cinci Tags: Letter to the editor Source Type: research

Wrist arthroplasty for treatment of infected distal radius nonunion using free vascularised proximal fibular bone graft
Treatment of infected distal radius nonunion is considered a challenge for the orthopaedic surgeon [1 –3]. (Source: Injury)
Source: Injury - November 16, 2020 Category: Orthopaedics Authors: H. Noaman, Y. Sorour, A. Marzouk Source Type: research

Letter regarding “Clinical outcomes and trans-syndesmotic screw frequency after posterior malleolar fracture osteosynthesis”
Dear Editor, (Source: Injury)
Source: Injury - November 16, 2020 Category: Orthopaedics Authors: Norio Yamamoto, Yosuke Tomita PT, Tomoyuki Noda, Kohei Iwamoto, Toshifumi Ozaki Source Type: research

The morphology of ligamentous sacroiliac lesions – challenge to the antero-posterior compression mechanism
Pelvic injuries are common after high-energy blunt trauma. During the late 20th century classification guided management emerged. Numerous classification schemes exist [1]. The Young and Burgess classification [2] considers the vector forces (originally proposed by Pennal et al. in 1980 [3]) responsible for pelvic ring injury. The authors defined the categories AP compression (APC), lateral compression (LC), or vertical shear (VS). This classification has been updated through the years with further examination (the AO/OTA Pelvic Ring fracture classification) [4]. (Source: Injury)
Source: Injury - November 16, 2020 Category: Orthopaedics Authors: A.D. Caterson, D.C. Olthof, C. Abel, Z.J. Balogh Source Type: research

A systematic review of the “Logsplitter” injury: how much do we know?
In recent years, with the rapid development of modern industry, construction and transportation, the incidence of ankle fracture and dislocation caused by the vertical and rotational violence is relatively high. Therein, the ankle trauma combined with distal tibiofibular syndesmotic injury accounts for about 11% - 20% [1-5]. As an emerging proposed type of ankle injury, the concept of logsplitter injury is a unified overview of the ankle fracture and dislocation accompanied by distal tibiofibular syndesmosis separation and displacement [6, 7]. (Source: Injury)
Source: Injury - November 16, 2020 Category: Orthopaedics Authors: Yuan-Wei Zhang, Yun-Feng Rui Tags: Review Source Type: research

Robot-assisted S2 screw fixation for posterior pelvic ring injury
Percutaneous sacroiliac screw is one of the main methods to treat posterior pelvic ring injury. Due to the complicated pelvic anatomy, the probability of malposition of screws under conventional fluoroscopy freehand operation ranges from 2% to 15%1, 2,which may result in neurovascular complications. Meanwhile, upper sacral vertebral body(S1) dysmorphism is widely recognized and the requirement of biomechanical stability is increased, people began to explore the clinical application of second sacral vertebrae(S2) fixation. (Source: Injury)
Source: Injury - November 16, 2020 Category: Orthopaedics Authors: Junqiang Wang, Teng Zhang, Wei Han, KeHan Hua, Xinbao Wu Source Type: research

Upper extremity emergencies during SARS-COV-2 pandemic: turnout trends
On a worldwide scale, on January 30, the World Health Organization (WHO) declared COVID-19 outbreak a public health emergency of international concern [1]. In the absence of a COVID-19 vaccine, governments around the world had to take a number of public health measures to reduce the transmission of the virus and to avoid a massive influx of patients into public hospitals that could overwhelm health systems. In Greece, the first government action was on February 27th following the first three confirmed COVID-19 cases, which was to ban seasonal celebratory parades about to take place on the last weekend of February. (Source: Injury)
Source: Injury - November 16, 2020 Category: Orthopaedics Authors: Apostolos Fyllos, Sokratis Varitimidis, Fotios Papageorgiou, Nikolaos Karamanis, Konstantinos Alexiou, Aikaterini Veloni, Konstantinos Malizos, Zoe Dailiana Source Type: research

A Multicentre Randomized Controlled Trial Comparing Plating with Intramedullary Nailing for Extra-articular Distal Tibial Fractures
Distal tibial fractures, characterised as fractures within 12cm of the tibial plafond, are usually sustained via high-energy mechanisms in which the patient may present with multiple trauma injuries and varying severity of damage to the surrounding tissues [1]. Due to recent advances in a number of surgical management techniques, there is conflicting and inconclusive evidence for the optimal definitive management for such injuries. (Source: Injury)
Source: Injury - November 16, 2020 Category: Orthopaedics Authors: Mr. Muhammad Tahir, Dr. Noman Khan, Mr. Ejaz Ali Chaudhry, Dr. Faridullah Khan Zimri, Dr Nadeem Ahmed, Dr Katherine Rose Watson, Dr Allah Rakhio Jamali, Mr. Ahmad Faraz, Prof. Amer Aziz, Prof Ghulam Mehboob Source Type: research

Prevalence and correlates of single and multiple unintentional non-fatal injuries among school-going adolescents in Liberia
Intentional or unintentional injuries are a major health concern in Liberia, a small low-income country of 4.2 million population located in West Africa [1]. Cause of death by injury (% of total) in Liberia was reported at 10% in 2016 [2]. In Liberia, “injuries contribute to 5.5% of total Disability Adjusted Life Years (DALYs), with 1.2% due to transport injuries and 3.0% due to unintentional injuries.” [1]. Liberia has experienced long periods of conflict resulting in violent injuries [3,4]. No data, however, were found on unintentional inju ry among young people in Liberia. (Source: Injury)
Source: Injury - November 16, 2020 Category: Orthopaedics Authors: Supa Pengpid, Johnson Tekay Hinneh, Karl Peltzer Source Type: research

Burn fluid resuscitation formulae: concept and misconception
Fluid resuscitation is the cornerstone of the early treatment of major burn patients, and has revolutionized burn care since its establishment, due to significant improvements in survival. Several formulae have been proposed since the late 1960s, and the ideal one is still the object of debate, which implies that none of them is perfect. This is unsurprising, as they take into account body weight and body surface area (BSA), but disregard factors that significantly impact fluid requirements, such as depth and mechanism of injury, presence of smoke inhalation injury, delayed fluid resuscitation, previous hydration status, i...
Source: Injury - November 16, 2020 Category: Orthopaedics Authors: Eduardo Gus, Heather Cleland Source Type: research

Scaphoid non-union during Covid-19 pandemic: need for a smart strategy.
The Covid-19 pandemic has changed our lives as hand surgeons. Working within the hospitals, we are almost completely devoted to trauma and emergency surgery [1]. (Source: Injury)
Source: Injury - November 16, 2020 Category: Orthopaedics Authors: Giulio Fioravanti Cinci Source Type: research

Surgical enhancement of fracture healing – operative vs. nonoperative treatment
Treatment options for fractures are numerous, ranging from conservative treatment methods to various internal or external fixation procedures as well as partial or complete joint replacement. Between 2005 and 2013, an increase of 21% in the number of internal fixation procedures was recorded in Germany, partly due to introductions of technical innovations such as locking plates [1,2]. Nevertheless, consensus among surgeons is still lacking as to which fractures and for which patient surgical treatment is beneficial. (Source: Injury)
Source: Injury - November 16, 2020 Category: Orthopaedics Authors: Susanne Baertl, Volker Alt, Markus Rupp Source Type: research

Letter to the editor regarding “The new AO classification system for intertrochanteric fractures allows better agreement than the original AO classification. An inter- and intra-observer agreement evaluation”
To the editor: To classify the intertrochanteric fractures, Ianiv Klaber et al. compared the inter- and intraobserver agreement by using a new AO/OTA classification (2018) or the original AO/OTA classification (1996), revealing that the new classification allowed better agreement than the original version when distinguishing stable from unstable patterns [1]. However, these results should be interpreted with caution. (Source: Injury)
Source: Injury - November 16, 2020 Category: Orthopaedics Authors: Weikun Meng, Zhong Huang, Liang Gao, Guanglin Wang Source Type: research

The Efficacy of Ultrasound for Visualizing Radial Nerve Lesions with Coexistent Plate Fixation of Humeral Shaft Fractures
Radial nerve palsy accompanied by humeral shaft fracture is uncommon in clinical practice, which has been commonly summed up into two categories: primary and secondary.[1] For patients with primary radial nerve palsy (PNP), the loss of nerve function occurs along with the humeral shaft fracture, which is supposed to be caused by initial high-energy trauma.[2, 3] These patients undergo spontaneous neurological recovery within 3-6 months after the initial surgical repair or conservative treatment, and the overall rate of spontaneous recovery ranged approximately from 70% to 80%.[3, 4] Secondary radial nerve palsy (SNP) is ch...
Source: Injury - November 16, 2020 Category: Orthopaedics Authors: Jun Shen, Fangjing Yang, Weimin Chen, Fei Wang, Chunmin Liang, Yanqun Qiu, Wendong Xu Source Type: research

Factors influencing functional outcomes following open reduction internal fixation of acetabular fractures
Acetabular fractures pose complex management challenges to orthopaedic traumatologists. Judet et al. first proposed that open reduction and internal fixation (ORIF) afforded superior results compared to closed management of displaced acetabular fractures [1]. Since then, the role of perioperative factors, including timing to surgery, surgical approach, and quality of articular reduction, have been investigated [2-8]. Despite optimization of surgical timing and technique, outcomes are not uniform, and complications are common, with nearly a quarter of patients experiencing poor clinical results within five years of fixation...
Source: Injury - November 15, 2020 Category: Orthopaedics Authors: Noah M. Joseph, Christopher D. Flanagan, Isabella M. Heimke, Elizabeth Cho, Sahini Pothireddy, Nicholas Scarcella, Heather A. Vallier Source Type: research

Letter to the editor regarding “Posterior tilt in nondisplaced femoral neck fractures increases the risk of reoperations after osteosynthesis. A systematic review and meta-analysis”
We read with interest the article by Nielsen et al. [1] We appreciate the authors ’ efforts to compile the latest systematic review on the posterior tilt of the femoral head for the management of nondisplaced femoral neck fractures. Although the findings are interesting, there are areas of concerns that must be addressed: (Source: Injury)
Source: Injury - November 15, 2020 Category: Orthopaedics Authors: Sheng-hui Wu, Jiong Mei Tags: Letter to the Editor Source Type: research

Pelvic packing and angio-embolization after blunt pelvic trauma: a retrospective 18-year analysis
Pelvic fractures and ring-disruptions in patients who sustained high-energy trauma have the potential to cause severe hemorrhagic shock and death. This is either due to uncontrollable pelvic bleeding in acidotic patients, or due to severe concomitant (neurological) injuries related to the high-energy impact. Despite advancements in hemorrhage control measures for pelvic trauma patients, mortality rates as high as 30 - 40% continue to be reported [1 –4]. (Source: Injury)
Source: Injury - November 15, 2020 Category: Orthopaedics Authors: Dennis Hundersmarck, Falco Hietbrink, Luke P.H. Leenen, Marilyn Heng Source Type: research

Patients ’ first-year adherence to different anti-osteoporotic therapy after hip fractures
The main clinical predictor for osteoporotic fracture is a history of a prior fracture. According to current evidence, one out of ten fracture patients with osteoporosis does not sustain another fracture if he or she is on adequatemedication[1-3]. The incidence of hip fracture has been increasing over time in global populations and hip fracture patients are at high risk of subsequent osteoporotic fractures [4]. Therefore, anti-osteoporosis medication after hip fracture is widely recommended by clinical practice guidelines and medication adherence is essential to maintain bone strength for most patients [5]. (Source: Injury)
Source: Injury - November 15, 2020 Category: Orthopaedics Authors: Seung-Ju Kim, Yun Jae Cho, Dong-Woo Lee Source Type: research

Patella Fracture Fixation with a Non-Locked Anterior Plating Technique: A Biomechanical Study
Patellar fractures account for about 1% of all bony fractures, with the transverse pattern predominating1,2. Non-operative management, partial and total patellectomy, suture fixation, circumferential cerclage wires, tension bands, lag screws, and plates have all been used alone or in combination to manage patella fractures over the year3 –8. Currently, one of the most commonly accepted open reduction and internal fixation method to treat transverse, non-comminuted patellar fractures is the anterior tension band (ATB) technique, which utilizes parallel longitudinal Kirshner wires (K-wires) over which a 14 gauge stainl...
Source: Injury - November 15, 2020 Category: Orthopaedics Authors: Daniel M Elkin, Joseph D Galloway, Mark Adams, Kenneth Koury, Jake J Ni, Mark C Reilly, Michael S Sirkin Source Type: research

The Injury AO ASIF Scientific Supplement: A journey through a history of unforgettable memories
The AO Research Institute (ARI) under the directorship of Prof. S. M. Perren established a collaboration with the Injury Journal in 1991 in order to publish the ‘AO ASIF Scientific Supplement’ (Fig. 1). Stephan M. Perren took responsibility for the Supplement in the role of Consultant Editor and asked me as ARI Translator and Publications Editor to implement the project. Numerous surgeons and researchers were invited to be guest editors including St. A rens, F. Baumgart, F. A. Bonnaire, J. Cordey, A. (Source: Injury)
Source: Injury - November 13, 2020 Category: Orthopaedics Authors: Joy S. Buchanan Source Type: research

Beyond morbidity and mortality: The practicality of measuring patient-reported outcomes in trauma
Over the last 50 years, survival in trauma patients has increased significantly, [1,2] such that over 90% survive to discharge. [3] This improvement, though, has resulted in a larger population of patients facing post-discharge physical and mental impairments after injury [4,5]. Yet, outcomes are generally only tracked to hospital discharge and are often focused solely on mortality. Despite a specific call to collect “comprehensive” data from the point of injury to societal re-entry in the National Academies of Sciences, Engineering, and Medicine's Zero Preventable Deaths report, [6] to date, data collection af...
Source: Injury - November 13, 2020 Category: Orthopaedics Authors: Justin S Hatchimonji, Elinore J Kaufman, Kristen Chreiman, Jordan B Stoecker, Patrick M Reilly, Brian P Smith, Daniel N Holena, Mark J Seamon Source Type: research

The Injury AO ASIF Scientific Supplement: A journey through a history of unforgettable memories.
The AO Research Institute (ARI) under the directorship of Prof. S. M. Perren established a collaboration with the Injury Journal in 1991 in order to publish the ‘AO ASIF Scientific Supplement’ (Figure 1). Stephan M. Perren took responsibility for the Supplement in the role of Consultant Editor and asked me as ARI Translator and Publications Editor to implement the project. Numerous surgeons and researchers were invited to be guest editors including St. Arens, F. Baumgart, F. A. Bonnaire, J. Cordey, A. (Source: Injury)
Source: Injury - November 13, 2020 Category: Orthopaedics Authors: Joy S. Buchanan Source Type: research

A contemporary prospective review of 205 consecutive patients with penetrating colon injuries
Large bowel is the second most frequently injured intra-abdominal (IA) organ after firearm injuries and most commonly injured IA-organ after posterior stab wounds [1-3]. Management of colon injuries has significantly evolved in the recent decades resulting in less extensive surgery and considerably decreased mortality. However, colon related morbidity remains high and many controversies still exist [4-6]. The safety of performing delayed anastomosis following damage control laparotomy for patients on inotropic support has been a subject of intense debate with different strategies and recommendations in recent years [7-10]. (Source: Injury)
Source: Injury - November 13, 2020 Category: Orthopaedics Authors: S. Saar, D. McPherson, A. Nicol, S. Edu, P. Talving, P. Navsaria Source Type: research

1obeyond morbidity and mortality: the practicality of measuring patient-reported outcomes in trauma
Over the last 50 years, survival in trauma patients has increased significantly, [1, 2] such that over 90% survive to discharge. [3] This improvement, though, has resulted in a larger population of patients facing post-discharge physical and mental impairments after injury. [4, 5] Yet, outcomes are generally only tracked to hospital discharge and are often focused solely on mortality. Despite a specific call to collect “comprehensive” data from the point of injury to societal re-entry in the National Academies of Sciences, Engineering, and Medicine's Zero Preventable Deaths report, [6] to date, data collection ...
Source: Injury - November 13, 2020 Category: Orthopaedics Authors: Justin S Hatchimonji, Elinore J Kaufman, Kristen Chreiman, Jordan B Stoecker, Patrick M Reilly, Brian P Smith, Daniel N Holena, Mark J Seamon Source Type: research

A Tribute to Professor Stephan M Perren: ‘A pioneer and visionary man of the AO Foundation’
We are deeply honored to be able to dedicate this special issue of Injury to the late Professor Stephan M Perren (Figure 1). A founding father of the AO Foundation in the 80 ′s Prof Stephan M Perren, died Thursday, November 21, 2019 at the age of 87 in Davos, Switzerland. (Source: Injury)
Source: Injury - November 13, 2020 Category: Orthopaedics Authors: Peter V Giannoudis, Geoff R. Richards Tags: Editorial Source Type: research

Assessment of intra-operative surgical performance: proof of concept of complete intra-operative image documentation in orthopaedic trauma.
The surgeon's skill is one of the main success factors in surgery.1,2 Intra-operative technical performance quality can correlate with the amount of caseload3 and can vary from one surgeon to another or from one day to another for the same surgeon.4-7 Different levels of technical performance in a clinical study, while ideally should be avoided, one can argue that should be at least recognizable. Written reports and selected x-rays without intraoperative images do not guarantee homogeneity of technical quality within one group and do not permit secondary analysis and comparison with other treatment groups. (Source: Injury)
Source: Injury - November 13, 2020 Category: Orthopaedics Authors: Regazzoni P, Fernandez A, Perren SM Source Type: research

Adoption of direct discharge of simple stable injuries amongst (orthopaedic) trauma surgeons
Approximately one third of all musculoskeletal injuries diagnosed in the Emergency Department (ED) are simple stable injuries (SSI's) with excellent prognosis.[1] Over the past few years, the added value of follow-up of patients with these injuries has been open to question. Several randomized trials show casting offers no benefit over functional treatment for fifth metacarpal neck fractures,[2,3] torus distal radius fractures [4] and minimally displaced distal radius fractures. [5,6] Several cohort studies show minimally displaced proximal fifth metatarsal fractures [7], radial head and neck fractures [8], and non-displac...
Source: Injury - November 11, 2020 Category: Orthopaedics Authors: T.H. Geerdink, B.A. Uijterwijk, D.T. Meijer, I.N. Sierevelt, W.H. Mallee, R.N. van Veen, J.C. Goslings, R. Haverlag Source Type: research

Periprosthetic femoral re-fractures pathogenesis, classification, and surgical implications
Periprosthetic femoral fractures (PFFs) are an emerging problem in daily clinical practice, because of the general population ageing and the increasing number of total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedures performed [1]. Therefore, in the last decades, a widening of the surgical indications to TKAs and THAs has been observed[2]. (Source: Injury)
Source: Injury - November 11, 2020 Category: Orthopaedics Authors: Vicenti Giovanni, Bizzoca Davide, Solarino Giuseppe, Carrozzo Massimiliano, Belluati Alberto, D Arienzo Antonio, De Carolis Oronzo, Moretti Biagio Source Type: research

Fracture nonunion in long bones: A literature review of risk factors and surgical management
Nonunion is thought to occur in approximately 2% of all fractures (1) but for diaphyseal fractures the incidence can be as high as 20% for certain injuries (2). The incidence of nonunion in the U.K. is estimated at 20 per 100,000 population with males of the working age being the most common group (3). The burden of a long bone nonunion is substantial with pain, loss of function and psychological distress commonly encountered (4). The financial implications can often be extensive for patients due to loss of potential earnings and with an estimated medical expense of up to £79,000 per case being reported (1,5). (Source: Injury)
Source: Injury - November 11, 2020 Category: Orthopaedics Authors: JA Nicholson, N Makaram, JF Keating, AHRW Simpson Source Type: research

Trauma-registry survival outcome follow up: 30 days is mandatory and appears sufficient
The quality evaluation of care for severely injured patients utilizes data from trauma registries. A common outcome definition in trauma-registry studies is the 30-day in-hospital mortality [1]. The adequacy of this outcome measure in benchmarking has been challenged, as deaths after hospital discharge before 30 days or late deaths beyond 30 days since the injury are not included. Trauma registries, with some exceptions, do not follow up patients after discharge. Thus, information on mortality after initial hospitalization is usually missing. (Source: Injury)
Source: Injury - November 10, 2020 Category: Orthopaedics Authors: T. Brinck, M. Hein änen, L. Handolin, T. Söderlund Source Type: research

New concepts in the surgical treatment of actual and impending pathological fractures in metastatic disease
The musculoskeletal system is the third site of metastases after liver and lung [1-3]. Long bone metastases are a disease of high social importance for frequency and impact on patients' prognosis and quality of life. Their incidence is continuously increasing due to early diagnosis and increased cancer patients' survival thanks to secondary prevention and improvements in cancer treatments [4-8]. Moreover, metastases in long bones can cause pain and be complicated with Skeletal Related Events (SRE), such as actual or impending pathological fractures [9-12]. (Source: Injury)
Source: Injury - November 10, 2020 Category: Orthopaedics Authors: Alessandro Cappellari, Giulia Trovarelli, Alberto Crim ì, Elisa Pala, Andrea Angelini, Antonio Berizzi, Pietro Ruggieri Source Type: research

Elbow hemiarthroplasty in distal humeral fractures: indication, surgical technique and results
Although the Elbow Hemiartrhoplasty (EHA) are used as salvage procedure following failed open reduction and internal fixation, nonunion or malunion, avascular necrosis of the articular surface, the most common indication is for the treatment of acute articular fractures of the distal humerus 1 –11. (Source: Injury)
Source: Injury - November 9, 2020 Category: Orthopaedics Authors: Roberto Rotini, Marco Ricciarelli, Enrico Guerra, Alessandro Marinelli, Andrea Celli Source Type: research

Enhancement of in vivo supraspinatus tendon –to-bone healing with an alginate-chitin scaffold and rhBMP-2
: Rotator cuff disorders present a high retear rate despite advances in surgical treatment. Tissue engineering could therefore be interesting in order to try to enhance a more biological repair. RhBMP-2 is one of the most osteogenic growth factors and it also induces the formation of collagen type I. However, it has a short half-life and in order to get a more stable release over time it could be integrated in a more slowly degradable carrier, such as an alginate-chitin scaffold. The aim of this study was to investigate the role of the alginate-chitin scaffold alone and in combination with different concentrations of rhBMP...
Source: Injury - November 9, 2020 Category: Orthopaedics Authors: Camilla Arvinius, Ana Civantos, Cruz Rodr íguez-Bobada, Francisco Javier Rojo, Daniel Pérez-Gallego, Yaiza Lopiz, Fernando Marco Source Type: research

Proximal humerus exposure with the inverted-L anterolateral deltoid flip approach, anterolateral deltoid splitting approach, and deltopectoral approach: A comparative cadaveric study
Incidence of proximal humeral fractures is approximately 5% of all fractures.[1] Three-part or four-part proximal humeral fractures in elderly patients can be treated successfully with nonoperative means, and long-term clinical outcomes, but not radiographic outcomes, are comparable with surgically treated patients because of the low demands of the group's daily living activity.[2] Affected shoulder range of motion recovery after nonoperative treatment was about 50-70% of the uninjured shoulder, which might not be adequate for a young, active population, especially if the affected side is dominant. (Source: Injury)
Source: Injury - November 9, 2020 Category: Orthopaedics Authors: Norachart Sirisreetreerux, Nachapan Pengrung, Theerachai Apivatthakakul Source Type: research

Assessment of fracture healing in orthopaedic trauma
Fracture healing is a complex physiologic process, relying on the crucial interplay between biological and mechanical factors, that finally results in the “restitutio ad integrum” of the injured bone [1,2]. Two different types of bone healing have been classically described, i.e. direct and indirect fracture healing [3].  Direct fracture healing typically occurs in fractures undergoing anatomical reduction and stable fixation, often achieved with plates and inter-fragmentary screws [4]. In relative stability constructs and in fractures conservatively managed, on the other hand, indirect bone healing is the...
Source: Injury - November 7, 2020 Category: Orthopaedics Authors: Davide Bizzoca, Giovanni Vicenti, Vincenzo Caiaffa, Antonella Abate, Oronzo De Carolis, Massimiliano Carrozzo, Giuseppe Solarino, Biagio Moretti Source Type: research

nAssessment of fracture healing in orthopaedic trauma
Fracture healing is a complex physiologic process, relying on the crucial interplay between biological and mechanical factors, that finally results in the “restitutio ad integrum” of the injured bone [1,2]. Two different types of bone healing have been classically described, i.e. direct and indirect fracture healing [3]. Direct fracture healing typically occurs in fractures undergoing anatomical reduction and stable fixation, often achieved with p lates and inter-fragmentary screws [4]. In relative stability constructs and in fractures conservatively managed, on the other hand, indirect bone healing is the prev...
Source: Injury - November 7, 2020 Category: Orthopaedics Authors: Bizzoca Davide, Vicenti Giovanni, Caiaffa Vincenzo, Abate Antonella, De Carolis Oronzo, Carrozzo Massimiliano, Solarino Giuseppe, Moretti Biagio Source Type: research

Instant intra-operative neutropenia despite the emergence of banded (CD16dim/CD62Lbright) neutrophils in peripheral blood - an observational study during extensive trauma-surgery in pigs
Surgical intervention activates the innate immune system. A local immune response following tissue damage is mandatory to stimulate wound healing and to prevent infection. However, in the case of extensive surgery this immune reaction is not restricted to the surgical site, but rather stimulates a systemic inflammatory response syndrome (SIRS) [1,2]. Polymorphonuclear neutrophils (PMNs) are important effector cells in both local and systemic early responses to tissue damage. Neutrophils are equipped with several mechanisms to protect the host from harmful pathogens [3,4]. (Source: Injury)
Source: Injury - November 6, 2020 Category: Orthopaedics Authors: Michel Teuben, Marjolein Heeres, Taco Blokhuis, Arne Hollman, Nienke Vrisekoop, Edward Tan, Roman Pfeifer, Hans-Christoph Pape, Leo Koenderman, Luke P.H. Leenen Source Type: research

The choice between allograft or demineralized bone matrix is not unambiguous in trauma surgery
Fracture surgery is regularly challenged by the presence of bone defects, reduced mechanical stability, and a lack of bone healing, wherein bone substitutes can be useful. Bone autograft is the gold standard, but has side effects from donor sites and is less useful when there is a need for larger amounts [1,2]. The alternatives are allograft and demineralised bone matrix (DBM), where there are no similar limitations in volume and no association with the same comorbidities as autograft [3]. Allograft bone is harvested from an individual different from the recipient, and DBM is a commercial and processed derivate from allogr...
Source: Injury - November 6, 2020 Category: Orthopaedics Authors: Ole Brink Source Type: research