Cling Wrap Technique: An Inexpensive and Simple Way to Seal Negative Pressure Wound Therapy on External Fixation Devices
Summary: Negative pressure therapy is often applied to treat limb traumas with or without bone exposure. However, sealing a negative pressure dressing in the presence of an external fixation device may be complicated and time consuming. In this technique, we attempted to maintain vacuum conditions by preventing air leakage around the screws using plastic drape and cling wrap as the final layer over the external fixation device. To prevent rupturing of the wrap, the prominences of the pins and rods were covered using cotton wool roll. This novel solution is also effective for complex and extended wounds, with no need fo...
Source: Journal of Orthopaedic Trauma - September 23, 2021 Category: Orthopaedics Tags: Technical Trick Source Type: research

A Machine Learning Algorithm to Identify Patients at Risk of Unplanned Subsequent Surgery After Intramedullary Nailing for Tibial Shaft Fractures
Conclusions: An ML algorithm was developed to predict the probability of subsequent surgery after IMN for TSFs. This ML algorithm may assist surgeons to inform patients about the probability of subsequent surgery and might help to identify patients who need a different perioperative plan or a more intensive approach. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - September 23, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

Incidence of Surgical Site Infections and Acute Kidney Injuries After Topical Antibiotic Powder Application in Orthopaedic Trauma Surgery
Conclusion: There was no detectable difference, with wide confidence intervals, in SSI and AKI between the topical antibiotic and control groups. Further studies need to be conducted to evaluate the relationship between topical antibiotics and clinical outcomes in orthopaedic trauma surgery. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - September 23, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

Complications and Soft-Tissue Coverage After Complete Articular, Open Tibial Plafond Fractures
Objectives: To evaluate the incidence of nonunion and wound complications after open, complete articular pilon fractures. Second, to study the effect that both timing of fixation and timing of flap coverage have on deep infection rates. Design: Retrospective case series. Setting: Three Academic Level 1 Trauma Centers. Patients: One hundred sixty-one patients with open OTA/AO type 43C distal tibia fractures treated with open reduction internal fixation (ORIF) between 2002 and 2018. The mean (SD) age was 46 (14) years, 70% male, with median (interquartile range) follow-up of 2.1 (1.3–5.0) years...
Source: Journal of Orthopaedic Trauma - September 23, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

Gunshot Fractures of the Forearm: A Multicenter Evaluation
Conclusions: Open fractures of the forearm from GSWs are serious injuries that carry high rates of nonunion and infection. Fractures with significant bone defects are at an increased risk of nonunion and should be treated with stable fixation and proper soft-tissue handling. Ulna fractures are at a particularly high risk for deep infection and septic nonunion and should be treated aggressively. Forearm fractures from GSWs should be followed until union to identify long-term complications. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence. (Sourc...
Source: Journal of Orthopaedic Trauma - September 23, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

Outpatient Surgical Fixation of Proximal Humerus Fractures Can Be Performed Without Increased Rates of Short-Term Complications or Readmissions
Objective: To delineate differences in short-term complications between outpatient versus inpatient open reduction and internal fixation (ORIF) of proximal humerus fractures. Design: Retrospective database review. Setting: Hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program database. Patients: Patients in the National Surgical Quality Improvement Program database with proximal humerus fractures from 2005 to 2017. Intervention: Proximal humerus fracture ORIF. Main Outcome Measurements: Thirty-day readmission, reoperation, thromboemb...
Source: Journal of Orthopaedic Trauma - September 23, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

Predicting the Behavior of Humeral Shaft Fractures: An Independent Validation Study of the Radiographic Union Score for HUmeral Fractures and Value of Assessing Fracture Mobility
Conclusion: The RUSHU score and clinical assessment of fracture mobility are effective and valid tools in identifying patients at risk of developing nonunion of humeral shaft fractures and can enhance early decision making in fracture management. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - September 23, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

Does Provisional Minifragment Fixation Prevent Compression With Dynamic Compression Plating? A Biomechanical Analysis
Conclusion: Provisional minifragment fixation does not have any adverse effect on the forces generated during compression plating. These findings suggest that provisional minifragment plates do not need to be removed before definitive fixation. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - September 23, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

Monitored Anesthesia Care and Soft-Tissue Infiltration With Local Anesthesia: An Anesthetic Option for High-Risk Patients With Hip Fractures
Conclusions: This feasibility study demonstrates safety for the MAC-STILA protocol with comparison to spinal and general anesthesia. The MAC-STILA protocol is a viable option for treatment of OTA/AO 13.A1-3 intertrochanteric fractures with a short cephalomedullary nail and may be the preferred method for patients with severe medical comorbidities or relative contraindications to general and/or spinal anesthesia. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of Levels of Evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - September 23, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

Debate Update: Surgery After 48 Hours of Admission for Geriatric Hip Fracture Patients Is Associated With Increase in Mortality and Complication Rate: A Study of 27,058 Patients Using the National Trauma Data Bank
Objective: To determine the association between surgical timing and short-term morbidity and mortality in elderly patients who sustain hip fractures using a national trauma database (OTA/AO 31A1-3, 31B1-3). Design: Retrospective cohort study. Setting: Level I–IV trauma centers in the United States. Patients/Participants: All patients ≥65 years of age who underwent surgery for hip fracture from 2011 to 2013. Intervention: Time to surgery of 48 hours from admission. Main outcome measurements: Primary outcome was mortality by hospital discharge. Secondary outcomes were complicat...
Source: Journal of Orthopaedic Trauma - September 23, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

Femoral Neck Shaft Angle and Management of Proximal Femur Fractures: Is the Contralateral Femur a Reliable Template?
Conclusions: There is no significant variability between bilateral femora in males and females. Use of this measurement method and contralateral NSA for proximal femur fracture planning is supported. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - September 23, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

Gluteus Minimus Debridement During Acetabular Fracture Surgery Does Not Prevent Heterotopic Ossification—A Comparative Study
Conclusion: GMM debridement was not associated with a decreased incidence of HO after acetabular fracture surgery. American Society of Anesthesiologists class is a novel risk factor associated with severe HO formation. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - September 23, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

Smith–Petersen Versus Watson–Jones Approach Does Not Affect Quality of Open Reduction of Femoral Neck Fracture
Objective: To compare immediate quality of open reduction of femoral neck fractures by alternative surgical approaches. Design: Retrospective cohort study. Setting: Twelve Level 1 North American trauma centers. Patients: Eighty adults 18–65 years of age with isolated, displaced, OTA/AO type 31-B2 or -B3 femoral neck fractures treated with internal fixation. Intervention: Thirty-two modified Smith–Petersen anterior approaches versus 48 Watson–Jones anterolateral approaches for open reduction performed by fellowship-trained orthopaedic trauma surgeons. Main outcome: Re...
Source: Journal of Orthopaedic Trauma - September 23, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

Combined Orthopaedic and Vascular Injuries With Ischemia: A Multicenter Analysis
Conclusions: In this series of combined orthopaedic and vascular injuries, we found a high rate of acute and late amputations. It is possible that other protocols, such as shunting and stabilizing the osseous injury, before vascular repair may benefit limb salvage, although this needs more study. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - September 23, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

A Systematic Review and Analysis of the Quality of Randomized Controlled Trials Comparing Infrapatellar and Suprapatellar Approach for Nailing of Tibial Fractures
Conclusions: RCTs are historically regarded as the gold standard for establishing principles of evidence-based medicine. However, our evaluation of the evidence shows that though they followed the Oxford LOE, RCTs were considered poor by the other 2 methods. The majority of studies that were included in our review were considered poor using the Modified Coleman and CONSORT systems. Half the articles supported suprapatellar tibial nailing over the infrapatellar approach, whereas other half demonstrated equivocal results between the 2 techniques. This study highlights the importance of evaluating studies judiciously rega...
Source: Journal of Orthopaedic Trauma - September 23, 2021 Category: Orthopaedics Tags: Review Article Source Type: research

Introduction—JOT Care Controversies
No abstract available (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - September 23, 2021 Category: Orthopaedics Tags: Introduction Source Type: research

In response
No abstract available (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - August 26, 2021 Category: Orthopaedics Tags: Letters to the Editor Source Type: research

Letter to the Editor on “Does the Helical Blade Lead to Higher Rates of Fixation Failure as Compared to Lag Screw in the Cephalomedullary Nailing Treatment of Hip Fractures? A Systematic Review and Meta-analysis”
No abstract available (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - August 26, 2021 Category: Orthopaedics Tags: Letters to the Editor Source Type: research

Technique for Removal of Broken InterTAN Integrated Cephalomedullary Screw
We present a case of a broken nail as well as a broken integrated screw, and describe a technique for successful implant removal. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - August 26, 2021 Category: Orthopaedics Tags: Technical Trick Source Type: research

An Economic Analysis of Direct Costs of Distal Radius Fixation and the Implications of a Disposable Distal Radius Kit
Conclusions: Eighty-three percent of the surgically treated distal radius fractures were treated with VP fixation alone. A disposable kit could help limit cost variance per case by roughly 22%, as only ancillary fixation varies these costs. Closed fractures and extra-articular fractures in older patients or female patients are more amenable to VP fixation alone. Level of Evidence: Economic Level III. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - August 26, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

Splint Padding Thickness: Temperature Effects and X-ray Visualization
Conclusions: Padding thickness can be consistently determined on X-ray. We determined that at least 2 layers of Webril significantly decrease temperature change at the level of the skin caused by plaster curing. Two layers of Webril can be identified on X-ray by measuring at least 1 mm of padding. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - August 26, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

The Anatomic Relevance of the Iliopectineal Fascia for Acetabular Surgery
Conclusions: The anatomic variants of the attachment of the IPF to the pelvic brim and its variants in relation to the external iliac vessels must be accounted for when performing acetabular surgery to prevent vascular injury and attain adequate exposure. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - August 26, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

Reconstruction of Septic Tibial Bone Defects With the Masquelet Technique and External Ring Fixation—A Low Healing Rate and High Complication and Revision Rates
Conclusions: The combination of the Masquelet technique and external fixation yielded a low healing rate and was associated with a significant number of cases of treatment failure. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - August 26, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

Defining the Mean Angle of Diaphyseal Long Bone Nonunions—Does Shear Prevail?
Conclusions: This study demonstrates the mean angle of diaphyseal nonunions from long bones of the lower limb approaches 45 degrees. This is noted in all types of fractures and is irrespective of anatomic location or sex. This confirms the hypothesis that shear is likely to play a role in the development of a nonunion. This study provides further evidence that nonunions occur primarily because of mechanical instability. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - August 26, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

Healing the Index Tibial Nonunion: Risk Factors for Development of a Recalcitrant Nonunion in 222 Patients
Conclusions: Internal fixation remains a successful method of treatment for most tibial nonunions. However, 27% of patients required a subsequent intervention because of failure to heal our index nonunion procedure. Factors that are associated with recalcitrant nonunions were a grade III open fracture, compartment syndrome, deep infection, and 2 or more or more prior surgical procedures. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - August 26, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

Single-Stage Versus 2-Stage Bilateral Intramedullary Nail Fixation in Patients With Bilateral Femur Fractures: A Multicenter Retrospective Review
Conclusions: This is the largest multicenter study to date evaluating the outcomes between single- and 2-stage IMN fixation for bilateral femoral shaft fractures. Single-stage bilateral femur IMN may decrease rates of ARDS in polytrauma patients who are able to undergo simultaneous definitive fixation. However, a future prospective study with standardized protocols in place will be required to discern whether single- versus 2-stage fixation has an effect on mortality and to identify those individuals at risk. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of lev...
Source: Journal of Orthopaedic Trauma - August 26, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

Does Malrotation After Minimally Invasive Plate Osteosynthesis Treatment of Distal Tibia Metaphyseal Fractures Effect the Functional Results of the Ankle and Knee Joints?
Conclusions: Despite high rates of malrotation after tibial metaphyseal–diaphyseal fractures treated with MIPO technique, this finding does not seem to have a significantly negative effect on knee and ankle joint functions. Meticulous intraoperative evaluation, through a range of different techniques, should be performed to avoid malrotation. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - August 26, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

Commentary on: ‟Diagnosing Fractures of the Distal Tibial Articular Surface in Tibia Shaft Fractures: Is Computed Tomography Always Necessary?”
No abstract available (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - August 26, 2021 Category: Orthopaedics Tags: Invited Commentary Source Type: research

Diagnosing Fractures of the Distal Tibial Articular Surface in Tibia Shaft Fractures: Is Computed Tomography Always Necessary?
Conclusions: CT scans performed on distal third tibia shaft fractures in search of articular fractures had a low yield (23%). Widespread use of CT scan to diagnose fractures of the distal tibia articular surface in the setting of distal tibia shaft fractures does not seem warranted. No statistically significant differences in RIDEFAST ratios were found between fractures with and without articular involvement, indicating that more work is necessary before RIDEFAST can be used to reliably rule out articular involvement in this setting. Level of Evidence: Diagnostic Level III. See Instructions for Authors for a com...
Source: Journal of Orthopaedic Trauma - August 26, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

External Validation of the Radiographic Investigation of the Distal Extension of Fractures Into the Articular Surface of the Tibia (RIDEFAST Study)
Conclusion: The FTP ratio is an effective and externally validated screening tool to rule out DIA in distal tibia shaft fractures. Level of Evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - August 26, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

Predicting Syndesmotic Injury in OTA/AO 44-B2.1 (Danis–Weber B) Fractures
Objective: To establish if preoperative radiographs could predict the rate of syndesmotic injury. Setting: Level 1 trauma center. Design: Retrospective cohort study. Patients/Participants: There were 548 OTA/AO 44-B2.1 fractures that were reviewed, and 287 patients were included in the study. Main Outcome Measurements: Ankle radiographs were used to determine the zone of distal extent of the proximal fracture fragment. Syndesmotic injury was defined as positive intraoperative stress examination that required syndesmotic fixation. Results: There were 191 zone 1 (ending below the plafon...
Source: Journal of Orthopaedic Trauma - August 26, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

Commentary on: “In Situ Placement Versus Anterior Transposition of the Ulnar Nerve for Distal Humerus Fractures Treated With Plate Fixation: A Multicenter Randomized Controlled Trial”
No abstract available (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - August 26, 2021 Category: Orthopaedics Tags: Invited Commentary Source Type: research

In Situ Placement Versus Anterior Transposition of the Ulnar Nerve for Distal Humerus Fractures Treated With Plate Fixation: A Multicenter Randomized Controlled Trial
Objectives: To compare clinical scores and electrodiagnostic evidence of ulnar neuropathy, between ulnar nerve mobilization and placement back in the cubital tunnel versus anterior transposition, during plate and screw fixation of a bicolumnar fracture of the distal humerus. Design: Multicenter randomized controlled trial. Setting: Eight tertiary care centres in Canada. Patients: Fifty-eight patients with distal humerus fractures undergoing plate fixation of both columns were recruited and randomized. Intervention: All patients underwent bicolumnar plate fixation for an acute, displaced frac...
Source: Journal of Orthopaedic Trauma - August 26, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

Evolution in the Acute Management of Open Fracture Treatment? Part 2
Introduction: In the first installment of this two-part series, we explored the history of open fracture treatment focusing primarily on bacteriology and antibiotic selection/stewardship. In this follow-up segment, we will analyze and summarize the other aspects of open fracture care such as time to debridement, pulsatile lavage, and open wound management (including time to closure)—finishing with summative statements and recommendations based on the current most up-to-date literature. Level of Evidence: Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence. (So...
Source: Journal of Orthopaedic Trauma - August 26, 2021 Category: Orthopaedics Tags: Review Article Source Type: research

Evolution in the Acute Management of Open Fracture Treatment? Part 1
Introduction: Despite decades of advancement in wound debridement, prophylactic antibiotic therapy, fracture stabilization, and soft tissue reconstruction, infection remains a serious complication after open fracture. Inconclusive historical data and new challenges with resistant organisms and antimicrobial stewardship having created a difficult environment within which to develop sound, evidence-based treatment protocols that can be applied universally. The first part of this 2-part series will synthesize the historical perspective along with the current concepts surrounding bacteriology and antibiotic use/stewardship...
Source: Journal of Orthopaedic Trauma - August 26, 2021 Category: Orthopaedics Tags: Review Article Source Type: research

In Response
No abstract available (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - July 22, 2021 Category: Orthopaedics Tags: Letters to the Editor Source Type: research

Letter to the Editor on “Medical School or Provider School”
No abstract available (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - July 22, 2021 Category: Orthopaedics Tags: Letters to the Editor Source Type: research

Intramedullary Antibiotic Depot Does Not Preclude Successful Intramedullary Lengthening or Compression
We present a combined technique to treat or prevent infection using femoral or tibial intramedullary antibiotic delivery with an absorbable calcium sulfate depot and concomitant internal lengthening or compression using a nail. Adequate débridement is required in cases of established infection and is a prerequisite for this technique. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - July 22, 2021 Category: Orthopaedics Tags: Technical Trick Source Type: research

Efficacy of PRECICE Nail in Treatment of Adult Patients With Posttraumatic Femoral Leg Length Discrepancy
Summary: Posttraumatic, limb length discrepancy in adults is a challenge to treat, and multiple treatment protocols over the years have shown varying levels of success and complications. Before the introduction of the PRECICE nail in 2011, our preferred method of limb lengthening used an Ilizarov or Taylor Spatial frame. To assess the PRECICE nail, we evaluated the accuracy and complications during treatment in a series of skeletally mature patients with posttraumatic femoral limb length discrepancy. The surgical technique along with a case series of 8 patients are described in detail. On average, the target lengthenin...
Source: Journal of Orthopaedic Trauma - July 22, 2021 Category: Orthopaedics Tags: Technical Trick Source Type: research

Compartment Syndrome in Children With a Supracondylar Fracture: Not Everyone has Risk Factors
Objectives: To clarify the incidence, associated conditions, and timing of fasciotomy for compartment syndrome (CS) in children with a supracondylar (SC) fracture of the humerus. Design: A retrospective trauma system database study. Setting: Accredited trauma centers in Pennsylvania. Patients: A statewide trauma database was searched for children 2–13 years of age admitted with a SC fracture between January 2001 and December 2015. Four thousand three hundred eight children met inclusion criteria. Intervention: Treatment of a SC fracture. Main Outcome Measurement: Diagnosis of CS...
Source: Journal of Orthopaedic Trauma - July 22, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

A Biomechanical Comparison of Trochanteric Versus Piriformis Reconstruction Nails for Femoral Neck Fracture Prophylaxis
Conclusions: A piriformis fossa entry site with or without an intramedullary implant weakens the femoral neck in load to failure testing. A greater trochanteric entry yields a load to failure equivalent to that of an intact femoral neck. Instrumentation with a greater trochanteric cephalomedullary nail is significantly stronger than a piriformis fossa cephalomedullary nail during axial loading in a composite femur model. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - July 22, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

Validation of Relative Motion Measurement Method of Lateral Compression Pelvic Fractures During Examination Under Anesthesia
Objectives: To determine if the relative distance between the acetabular teardrops on unstressed and lateral compressive stress examination under anesthesia (EUA) pelvic fluoroscopic images is reproducible between independent reviewers. Design: Retrospective database review. Setting: Level 1 trauma center. Patients/Intervention: Fifty-eight patients with a lateral compression type 1 pelvic ring injury who underwent EUA. Main Outcome Measure: Validation of EUA objective measurements between blinded, independent reviewers using interclass and intraclass correlation coefficients. Results: ...
Source: Journal of Orthopaedic Trauma - July 22, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

Quantitative Evaluation of Embolic Load in Femoral and Tibial Shaft Fractures Treated With Reamed Intramedullary Fixation
Objectives: To compare the volume of embolic load during intramedullary fixation of femoral and tibial shaft fractures. Our hypothesis was that tibial intramedullary nails (IMNs) would be associated with less volume of intravasation of marrow than IM nailing of femur fractures. Design: Prospective observational study. Setting: Urban Level I trauma center. Patients/Participants: Twenty-three patients consented for the study: 14 with femoral shaft fractures and 9 with tibial shaft fractures. Intervention: All patients underwent continuous transesophageal echocardiography, and volume of embolic...
Source: Journal of Orthopaedic Trauma - July 22, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

Large Individual Bilateral Differences in Tibial Torsion Impact Accurate Contralateral Templating and the Evaluation of Rotational Malalignment
Objective: To determine individual bilateral differences (IBDs) in tibial torsion in a diverse population. Methods: Computed tomography scans of uninjured bilateral tibiae were used to determine tibial torsion and IBDs in torsion using 4 measurement methods. Age, sex, and self-identified race/ethnicity were also recorded for each subject. Mean tibial torsion and IBDs in torsion were compared in the overall cohort and when stratified by sex and race/ethnicity. Simple and multiple linear regression models were used to correlate demographic variables with tibial torsion and IBDs in torsion. Results: One hund...
Source: Journal of Orthopaedic Trauma - July 22, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

Outcomes of Patients With Nonunion After Open Tibial Shaft Fractures With or Without Soft Tissue Coverage Procedures
Conclusions: Utilization of soft tissue flaps in the setting of open tibia shaft nonunion repair surgery are associated with a high union rate (>90%). Coverage with or manipulation of soft tissue flaps did not result in improved bony healing rate or time to union compared with those who did not require flaps. However, soft tissue flap coverage was associated with higher functional scores at long-term follow-up. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - July 22, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

Randomized Controlled Trial Comparing Silver-Impregnated Fibrous Hydrocolloid Dressings With Silver Sulfadiazine Cream Dressings for the Treatment of Fracture Blisters to Determine Time to Surgical Readiness
Objectives: To investigate, in patients with fracture blisters, the time to surgical readiness in those treated with silver-impregnated fibrous hydrocolloid (SFH) dressings compared with those treated with topical silver sulfadiazine (SS) cream and to determine the direct costs associated with both treatments. Design: A single-blind, randomized controlled trial. Setting: The study was conducted at Tygerberg Hospital, a tertiary care facility, and Worcester Provincial Hospital, a secondary care facility, Western Cape, South Africa. Patients: Patients>18 years of age with one or more fracture blis...
Source: Journal of Orthopaedic Trauma - July 22, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

National Metrics Improved Timeliness of Antibiotic Administration for Open Extremity Fractures
Conclusions: Metrics developed and measured by a physician-led national organization led to practice changes at our hospital. Tracking of antibiotic timing for open fracture treatment was more effective than institutional education of healthcare providers alone. This study suggests that nationally published guidelines, developed and measured by physician leaders, will be found to be relevant by other physicians and can be a powerful tool to drive change. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - July 22, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

Timing of Flap Coverage With Respect to Definitive Fixation in Open Tibia Fractures
Objectives: We conducted a large, U.S wide, observational study of type III tibial fractures, with the hypothesis that delays between definitive fixation and flap coverage might be a substantial modifiable risk factor associated with nosocomial wound infection. Design: A retrospective analysis of a multicenter database of open tibial fractures requiring flap coverage. Setting: Fourteen level-1 trauma centers across the United States. Patients: Two hundred ninety-six (n = 296) consecutive patients with Gustilo III open tibial fractures requiring flap coverage at 14 trauma centers were retrospectivel...
Source: Journal of Orthopaedic Trauma - July 22, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

Anterior Minimally Invasive Plate Osteosynthesis for Humeral Shaft Fractures Is Safer Than Open Reduction Internal Fixation: A Matched Case-Controlled Comparison
Conclusions: The cumulative complication rate was 10 times higher after ORIF of humeral shaft fractures compared with the MIPO technique. MIPO achieved nearly equivalent radiographic alignment, with no clinically meaningful differences observed. MIPO is the safer option and should be considered for patients with humeral shaft fractures that would benefit from surgical intervention. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - July 22, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

Open Reduction and Internal Fixation for Humeral Shaft Nonunion: Bone Grafting Is Not Routinely Required and Avoids Donor Site Morbidity
Conclusions: ORIF for humeral diaphyseal nonunion was associated with a high rate of union. Routine BG was not required and avoided the risk of donor site morbidity. One in 5 patients were dissatisfied despite the majority achieving union. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - July 22, 2021 Category: Orthopaedics Tags: Original Article Source Type: research