A Percutaneous Threaded Wire as a Clamp Technique for Avoiding Wedge Deformity While Nailing Intertrochanteric Femur Fractures
Summary: Hip fractures are common injuries managed by the orthopaedic surgeon, and within the umbrella of hip fractures, intertrochanteric femur fractures constitute a significant portion of these injuries. Recent trends have shown an increased usage of cephalomedullary nails for these injuries. A known potential complication of this technique is the generation of a wedge deformity creating a varus alignment, especially when the cranial portion of the intertrochanteric fracture exits at or near the starting point of the nail. Although the biomechanics of this phenomenon are well described, few reports have shown techniqu...
Source: Journal of Orthopaedic Trauma - June 20, 2019 Category: Orthopaedics Tags: Technical Trick Source Type: research

Ligamentous Lisfranc Injury: A Biomechanical Comparison of Dorsal Plate Fixation and Transarticular Screws
Objectives: Optimal fixation technique after purely ligamentous Lisfranc injury remains controversial. This biomechanical study compares dorsal plate versus transarticular screw fixation by measuring dorsal and plantar joint diastasis. A unique protocol was developed, using reflective triad markers and positional cameras. Methods: Eleven cadaveric matched pairs were assigned to either transarticular screw or dorsal plate fixation. Two reflective triad markers were placed into the medial cuneiform (C1) and second metatarsal base (MT2). Three cameras recorded the 3-dimensional location of triads to quantify C1-MT2 diast...
Source: Journal of Orthopaedic Trauma - June 20, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

Uncemented Reverse Total Shoulder Arthroplasty as Initial Treatment for Comminuted Proximal Humerus Fractures
Conclusions: Our data show that treatment of comminuted PHFs in elderly patients with uncemented RTSA can consistently produce good clinical outcomes with a low rate of complications and suggest that cement may not be necessary for RTSA in the trauma setting. 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 - June 20, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

A Systematic Review and Standardized Comparison of Available Evidence for Outcome Measures Used to Evaluate Proximal Humerus Fracture Patients
Conclusions: Evidence on the measurement properties of outcome measures for proximal humerus fracture patients is limited. With the available evidence, the SFINX is recommended as a clinician-measured functional outcome measure, the DASH as a patient-reported functional outcome measure, and the EQ5D as a general health status measure. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - June 20, 2019 Category: Orthopaedics Tags: Review Article Source Type: research

Sternoclavicular Joint Dislocation: A Systematic Review and Meta-analysis
Objectives: This meta-analysis was performed to answer the following questions: (1) What is the expected outcome of sternoclavicular (SC) dislocations left untreated? (2) What are the indications for closed reduction of SC dislocations? (3) What are the indications for open reduction of SC dislocations? and (4) Does the evidence support the need for a cardiothoracic surgeon to be available for the open reduction of a SC dislocation? Data Sources: Articles were obtained from the database EBSCOhost and supplemented by hand searching of bibliographies of included references. A search using the following terms: SC joint A...
Source: Journal of Orthopaedic Trauma - June 20, 2019 Category: Orthopaedics Tags: Review Article Source Type: research

Functional Outcomes After Muscle-Sparing Fixation of Flail Chest Injuries
Conclusions: Use of anatomically designed modern locking plate and screw fixation constructs with muscle-sparing approaches results in efficient return to function and restoration of shoulder function and strength as compared with the noninjured shoulder. 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 - June 20, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

Mortality Rates of Humerus Fractures in the Elderly: Does Surgical Treatment Matter?
Discussion: Fewer PH than DH fractures were treated operatively. Operative treatment was associated with improved survival in patients hospitalized with PH or DH fracture even after controlling for patient demographic and comorbid factors. 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 - June 20, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

External Fixation as a Definitive Treatment for Humeral Shaft Fractures: Radiographic and Functional Results With Analysis of Outcome Predictors
Objectives: To evaluate the results obtained using unilateral external fixation as a definitive treatment for humeral shaft fractures and to identify possible predictors of radiographic and functional outcomes. Design: Retrospective study. Setting: One large metropolitan hospital. Patients: A consecutive cohort of 107 patients who underwent external fixation for 109 humeral shaft fractures. Main Outcome Measures: Union rate, time to fracture healing, and functional assessment with disabilities of the arm, shoulder, and hand questionnaire, Constant score, Mayo Elbow Performance Index, and return to prefracture...
Source: Journal of Orthopaedic Trauma - June 20, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

Symptomatic Iliosacral Screw Removal After Pelvic Trauma—Incidence and Clinical Impact
Objective: To calculate the incidence of symptomatic iliosacral (SI) screw removal following pelvic trauma and to determine the clinical impact of the secondary intervention. Design: Retrospective chart review. Setting: Level 1 and Level 2 trauma centers. Patients: Four hundred seventy-one consecutive patients undergoing percutaneous posterior pelvic fixation over 10 years, with 7 excluded for spinopelvic fixation,and 7 excluded due to age (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - June 20, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

Nonoperative Geriatric Hip Fracture Treatment Is Associated With Increased Mortality: A Matched Cohort Study
Objective: To report the mortality data and life expectancy of geriatric hip fracture patients who underwent nonoperative management and compare that with a matched operative cohort. Design: Retrospective cohort study. Setting: Level 1 trauma center. Patients: Geriatric (65 years of age and older) femoral neck or intertrochanteric fracture (OTA/AO 31A and 31B) patients. Intervention: Operative treatment with either arthroplasty, cannulated screws, sliding hip screw device, or cephalomedullary nail compared with nonoperative cohort. Main Outcome Measurements: In-hospital, 30-day, and 1-year mortality. Resu...
Source: Journal of Orthopaedic Trauma - June 20, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

Treatment of Peritrochanteric Femur Fractures With Proximal Femur Locked Plating
Conclusions: Proximal femoral locking plates continue to be associated with a high complication rate. However, based on our experience, proximal femoral locking plates may be considered in highly selected cases when absolutely no other implant is deemed appropriate, based on the degree of comminution and the complexity of the fracture pattern. Patients must be informed about the possibility of revision surgery based on the inherent limitations of these devices. 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 - June 20, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

Ninety-Five Degree Angled Blade Plate Fixation of High-Energy Unstable Proximal Femur Fractures Results in High Rates of Union and Minimal Complications
Conclusions: We found that high-energy proximal femur fractures treated with a 95-degree condylar blade plate and articulated tensioning device had a high rate of union with minimal postoperative complications. Although intramedullary nailing of these fractures remains a preferred treatment modality, the angled blade plate with articulated tensioning device is an excellent option to restore anatomical alignment and obtain bony union in certain highly comminuted fracture patterns. 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 - June 20, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

Is the Cranial and Posterior Screw of the “Inverted Triangle” Configuration for Femoral Neck Fractures Safe?
Conclusions: Seventy percent of screws that were judged to be radiographically contained had cortical breach near the area where the lateral epiphyseal vessels enter the femoral neck. We urge caution against placement of posterior-cranial implants with fluoroscopy alone even if they appear radiographically contained. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - June 20, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

Bundled Care for Hip Fractures: A Machine-Learning Approach to an Untenable Patient-Specific Payment Model
Conclusions: Our naive Bayes machine-learning algorithm provided excellent accuracy and responsiveness in the prediction of length of stay and cost of an episode of care for hip fracture using preoperative variables. This model demonstrates that the cost of delivery of hip fracture care is dependent on largely nonmodifiable patient-specific factors, likely making bundled care an implausible payment model for hip fractures. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - June 20, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

New Five-Factor Modified Frailty Index Predicts Morbidity and Mortality in Geriatric Hip Fractures
Conclusions: The mFI-5 is an independent predictor of postoperative morbidity and mortality in elderly patients undergoing surgery for hip fractures. This clinical tool can be used by hospitals and surgeons to identify high-risk patients, accurately council patients and families with transparency, and guide perioperative care to optimize patient outcomes. 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 - June 20, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

Orthogonal Plating With a 95-Degree Blade Plate for Salvage of Unsuccessful Cephalomedullary Nailing of Atypic Femur Fractures: A Technical Trick
We present a technique that uses orthogonal, dual plating of the proximal femur in addition to biologic augmentation for the management of these challenging fractures. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - May 24, 2019 Category: Orthopaedics Tags: Technical Trick Source Type: research

Biomechanical Comparison of Tension Band Fixation of Patella Transverse Fracture: Headless Screws Versus Headed Screws
Conclusions: Headless screw tension band fixation demonstrated superior biomechanical behaviors over standard headed screw fixation with higher construct rigidity, smaller interfragmentary motion, and greater fixation strength. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - May 24, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

Risk Factors for Infection After Intramedullary Nailing of Open Tibial Shaft Fractures in Low- and Middle-Income Countries
Objectives: (1) To determine the infection rate after fixation of open tibial shaft fractures using the Surgical Implant Generation Network (SIGN) intramedullary nail in low- and middle-income countries (LMICs) and (2) to identify risk factors for infection. Design: Prospective cohort study using an international online database. Setting: Multiple hospitals in LMICs worldwide. Patients/Participants: A total of 1061 open tibia fractures treated with the SIGN nail in LMICs between March 2000 and February 2013. Intervention: Intravenous antibiotic administration, surgical debridement, and definitive intramedulla...
Source: Journal of Orthopaedic Trauma - May 24, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

Factors Predictive of Blocking Screw Placement in Retrograde Nailing of Distal Femur Fractures
Objectives: (1) Identify factors that predict blocking screw placement in the treatment of a distal femur fracture with retrograde nail fixation and (2) determine whether acceptable alignment and stability were achieved in fractures that received blocking screws. Design: Retrospective Comparative Study. Setting: Level I Trauma Center. Patients/Participants: Between 2011 and 2017, we identified 84 patients with distal third femur fractures treated with a retrograde femoral nail. Data were analyzed according to those who did (BLOCK, n = 30) and did not (NO BLOCK, n = 54) receive blocking screws. Patients in both g...
Source: Journal of Orthopaedic Trauma - May 24, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

Standardized Hospital-Based Care Programs Improve Geriatric Hip Fracture Outcomes: An Analysis of the ACS NSQIP Targeted Hip Fracture Series
Objective: To determine relative complication rates and outcome measures in patients treated under a standardized hip fracture program (SHFP). Methods: The American College of Surgeons National Surgical Quality Improvement Program was queried to identify patients who underwent operative fixation of femoral neck, intertrochanteric hip, and subtrochanteric hip fractures in 2016. Cohorts of patients who were and were not treated under a documented SHFP were identified. Relevant perioperative clinical and outcomes data were collected. Multivariate regression was used to assess risk-adjusted complication rates and outcomes...
Source: Journal of Orthopaedic Trauma - May 24, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

Fewer Hospitals Provide Operative Fracture Care to Medicaid Patients Than Otherwise-Insured Patients in 4 Large States
Conclusions: Fewer hospitals provide operative fracture care to Medicaid patients than otherwise-insured patients, but Medicaid patients do not travel longer distances to the hospital on a population level. Level of Evidence: Prognostic Level III. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - May 24, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

Effect of Mental Health Conditions on Complications, Revision Rates, and Readmission Rates Following Femoral Shaft, Tibial Shaft, and Pilon Fracture
Conclusions: Comorbid MH conditions are associated with higher postoperative complication, readmission, and revision surgery rates for treated femoral, tibial, and pilon fractures. 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 - May 24, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

Ability of a Risk Prediction Tool to Stratify Quality and Cost for Older Patients With Operative Ankle Fractures
Conclusion: The Score for Trauma Triage in Geriatric and Middle-Aged tool is able to meaningfully stratify older patients with ankle fracture who require operative fixation regarding hospital quality metrics and cost. This information may allow for efficient targeted reductions in costs while optimizing outcomes. 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 - May 24, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

Knee Disarticulations Versus Transfemoral Amputations: Functional Outcomes
Conclusions: We detected no functional differences measured on the PEQ, LLQ, SF-36, and Tegner Activity Scale scores between KDs and TFAs. In the absence of a proven functional difference, we advocate performing trauma-related amputations at the most distal level the osseous and soft tissue injuries permit. 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 - May 24, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

Inter-Rater Reliability of the Modified Radiographic Union Score for Diaphyseal Tibial Fractures With Bone Defects
Objectives: To evaluate inter-rater reliability of the modified Radiographic Union Score for Tibial (mRUST) fractures among patients with open, diaphyseal tibia fractures with a bone defect treated with intramedullary nails (IMNs), plates, or definitive external fixation (ex-fix). Design: Retrospective cohort study. Setting: Fifteen-level one civilian trauma centers; 2 military treatment facilities. Patients/Participants: Patients ≥18 years old with open, diaphyseal tibia fractures with a bone defect ≥1 cm surgically treated between 2007 and 2012. Intervention: Three of 6 orthopedic traumatologists revi...
Source: Journal of Orthopaedic Trauma - May 24, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

Loss of Independence After Operative Management of Femoral Neck Fractures
Conclusions: Femoral neck fracture patients suffer great losses of independence. Identifying factors associated with living and walking independently after hip fracture may help surgeons better identify which patients are at risk and optimize care of patients with this injury. 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 - May 24, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

Hypoalbuminemia Is an Independent Risk Factor for 30-Day Mortality, Postoperative Complications, Readmission, and Reoperation in the Operative Lower Extremity Orthopaedic Trauma Patient
Conclusion: Hypoalbuminemia is a powerful predictor of acute postoperative course and mortality after surgical fixation in nongeriatric, lower extremity orthopaedic trauma patients. Admission albumin should be a routine part of the orthopaedic trauma workup. Further study into the utility of supplementation is warranted, as this may represent a modifiable risk factor. 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 - May 24, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

Radiographic Healing of Far Cortical Locking Constructs in Distal Femur Fractures: A Comparative Study With Standard Locking Plates
Conclusions: To our knowledge, this is the first comparative study between FCL and LP constructs. The FCL group was noted to have significantly higher mRUST scores at all periods indicating increased callus formation, but the differences seen were small and there were no differences in healing rates or complications between the 2 groups, thus bringing the clinical benefit of FCL into question. Further prospective study designs are needed to compare FCL with LP constructs and to investigate the role of interfragmentary motion on callus formation in distal femur fractures. Level of Evidence: Therapeutic Level III. See I...
Source: Journal of Orthopaedic Trauma - May 24, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

Risk Assessment After Orthopaedic Trauma: Coming of Age
No abstract available (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - May 24, 2019 Category: Orthopaedics Tags: Invited Commentary Source Type: research

Is the Caprini Score Predictive of Venothromboembolism Events in Orthopaedic Fracture Patients?
Objective: Explore the validity of the Caprini Score in orthopaedic patients with lower-extremity fractures. Design: Retrospective cohort study. Setting: Level I trauma academic medical center. Patients/Participants: Eight hundred forty-eight patients with lower-extremity fractures from 2002 to 2015 with exclusion criteria: minors, follow-up less than 30 days. Intervention: Stratify patients into 2 groups: high-risk (pelvic and acetabular fractures) and low-risk groups (isolated foot and ankle fractures). Main Outcome: Caprini Score, fracture classification, length of follow-up, deep vein thrombosis (DVT) ...
Source: Journal of Orthopaedic Trauma - May 24, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

In Memoriam: AONA Tribute to Jeffrey Welling Mast, MD (1940–2019)
No abstract available (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - May 24, 2019 Category: Orthopaedics Tags: In Memoriam Source Type: research

In response
No abstract available (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - April 20, 2019 Category: Orthopaedics Tags: Letters to the Editor Source Type: research

Re: Knee Pain and Functional Scores After Intramedullary Nailing of Tibial Shaft Fractures Using a Suprapatellar Approach
No abstract available (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - April 20, 2019 Category: Orthopaedics Tags: Letters to the Editor Source Type: research

Systemic Change for Value-Based Care in Orthopaedic Trauma
No abstract available (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - April 20, 2019 Category: Orthopaedics Tags: Letters to the Editor Source Type: research

A Novel Traction Frame for Femur Fracture Management in Developing Countries: Technique and Outcomes
We describe a new technique for assembly of a polyvinyl chloride traction frame for treatment of femur fractures in resource-poor settings. Our report includes a retrospective review of patients treated with polyvinyl chloride traction frames in the Dominican Republic and Haiti. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - April 20, 2019 Category: Orthopaedics Tags: Technical Trick Source Type: research

Fracture Pattern and Periosteal Entrapment in Adolescent Displaced Distal Tibial Physeal Fractures: A Magnetic Resonance Imaging Study
Conclusions: Salter–Harris type II and triplane fractures have a high risk of periosteal entrapment especially in the anterolateral corner. Therefore, even without preoperative magnetic resonance imaging, surgical repositioning of entrapped periosteum should be considered after failed closed reduction. In cases of supinated foot injuries of type II or triplane fractures requiring surgical fixation, a metaphyseal fracture plane parallel to the oblique coronal plane connecting the medial and lateral malleoli may assist surgeons in achieving appropriate metaphyseal fixation. Level of Evidence: Diagnostic Level IV. ...
Source: Journal of Orthopaedic Trauma - April 20, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

Salter–Harris II Ankle Fractures in Children: Does Fracture Pattern Matter?
Conclusions: Salter–Harris II fractures of the ankle are common in children, with fracture pattern directly related to PPC and the chance for angular deformity. PER injuries are more likely to have a PPC associated with an angular deformity compared with SER and supination-plantar flexion injuries. The odds ratio of having an angular deformity with PER injuries compared with SER and SPF injuries is 25. Significance: Fracture pattern of the ankle is related to growth disturbance, which must be taken into consideration when treating these injuries and addressed with the patient and family. Level of Evidence: Pr...
Source: Journal of Orthopaedic Trauma - April 20, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

Biomechanical Evaluation of Interfragmentary Compression of Lag Screw Versus Positional Screw at Different Angles of Fixation
Conclusions: Lag screw technique compressive force was superior to positional screw technique at 60 and 90 degrees. Comparison of force at angles of 60 and 90 degrees showed no significant difference for both techniques. Indicating 30 degrees deviation from perfect technique is tolerated without significant decrease in compressive force. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - April 20, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

Clinical Practice Guidelines for Pain Management in Acute Musculoskeletal Injury
Conclusions: Balancing comfort and patient safety following acute musculoskeletal injury is possible when utilizing a true multimodal approach including cognitive, physical, and pharmaceutical strategies. In this guideline, we attempt to provide practical, evidence-based guidance for clinicians in both the operative and non-operative settings to address acute pain from musculoskeletal injury. We also organized and graded the evidence to both support recommendations and identify gap areas for future research. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - April 20, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

Correlation of Fracture Energy With Sanders Classification and Post-traumatic Osteoarthritis After Displaced Intra-articular Calcaneus Fractures
Conclusions: Fracture energy positively correlates with Sanders classification for DIACFs, which can be used to identify more severe fractures at greater risk of progressing to PTOA. 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 - April 20, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

Effect of Elbow Position on Load to Failure in Olecranon Fracture Fixation: A Biomechanical Cadaveric Study
Conclusions: Ulnohumeral position does not significantly affect overall construct strength even in olecranon fractures with small proximal fragments with limited points of fixation. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - April 20, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

Risk Factors That Influence Subsequent Recurrent Instability in Terrible Triad Injury of the Elbow
Conclusions: Recurrent instability was associated with high-energy trauma, time between injury and operation, Mason type III radial head fracture, medial collateral injury, and coronoid nonrepair. Patients with recurrent instability were more likely to require secondary surgery and develop posttraumatic arthritis than those with concentric stability. 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 - April 20, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

Differences in the Majeed Pelvic Score Between Injured and Uninjured Patients
Objectives: To investigate the differences in the Majeed Pelvic Score (MPS) between injured and uninjured patients. Discriminative power and applicability of the MPS in elderly are also investigated, and a norm score for the MPS in the Netherlands is provided. Design: Cross-sectional cohort study. Setting: Urban level 1 trauma center. Patients/Participants: One hundred ninety-five patients with pelvic ring disruptions; 101 61A, 67 61B, and 27 61C (OTA/AO classification; 6%, 27%, and 82% surgically treated, respectively); mean follow-up 29 months (range 6–61); 554 adults from the Longitudinal Internet Studi...
Source: Journal of Orthopaedic Trauma - April 20, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

Distal Femur Locking Plates Fit Poorly Before and After Total Knee Arthroplasty
Objective: To evaluate the fit of distal femur locking plates. Secondarily, we sought to compare plate fit among patients with and without a total knee arthroplasty (TKA). Design: Retrospective. Setting: University hospital. Intervention: Standard length precontoured distal femur locking plates from 4 manufacturers were digitally templated onto each patient's pre-TKA and post-TKA radiographs. Main Outcome Measurements: The maximum distance from the plate to the lateral femoral cortex (plate-bone distance) was measured in the metaphyseal region. Mean plate-bone distances were compared between manufacturers and...
Source: Journal of Orthopaedic Trauma - April 20, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

Are Geriatric Patients Who Sustain High-Energy Traumatic Injury Likely to Return to Functional Independence?
Objectives: To evaluate physical function and return to independence of geriatric trauma patients, to compare physical function outcomes of geriatric patients who sustained high-energy trauma with that of those who sustained low-energy trauma, and to identify predictors of physical function outcomes. Design: Retrospective. Setting: Urban Level I trauma center. Patients: Study group of 216 patients with high-energy trauma and comparison group of 117 patients with low-energy trauma. Intervention: Injury mechanism (high- vs. low-energy mechanism). Main Outcome Measurement: Patient-Reported Outcomes Measuremen...
Source: Journal of Orthopaedic Trauma - April 20, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

Cortical Impaction in Posterior Wall Acetabular Fractures
Conclusions: Our study demonstrates that a small number of patients sustain cortical impaction of the posterosuperior acetabular cortical surface along with their posterior wall acetabular fracture-dislocation. Although uncommon, preoperative imaging should be scrutinized to identify this clinical entity. As part of the preoperative plan, the surgeon can anticipate the cortex available for reduction verification and whether any additional steps or altered surgical approaches are needed to achieve an anatomical reduction. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of...
Source: Journal of Orthopaedic Trauma - April 20, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

Early Immunologic Response in Multiply Injured Patients With Orthopaedic Injuries Is Associated With Organ Dysfunction
Conclusions: Temporal quantification of immune mediators identified 8 biomarkers associated with greater levels of organ dysfunction in polytrauma patients with major orthopaedic injuries. 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 - April 20, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

Chemoprophylaxis for the Hip Fracture Patient: A Comparison of Warfarin and Low-Molecular-Weight Heparin
Conclusions: Patients prescribed warfarin after hip fractures had higher rates of DVT and PE compared with those prescribed LMWH, although both agents had similar complication profiles. 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 - April 20, 2019 Category: Orthopaedics Tags: Original Article Source Type: research

“Orthopaedic Surgeons Responding to the US Opioid Crisis.” Commentary on: “Clinical Practice Guidelines for Pain Management in Acute Musculoskeletal Injury.”
No abstract available (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - April 20, 2019 Category: Orthopaedics Tags: Editorial Source Type: research