Proceed with Caution: Medial Plating Risks Irreversible Challenges
No abstract available (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - December 24, 2021 Category: Orthopaedics Tags: Care Controversies Source Type: research

Medial Plating in Open Pilon Fractures May Be Indicated in the Right Patient
Clinical vignette: A 55-year-old retired overweight male contractor with controlled type 2 diabetes is performing repairs on his barn when he slips and falls from a ladder. He catches his foot in the rungs and sustains a type 2 open pilon fracture with metaphyseal comminution (OTA/AO 43-C family) and an associated fibula fracture. The 6-cm open wound is located medially and is contaminated with clothing but not the surrounding environment. One of your partners performs a thorough surgical debridement, is able to close the wound, and applies a spanning ankle external fixator and asks you to care for the patient to provi...
Source: Journal of Orthopaedic Trauma - December 24, 2021 Category: Orthopaedics Tags: Care Controversies: Plating strategies in open pilon fractures with a medial wound: should a buttress plate be placed medially through the open wound during definitive fixation? Source Type: research

Erratum
No abstract available (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - December 24, 2021 Category: Orthopaedics Tags: Erratum Source Type: research

Anterior Intrapelvic Plating of the Sacroiliac Joint—A Cadaveric Quantification of Visualized Area with Case Series
The objective of this study was to quantitatively describe the area available on the sacrum for reduction and plating using the Anterior Intrapelvic approach and describe its use clinically in a case series. The area available for plate and screw placement on 5 cadavers was on average 1007 ± 231 mm3. The cranial/caudal dimension at greatest length was 39.78 ± 6.91 mm, and the greatest length medial to the sacroiliac joint was 30.91 ± 3.43 mm. The major anatomic restraints to visualization were the S1 nerve root and the external and internal iliac vessels. Large fragment plates had an area overlying the sacrum of 360 mm3...
Source: Journal of Orthopaedic Trauma - December 24, 2021 Category: Orthopaedics Tags: Technical Trick Source Type: research

Unicolumnar Pin Fixation of Type III Supracondylar Humeral Fractures Is Associated With Over 3 Times Higher Odds of Lost Reduction
Conclusions: There is a statistically significant increase in the rate of supracondylar fracture loss of reduction for patients with unicolumnar fixation when compared with bicolumnar fixation. 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 - December 24, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

Intramedullary Screw Fixation of Olecranon Fractures Reduces the Risk of Early Unplanned Reoperation: A Retrospective Review of 556 Patients
Conclusions: Intramedullary screw–based fixation of olecranon fractures results in decreased need for early reoperation compared with more common olecranon fixation strategies. 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 - December 24, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

Muscular Forces Responsible for Proximal Humeral Deformity After Fracture
Objectives: To evaluate the contribution of each of the rotator cuff muscles and deltoid to fracture deformity in a 2-part proximal humerus fracture model. Our hypothesis was that superior cuff muscles would have the greatest contribution to coronal plane deformity, whereas muscles with anterior and posterior attachments would have the greatest contribution to axial and sagittal plane deformity. Methods: A medial wedge osteotomy was created in 8 cadaveric shoulder specimens. A custom shoulder testing system was used to load each rotator cuff muscle and deltoid under increasing loading conditions. Fracture displa...
Source: Journal of Orthopaedic Trauma - December 24, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

A Novel Fluoroscopic Method for Assessing Rotational Malalignment of the Tibia
Conclusion: Measuring tibial rotation fluoroscopically using the intermalleolar method is both accurate and reliable. Compared with the previously described mortise method, it has similar accuracy and provides a value that approximates the true tibial rotation. Also, it can be used reliably and effectively intraoperatively to identify tibial malrotation and assist in intraoperative rotational corrections. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - December 24, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

Progression of Tibia Fracture Healing Using RUST: Are Early Radiographs Helpful?
Conclusions: The median time to radiographic union (RUST = 9) after tibial nailing was approximately 20 weeks, and little radiographic healing occurred within the first 8 weeks after surgery. Routine radiographs in this period may offer little additional information in the absence of clinical concerns such as new trauma, malalignment, or infection. Level of Evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - December 24, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

Lack of Displacement of the Fibula Is Not a Confirmation of Ankle Stability in Supination External Pattern Ankle Fractures
Conclusions: Previous work indicated that patients with an isolated SE pattern fibula fracture, a normal MCS, and ≤2 mm of fibular displacement on the lateral radiograph have a high rate of ankle stability, with a positive predictive value of approximately 97%. We were unable to confirm this finding because 15% of unstable ankles had 0 mm and 55% had ≤2 mm of fibular displacement. We conclude that stability may not be inferred from a lack of fibular displacement on the lateral view in this population of patients. If stability is to be determined, it must be tested irrespective of fibular displacement on the lateral...
Source: Journal of Orthopaedic Trauma - December 24, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

Simultaneous Posterolateral and Posteromedial Approaches for Fractures of the Entire Posterior Tibial Plafond: A Safe Technique for Effective Reduction and Fixation
Conclusions: Surgical fixation using simultaneous, combined posterolateral and posteromedial approaches for posterior pilon fractures had a low rate of wound complications and was an effective strategy for obtaining an accurate reduction. The rate of syndesmotic instability requiring fixation was lower than previous work reporting on fixation using a single approach. This may be a useful technique for surgeons who treat these injuries. Careful assessment of the preoperative imaging is required in patients with posterior pilon fractures. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a ...
Source: Journal of Orthopaedic Trauma - December 24, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

Open Ankle Fractures: What Predicts Infection? A Multicenter Study
Conclusions: Several patient, injury, and surgical factors were associated with FRI in the treatment of open ankle 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 - December 24, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

A Prospective, Randomized, Controlled, Two-Center, International Trial Comparing the Fibular Nail With Open Reduction and Internal Fixation for Unstable Ankle Fractures in Younger Patients
Conclusions: In younger patients with ankle fractures, no difference was found in the patient-reported outcome between fibular nail and plate fixation at 1 year after surgery. The fibular nail is an effective and safe option for the stabilization of ankle fractures in younger patients, although the benefits associated with reduced wound complications are not as apparent as for elderly patients. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence. (Source: Journal of Orthopaedic Trauma)
Source: Journal of Orthopaedic Trauma - December 24, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

Nonoperative Treatment of Select Lateral Compression Type II Pelvic Ring Injuries (OTA/AO 61B2.2) Results in a Low Rate of Radiographic Displacement
Conclusions: A spectrum of injury severity and stability exists in the LC-2 pattern. Nonoperative treatment of LC-2 injuries with low initial deformity and CFD results in minimal subsequent displacement. 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 - December 24, 2021 Category: Orthopaedics Tags: Original Article Source Type: research

The Effect of Hospital and Surgeon Volumes on Complication Rates After Fixation of Peritrochanteric Hip Fractures
This study evaluates the relationship between hospital and surgeon volumes of peritrochanteric hip fracture fixation and complication rates. Methods: Adults (60 years of age or older) who underwent surgical fixation for closed peritrochanteric fractures from 2009 to 2015 were identified using International Classification of Diseases 9 and 10 Clinical Modification and Procedural codes in the New York Statewide Planning and Research Cooperative System database. Readmission, reoperations, in-hospital mortality, and other adverse events were compared across surgeon and facility volumes. Statistical significance was set ...
Source: Journal of Orthopaedic Trauma - December 24, 2021 Category: Orthopaedics Tags: Original Article Source Type: research