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Journal: Journal of orthopaedic trauma


Iliosacral screw fixation into the first sacral body is a common method for pelvic ring fixation. However, this construct has been shown to be clinically unreliable for the percutaneous fixation of unstable Type C zone II vertically oriented sacral fractures with residual fracture site separation. The objective of this study was to biomechanically compare a locked transsacral construct versus the standard iliosacral construct in a Type C zone II sacral fracture model.

Concepts: Fracture mechanics, Sacroiliac joint, Bone fracture, Comparisons, Pelvis, Comparison, Fracture, Object-oriented programming


: The aims of this study were as follows: to determine if the presence of the nail entry zone alters the biomechanics of the proximal tibia after intramedullary (IM) nailing using a computational model; to determine if nail removal restores normal biomechanics to the proximal tibia; and to determine if these effects are magnified with anterior cortical bone loss.

Concepts: Computational model, Skeletal system, Osteoporosis, Biomechanics, Bone


SUMMARY:: Acute compartment syndrome (ACS) after trauma is often the result of increased size of the damaged tissues after acute crush injury or from reperfusion of ischemic areas. It usually is not solely caused by accumulation of free blood or fluid in the compartment, although that can contribute in some cases. There is no reliable and reproducible test that confirms the diagnosis of ACS. A missed diagnosis or failure to cut the fascia to release pressure within a few hours can result in severe intractable pain, paralysis, and sensory deficits. Reduced blood circulation leads to oxygen and nutrient deprivation, muscle necrosis, and permanent disability. Currently, the diagnosis of ACS is made on the basis of physical examination and repeated needle sticks over a short time frame to measure intracompartmental pressures. Missed compartment syndromes continue to be one of most common causes of malpractice lawsuits. Existing technology for continuous pressure measurements are insensitive, particularly in the deep tissues and compartments, and their use is restricted to highly trained personnel. Newer concepts of the pathophysiology accompanied by new diagnostic and therapeutic modalities have recently been advanced. Among these are the concept of inflammatory mediators as markers and anti-inflammatories as medical adjunct therapy. New diagnostic modalities include near-infrared spectroscopy, ultrafiltration catheters, and radio-frequency identification implants. These all address current shortcomings in the diagnostic armamentarium that trauma surgeons can use. The strengths and weaknesses of these new concepts are discussed to allow the trauma surgeon to follow current evolution of the field.

Concepts: Necrosis, Causality, Physical examination, The Canon of Medicine, Surgery, Syndromes, Inflammation, Compartment syndrome


SUMMARY:: Although Kirschner wires (K-wires) are useful implants in many situations, migration of the wire and irritation of the surrounding soft tissues are common complications. Seven steps are described herein which result in a K-wire that is bent 180°, providing a smooth anchor into bone. Use of this technique produces implants that provide stable fixation with few soft tissue complications.

Concepts: Soft tissue sarcoma, Wire, Ilizarov apparatus, Soft tissue, Orthopedic surgery, Implants, Kirschner wire, Tissues


OBJECTIVES:: To evaluate the treatment alternatives for the management of the metaphyseal tibial comminution in severe plafond fractures, and to investigate the role of the fibula fracture fixation. DESIGN:: Retrospective clinical study. SETTING:: Level-2 trauma hospital. PARTICIPANTS:: Patients with highly comminuted tibial plafond fractures. INTERVENTION:: All patients were treated with open reduction and internal fixation of the articular surface and external fixation of the metaphyseal fracture. If metaphyseal comminution was minimal, bone graft was applied and the fibular was plated (group 1); if comminution was between 1 and 3 cm, acute shortening and distraction osteogenesis was performed (group 2); and if comminution was >3 cm, distraction osteogenesis without acute shortening was performed (group 3). MAIN OUTCOME MEASUREMENTS:: Radiographic union, AOFAS ankle score. RESULTS:: Of 30 fractures, 15 fractures (50%) had an anatomic reduction of the joint. Union occurred in all but 2 fractures. Group 1 fractures healed at an average of 19 weeks (16-22). Four fractures had associated malalignment problems. The mean AOFAS score was 72.5 (range 45-100). Group 2 fractures healed at an average of 18.3 weeks (16-21). One fracture healed with 5-degrees of angulation. Group 3 fractures healed at an average of 17.5 weeks (14-24). Two fractures healed with malalignment. When groups 2 and 3 were combined to evaluate the AOFAS outcome for fractures treated with distraction osteogenesis, a score of 75.83 was obtained (45-90). There was no difference between the Group 1 versus combined Groups 2/3 with regard to this latter score (P = 0.372). Additionally, when fibula fixation (Group 1) was compared with those fractures where it was not performed (groups 2/3), no difference was seen (P = 0.276). CONCLUSIONS:: The reconstruction of severe tibial plafond fractures treated with small wire hybrid fixation may be achieved by different techniques leading to a satisfactory result. The fixation of the fibula fracture is dependent mainly on the treatment chosen for the management of the metaphyseal lesion. LEVEL OF EVIDENCE:: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Concepts: Fracture, Skeletal system, Distraction osteogenesis, External fixation, Touring car racing, Bone, Bone fracture, Orthopedic surgery


To evaluate the lateral transmalleolar (LTM) approach for a displaced postero-lateral fragments of a posterior malleolus fracture (PMF).

Concepts: Fracture mechanics, Bone fracture, Fracture


To compare single versus multiple procedures in the same surgical setting. We hypothesized that complication rates would not be different and length of stay would be shorter in patients undergoing multiple procedures.

Concepts: Hospital


For patients with femoral neck fractures, total hip arthroplasty (THA) demonstrates superior outcomes compared with hemiarthroplasty. However, hemiarthroplasty remains a common treatment for femoral neck fractures and the conversion rates are unknown. We compared the results of the 2 procedures using a Medicare database.

Concepts: Hip replacement, Orthopedic surgery


The magnetic intramedullary lengthening nail is an innovative technology that allows for creative ways to treat difficult problems. The lengthening option has revolutionized femur fracture management with bone loss and malunion therapy. The compression version of this nail has provided a gradual method to compress nonunions and difficult fractures that may obviate the need for many current uses of external fixation. Three cases are presented in this manuscript demonstrating a new paradigm in the management of bone loss/shortening of the tibia and femur, and recalcitrant nonunions.

Concepts: Osteoporosis, Orthopedic surgery, Femur, Bone fracture, Fracture, Hip fracture, Distraction osteogenesis, Bone