A Targeting Arm for Interlocking Screws Reduces Radiation Exposure: Results of a Prospective Randomized Controlled Trial.

Objectives: To compare time, fluoroscopic utilization, and number of misses for placement of far interlocking screws in tibial and femoral nails using a targeting arm (Targeter) versus perfect circle technique (Control).

Methods Design: Prospective randomized controlled trial.

Setting: Single-center, large, urban, level 1 trauma center.

Percutaneous anterior pelvic ring fixation in addition to percutaneous posterior pelvic ring fixation decreases postoperative pain and narcotic usage in hospital for LC1 and LC2 injuries.

Objectives: To compare postoperative pain and opioid requirements between LC1 and LC2 injuries treated with anterior and posterior fixation (AF+PF) vs. posterior fixation (PF) only.

Methods: Design: Retrospective review of propensity matched cohorts for sex, age, LC1 vs.

Erratum: Comparison of the Neer classification to the 2018 update of the Orthopedic Trauma Association/AO fracture classification for classifying proximal humerus fractures: Erratum.

[This corrects the article DOI: 10.1097/OI9.0000000000000200.

Comparison of software-assisted and freehand methods of rotational assessment for diaphyseal tibia fractures.

Objective: Accurate rotational reduction following tibial shaft fracture fixation is absent in up to 36% of cases yet may be critical for lower extremity biomechanics. The objective of this cadaveric study was to compare the results of freehand methods of reduction with software-assisted reduction.

Methods: Four fellowship-trained orthopaedic trauma surgeons attempted rotational correction in a cadaveric model with fluoroscopic assistance (without radiographic visualization of the fracture site) using (1) their method of choice (MoC) and (2) software assistance (SA).

Determinants for successful medullary fixation of the superior ramus.

Objectives: The purpose of this study is to determine what demographic and anatomical variables affect successful placement of a superior medullary ramus screw, and how they affect the maximal diameter of that screw.

Methods: Design: Prognostic Level IV SETTING: Level I Trauma Center Patients/Participants: Two hundred consecutive patients underwent computed tomography (CT) of the pelvis. We included those patients aged 18 and older without osseous injury or abnormalities precluding measurement.

Mid to long term follow up of early weightbearing after open reduction internal fixation of ankle fractures.

Introduction: Studies have demonstrated successful outcomes with early weightbearing following open reduction internal fixation (ORIF) of specific ankle fractures. The external validity of an early weightbearing protocol and its effects on patient-reported outcome information scores (PROMIS) has yet to be investigated. This study aimed to investigate the effects of an early weightbearing protocol for all operatively treated ankle fractures and its impact on clinical outcomes and complications.

Comparison of software-assisted and freehand methods of rotational assessment for diaphyseal femur fractures.

Objective: Accurate rotational reduction following femoral shaft fracture fixation is absent in up to 28% of cases yet is critical for lower extremity biomechanics. The objective of this cadaveric study was to compare the results of freehand methods of rotational reduction with software-assisted rotational reduction.

Methods: Four fellowship-trained orthopedic trauma surgeons attempted rotational correction in a cadaveric model with fluoroscopic assistance using (1) their method of choice (MoC) and (2) software assistance (SA).

Automated Balanced Cable Trifocal Bone Transport: A Case Report.

Case: A 14-year-old adolescent boy sustained a Gustilo-Anderson Type 3A tibia fracture treated with medullary nailing. He developed an atrophic nonunion with a 10.5-cm defect after debridement.

Radiographic Accuracy of Identifying Anterolateral Tibial Plafond Involvement in Pronation Abduction Ankle Fractures.

Objectives: To evaluate the incidence of anterolateral tibial plafond involvement in pronation-abduction (PAB) ankle fractures and analyze the accuracy of radiographs in detecting anterolateral tibial plafond involvement, impaction, and predicting the need for direct visualization and an articular reduction.

Design: A multi-institutional retrospective chart review.

Setting: Five Level 1 trauma centers in the United States.

Success of Resident Research Grants in Orthopaedic Trauma From 2000 to 2022: A Retrospective Review.

Objectives: The objective of this study was to determine the publication rate for orthopaedic trauma resident research projects that receive grant funding and the long-term academic involvement of the grant recipients.

Design: Retrospective.

Setting: Publically available records for resident research grant recipients.

Standardization and Reproducibility of Dynamic Stress Testing for Occult Pelvic Ring Instability.

Introduction: Examination under anesthesia (EUA) (stress fluoroscopy) is commonly done after pelvic ring injury to identify occult instability because unstable disruptions may displace causing morbidity. The force applied during EUA for these injuries has not been standardized. The purpose of this study was to examine the forces used during the EUA by experienced orthopaedic trauma pelvic surgeons.

Biomechanical evaluation of a central collinear entry reconstruction nail for femoral neck fracture prophylaxis.

Introduction: Reconstruction nails are commonly used to treat proximal femur fractures, with cephalic screw placement for femoral neck "prophylaxis" becoming standard practice. These implants are traditionally introduced through piriformis fossa (PF) or greater trochanter (GT) entry portals. A third "central collinear" (CC) portal has been proposed that allows entry along the femoral anatomic axis and central placement of cephalic screws.

Subchondral rafting wires reduce tibial plateau fracture subsidence.

Purpose: To determine if subchondral rafting wires retained as adjunctive tibial plateau fracture fixation affect postoperative articular subsidence.

Methods: A retrospective cohort study was conducted at one Level 1 trauma center and one academic university hospital. Consecutive adults with closed, displaced OTA/AO 41B/C tibial plateau fractures treated between 2018 and 2023 with open reduction internal fixation were included.

Current Management of Acute and Posttraumatic Critical Bone Defects.

Limb reconstruction in patients with critical-sized bone defects remains a challenge due to the availability of various technically demanding treatment options and a lack of standardized decision algorithms. Although no consensus exists, it is apparent from the literature that the combination of patient, surgeon, and institutional collaborations is effective in providing the most efficient care pathway for these patients. Success relies on choosing a particular surgical approach that manages infection, soft tissue defects, stability, and alignment.

Optimizing the Entry Point for Medullary Hip Screws.

Introduction: Medullary hip screws (MHSs) are the most common treatment of intertrochanteric hip fractures because they can be used for varied fracture patterns and resist shortening. Identifying the appropriate MHS entry point can be intellectually and technically challenging. We aimed to quantify the variability in the ideal entry point (IEP) for MHSs.

Axial Plane Deformity: How to Avoid It and How to Correct It.

Malreductions in the axial plane (ie, length and rotation) are common when managing long bone fractures. Careful attention to detail during the initial treatment can prevent these malreductions. Various fluoroscopy-based techniques exist for the prevention of malrotation and limb-length discrepancy during surgery for fracture.

Does Fibular Displacement Predict Tibial Malrotation in Simulated Tibia-Fibula Fractures.

Introduction: Tibial malrotation can occur with medullary nailing of diaphyseal tibial fractures. Fibular alignment has been proposed as a surrogate for axial plane reduction intraoperatively. The purpose of this study was to determine whether fibular alignment is a reliable marker of accurate tibial rotation.

Limb position affects intraoperative assessment of condylar width.

Purpose: We sought to define how changes in position and rotation of fluoroscopic imaging may affect the assessment of condylar widening intraoperatively.

Methods: Thirty-three patients with tibial plateau fractures were prospectively identified and included in this study. Fluoroscopic images of the uninjured tibial plateau were obtained in (1) full extension and (2) slight flexion on foam ramp.

Orthopaedic Advances: Use of Three-Dimensional Metallic Implants for Reconstruction of Critical Bone Defects After Trauma.

Multiple successful strategies exist for the management of critical-sized bone defects. Depending on the location and etiology of an osseous defect, there are nuances that must be considered by the treating surgeon. The induced membrane technique and various modifications of the Ilizarov method (bone transport by distraction osteogenesis) have been the most common methods for biologic reconstruction.

Standard versus low-dose computed tomography for assessment of acetabular fracture reduction using novel step and gap measurement technique.

Purpose: Quality of reduction is of paramount importance after acetabular fracture and is best assessed on computed tomography (CT). A recently proposed measurement technique for assessment of step and gap displacement is reproducible but has not been validated. The purpose of this study is to validate a well-established measurement technique against known displacements and to determine if it can be used with low dose CT.

Optimizing the Entry Point for Reconstruction Nailing of the Femur.

Introduction: Varus after antegrade medullary nailing of the proximal femur is associated with worse outcomes. Anecdotally, a more medialized "trochiformis" entry is beneficial to avoid varus with valgus-bend (greater trochanteric entry) femoral nails. However, the optimal entry point remains unknown.

Free Vascularized Fibula Graft for Staged Reconstruction of Infected Humerus Nonunions.

Objective: To evaluate the union rate and rate of postoperative complications in patients with septic nonunions of the humerus after a two-stage reconstruction using a free vascularized fibula graft.

Design: Retrospective case series.

Setting: Academic, tertiary referral center.

A Central Collinear Start Point for Reconstruction Nailing of Femur Fractures: A Technical Trick and Case Series.

Selecting the optimal entry point for reconstruction nailing is critical to avoid iatrogenic malalignment and optimize mechanical stability. In-line nailing is familiar to surgeons and desirable for its on-axis position. However, there are several potential drawbacks.

Adaptation of the Centers for Disease Control Surgical Wound Classification System for Orthopaedic Trauma Surgery.

Objectives: To evaluate a proposed orthopaedic-specific surgical wound classification system (SWCS) and the current Centers for Disease Control (CDC) system in a series of detailed clinical vignettes and to identify the degree of satisfaction with CDC SWCS and desire for institution of an orthopaedic-specific SWCS.

Methods: Forty-five clinical vignettes and a 5-question survey were distributed to current and past members of the Orthopaedic Trauma Association's Classification Committee. Respondents were asked to provide wound class for each vignette using the CDC system and orthopaedic-specific SWCS.