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.

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.

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).

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.

A Retrospective Cohort Study on Chronic Opioid Use After Geriatric Hip Fracture Surgery-Risk Factors, Trends, and Outcomes.

Introduction: The purpose of this study is to identify the risk factors for prolonged opioid use after surgery in geriatric hip fracture patients and the effects of prolonged use on mortality and readmission rates.

Methods: An institutional registry was queried for all patients older than 65 years who underwent surgical treatment of a hip fracture between January 2016 and June 2017. Using the Controlled Substance Utilization Review and Evaluation System (CURES), we identified patients who had filled an opioid prescription within 3 months of hospital admission as opioid exposed and patients without a history of opioid use as opioid naïve (ON).

Trust but Verify: Discordance in Opioid Reporting Between the Electronic Medical Record and a Statewide Database.

Introduction: The electronic medical record (EMR) is often used as the primary source for patient medication lists and history. We sought to determine the accuracy of the EMR in documenting opioid prescriptions in patients undergoing fracture repair compared to a statewide database.

Methods: This retrospective study was conducted at an urban level 1 trauma center.

Chronic Warfarin Anticoagulation in Hip Fracture Patients Delays Surgery and Is Associated With Increased Risk of Postoperative Complications: A Multicenter Propensity-Score-Matched Analysis.

Objective: To evaluate the effect of warfarin on blood transfusion and postoperative complications in a low-energy hip fracture population compared with a non-anticoagulated comparison group.

Design: Multicenter Retrospective Cohort.

Setting: Three Urban Level I Academic Trauma Centers.

Risk Factors for Development of a Recalcitrant Femoral Nonunion: A Single Surgeon Experience in 122 Patients.

Objectives: The goals of the study were (1) to document the healing rates of femoral nonunions stratified by those that healed as intended, healed after a subsequent intervention, and those that did not heal; (2) to report the prevalence of recalcitrant femoral nonunions and (3) to identify specific demographic, injury, and treatment-related risk factors for the development of a recalcitrant nonunion.

Design: Longitudinal observational cohort study.

Setting: Academic Level 1 trauma center.

Delayed Surgery Does Not Reduce Transfusion Rates in Low-Energy Hip Fractures on Direct Oral Anticoagulants.

Objectives: To compare transfusion rates in patients on direct oral anticoagulants (DOACs) with nonanticoagulated patients undergoing hip fracture surgery and, secondarily, to determine whether time to surgery or complications differ between these groups.

Design: Multicenter retrospective cohort.

Setting: Three tertiary care, academic, Level I trauma centers.

Characterization of Infraspinatus Tendon Anatomy: The Soft-Tissue Portion of Remplissage.

Purpose: To characterize the morphology of the infraspinatus (IS) tendon and evaluate the bony anatomy of the humeral head (HH) to determine if there is a correlation between HH measurements and the amount of available IS tendon.

Methods: The superior-inferior width as well as the medial-lateral (M-L) length of the inferior and superior portions of the IS tendon were measured in 15 human cadaveric shoulders. Three measurements were then obtained for each corresponding humeral head: (1) anterior to posterior (A-P) distance, (2) midcoronal humeral head distance (MCHH), and (3) M-L distance.

Healing the Index Tibial Nonunion: Risk Factors for Development of a Recalcitrant Nonunion in 222 Patients.

Objectives: To compare and stratify the healing rates after our index nonunion surgery using contemporary methods of fixation, report the prevalence of recalcitrant non-union, and identify specific demographic, injury, and treatment-related risk factors for the development of a recalcitrant nonunion.

Design: Retrospective analysis of a prospectively collected database.

Setting: Academic Level 1 Trauma Center.

Clavicle nonunion: plate and graft type do not affect healing rates-a single surgeon experience with 71 cases.

Background: Clavicle nonunions often result after nonoperative treatment for the acute fracture. Those that require >1 surgical procedure in order for a nonunion to heal are termed recalcitrant. The aims of the present study were to (1) determine healing rates of clavicle nonunions after plate osteosynthesis using either a conventional or locked plate, (2) compare iliac crest bone graft vs.

Pain Management with Early Regional Anesthesia in Geriatric Hip Fracture Patients.

Background: Geriatric hip fracture patients are susceptible to the adverse effects of opioid-induced analgesia. Fascia iliaca blocks (FIBs) have emerged as an analgesic technique for this population. There are limited data on a preoperative FIB's effect on perioperative opioid intake.

A Comparison of 3 Fixation Strategies in the Treatment of Neer Type IIB Distal Clavicle Fractures.

Objectives: To compare the stability of NT2B clavicle fractures fixed with either a hook plating (HP), Superior Plating with Suture Augmentation (SPSA), or dual orthogonal plating (DP) with the hypothesis that DP would provide increased multiplanar stability across NT2B fractures.

Methods: NT2B distal clavicle fractures were created in cadaveric specimens and fixed using (1) HP, (2) SPSA, or (3) DP. Specimens were cyclically loaded in 3 different planes of motion: (1) anteroposterior (AP), (2) superior-inferior, and (3) axial rotation while displacement was continually recorded.

Healing the Index Humeral Shaft Nonunion: Risk Factors for Development of a Recalcitrant Nonunion in 125 Patients.

Background: Humeral shaft nonunions are challenging to treat, and those that require >1 surgical procedure in order for a nonunion to heal are termed recalcitrant. Most studies on nonunion have evaluated the union rate independent of the number of procedures required to achieve union. The aims of the present study were (1) to compare the healing rates after the index operation for the treatment of a nonunion with conventional versus locked plating with or without graft augmentation, (2) to report the prevalence of recalcitrant nonunion, and (3) to identify risk factors that predict a recalcitrant nonunion.

Infraspinatus Tenotomy Improves Glenoid Visualization With the Modified Judet Approach.

Objectives: To determine if the addition of an infraspinatus tenotomy to the modified Judet approach (MJA) improves glenoid visualization.

Methods: We performed an MJA on 14 human cadaveric shoulders. After exposing the glenoid, the boundary of the visualized glenoid surface was marked with a 1.

Virtual reality for management of pain in hospitalized patients: A randomized comparative effectiveness trial.

Objectives: Therapeutic virtual reality (VR) has emerged as an effective, drug-free tool for pain management, but there is a lack of randomized, controlled data evaluating its effectiveness in hospitalized patients. We sought to measure the impact of on-demand VR versus "health and wellness" television programming for pain in hospitalized patients.

Methods: We performed a prospective, randomized, comparative effectiveness trial in hospitalized patients with an average pain score of ≥3 out of 10 points.

Yoga-Induced Myositis Ossificans Traumatica of the Scapholunate Ligament.

 Myositis ossificans traumatica (MOT) involves the heterotopic development of lamellar bone after a traumatic injury. Despite being termed "myositis," MOT is not limited to muscle but rather can involve tendons, fat, and fascia. "Traumatica" reflects that lesions are usually associated with a history of significant trauma, that is, fractures or surgery; however, many reports suggest they can also be linked to repetitive low-energy insults.

Postoperative complications with cryotherapy in bone tumors.

The technique of cryosurgery has been used to control local recurrence in a variety of benign and malignant bone tumors. Early studies revealed significant complication rates (25%) that included fracture, infection, and soft tissue injury. Our method of cryosurgery has yielded excellent tumor control with improved complication rates.