Higher Reoperation Rates in Planned, Staged Treatment of Open Fractures Compared with Fix-and-Close: A Propensity Score-Matched Analysis.

Background: Initial surgical management of Gustilo-Anderson type-I to IIIA open fractures varies from surgical fixation of the fracture with immediate closure of the traumatic wound to various combinations of staged fracture and wound management. The decision to choose staged management has historically been based on wound contamination and the severity of the open fracture. The purpose of this study was to compare the rates of surgical site infection (SSI), wound complication, nonunion, and 1-year reoperation between patients with type-I to IIIA open fractures who underwent fix-and-close treatment and those who underwent planned, staged treatment.

Differences in Practice Patterns in the Use of Temporary External Fixation for the Management of Open Lower-Extremity Fractures.

Background: External fixation is often used in the management of open lower-extremity fractures. The objectives of this study were to identify hospital characteristics that are associated with greater use of temporary external fixation and to determine if external fixation reduces the odds of surgical site infection (SSI) and unplanned reoperation among patients with open lower-extremity fractures.

Methods: This is a secondary analysis of the Aqueous-PREP and PREPARE-Open trials involving open lower-extremity fractures.

Temporary Reduction Assisting Corridor Constraint Wires for Intramedullary Nailing of Periarticular Fractures: A Technical Trick and Case Series.

Achieving satisfactory alignment during intramedullary nailing of periarticular fractures can be technically challenging due to a combination of deforming forces and the lack of cortical contact by the nail in the articular segment metaphysis allowing malreduction to persist during nail passage. Although blocking screws are described to facilitate reduction, they risk impeding subsequent implant fixation. This article introduces an innovative Temporary Reduction Assisting Corridor Constraint Wires (TRACC-wires) technique to safely correct multiplanar deformities without limiting fixation options.

Are Orthopaedic Trauma Surgeons Appropriately Compensated for Treating Acetabular Fractures? An Analysis of Operative Times and Relative Value Units.

Objectives: To evaluate the work relative value units (RVUs) attributed per minute of operative time (wRVU/min) in fixation of acetabular fractures, evaluate surgical factors that influence wRVU/min, and compare wRVU/min with other procedures.

Design: Retrospective.

Setting: Level 1 academic center.

Assessment of sacral osseous fixation pathways for same-level dual transiliac-transsacral screw insertion.

Introduction: The purpose of this study is to (1) describe a pre-operative planning technique using non-reformatted CT images for insertion of multiple transiliac-transsacral (TI-TS) screws at a single sacral level, (2) define the parameters of a sacral osseous fixation pathway (OFP) that will allow for insertion of two TI-TS screws at a single level, and (3) identify the incidence of sacral OFPs large enough for dual-screw insertion in a representative patient population.

Methods: Retrospective review at a level-1 academic trauma center of a cohort of patients with unstable pelvic injuries treated with two TI-TS screws in the same sacral OFP, and a control cohort of patients without pelvic injuries who had CT scans for other reasons.

Results: Thirty-nine patients had two TI-TS screws at S1.

A Randomized Trial of Preoperative Practice in a Simulated Operative Environment: 3D Printed Pilon Model Improves Resident Performance.

This study assessed the effect of preoperative planning using a 3D-printed periarticular fracture model on operative performance. A complex pilon fracture was 3D-printed, and a preoperative plan was developed. Orthopaedic surgery residents (n = 20) were randomized into two groups.

Age and socioeconomic status affect access to telemedicine at an urban level 1 trauma center.

Objectives: Despite clinical and economic advantages, routine utilization of telemedicine remains uncommon. The purpose of this study was to examine potential disparities in access and utilization of telehealth services during the rapid transition to virtual clinic during the coronavirus pandemic.

Design: Retrospective chart review.

Single-Stage Treatment of Fracture-related Infections.

Fracture-related infections (FRIs) remain a significant problem. Many approach FRI cases in a staged fashion, focusing on infection eradication initially and fracture union during subsequent procedures. The literature quotes high success rates with this strategy.

Why Make the Cut? Trochanteric Slide Osteotomy Can Improve Exposure to the Anterosuperior Acetabulum.

Objective: To define relative increases in visual bony surface area and access to critical landmarks with the addition of a trochanteric slide osteotomy to a Kocher-Langenbeck approach.

Methods: A Kocher-Langenbeck approach followed by a trochanteric slide osteotomy was sequentially performed on 10, fresh-frozen, hemipelvectomy cadaveric specimens. Visual and palpable access to relevant surgical landmarks was recorded.

Surgical Approaches to the Proximal Humerus: A Quantitative Comparison of the Deltopectoral Approach and the Anterolateral Acromial Approach.

Background: Debate exists over the optimal approach for addressing fractures of the proximal humerus. The purpose of this study was to objectively quantify the surface area of the humerus exposed using the deltopectoral (DP) and anterolateral acromial (ALA) approaches and to compare visualized and palpable anatomic landmarks.

Methods: Ten arms on five fresh-frozen torsos underwent the DP and ALA approaches.

A Preoperative Planning Tool: Aggregate Anterior Approach to the Humerus With Quantitative Comparisons.

Extensile approaches to the humerus are often needed when treating complex proximal or distal fractures that have extension into the humeral shaft or in those fractures that occur around implants. The 2 most commonly used approaches for more complex fractures include the modified lateral paratricipital approach and the deltopectoral approach with distal anterior extension. Although the former is well described and quantified, the latter is often associated with variable nomenclature with technical descriptions that can be confusing.

A Quantitative Exposure Planning Tool for Surgical Approaches to the Sacroiliac Joint.

Objectives: To aid in surgical planning by quantifying and comparing the osseous exposure between the anterior and posterior approaches to the sacroiliac joint.

Methods: Anterior and posterior approaches were performed on 12 sacroiliac joints in 6 fresh-frozen torsos. Visual and palpable access to relevant surgical landmarks was recorded.

A Comparison of Exposure Between the Classic and Modified Judet Approaches to the Scapula.

Objectives: A debate exists over the optimal approach for addressing fractures of the scapula and glenoid. The purpose of this study is to (1) quantify and compare osseous exposure using modified Judet (MJ) and classic Judet (CJ) approaches and (2) assess the change in scapular exposure after triceps release from the inferior glenoid.

Methods: Ten arms on 5 fresh-frozen torsos underwent MJ and CJ approaches.

Spontaneous Ruptures of the Distal Biceps and Rotator Cuff Tendons Secondary to Syringomyelia: A Case Report.

Case: We present a case of ipsilateral spontaneous ruptures of the distal biceps and rotator cuff tendons secondary to syringomyelia of the cervical spine. The distal biceps tendon ruptured first and underwent successful repair. Six months postoperatively, the patient was found to have an ipsilateral massive acute-on-chronic rotator cuff tear following minimal trauma, with a well-maintained glenohumeral joint space.

Return to high school- and college-level football after anterior cruciate ligament reconstruction: a Multicenter Orthopaedic Outcomes Network (MOON) cohort study.

Background: There is a relative paucity of data regarding the effect of anterior cruciate ligament (ACL) reconstruction on the ability of American high school and collegiate football players to return to play at the same level of competition as before their injury or to progress to play at the next level of competition.

Purpose: (1) To identify the percentage of high school and collegiate American football players who successfully returned to play at their previous level of competition, (2) to investigate self-reported performance for those players able to return to play or reason(s) for not returning to play, and (3) to elucidate risk factors responsible for players not being able to return to play or not returning to the same level of performance.

Study Design: Cohort study; Level of evidence, 3.

Comparative study of short forms of the Tampa Scale for Kinesiophobia: fear of movement in a surgical spine population.

Objective: To compare the factor structure of 6 short forms of the Tampa Scale for Kinesiophobia (TSK) by means of confirmatory factor analysis in patients after spinal surgery for degenerative conditions.

Design: A cross-sectional survey study.

Setting: University-based surgical clinic.

Neurochemical characterization of tyrosine hydroxylase-immunoreactive interneurons in the developing rat cerebral cortex.

Understanding the development of cortical interneuron phenotypic diversity is critical because interneuron dysfunction has been implicated in several neurodevelopmental disorders. Here, tyrosine hydroxylase (TH)-immunoreactive neurons in the developing and adult rat cortex were characterized in light of findings regarding interneuron neurochemistry and development. Cortical TH-immunoreactive neurons were first observed 2 weeks postnatally and peaked in number 3 weeks after birth.