Use of Direct Oral Anticoagulants Among Patients With Hip Fracture Is Not an Indication to Delay Surgical Intervention.

Objectives: To compare outcomes in patients on direct oral anticoagulants (DOACs) treated within 48 hours of last preoperative dose with those with surgical delays >48 hours.

Design: Retrospective cohort study.

Setting: Three academic Level 1 trauma centers.

Lack of Surgeon Standardization on Implant Selection in Ankle Fracture Fixation May Increase Costs and Decrease Contribution Margin.

Background: Surgical standardization has been shown to decrease costs without impacting quality; however, there is limited literature on this subject regarding ankle fracture fixation. Methods. Between October 5, 2015 and September 27, 2017, a total of 168 patients with isolated ankle fractures who underwent open reduction, internal fixation (ORIF) were analyzed.

A Limited Fixation, Olecranon Sparing Approach, for Management of Geriatric Intra-Articular Distal Humerus Fractures.

Purpose: We propose that geriatric comminuted intra-articular distal humerus fractures can be effectively treated with a limited fixation approach aimed at achieving varus/valgus stability with columnar fixation, but allowing intra-articular comminution to heal by secondary congruency against an intact olecranon, thus avoiding an olecranon osteotomy.

Methods: Fifty-six elderly patients with AO 13-C type fractures, who underwent surgical fixation with ≥12-months of follow-up were retrospectively reviewed. Thirty patients were treated with intra-articular open reduction internal fixation (ORIF) with an olecranon osteotomy and 26 patients were treated with our limited fixation (L-ORIF) approach.

The utility of post-operative hip radiographs in patients treated with hip hemiarthroplasty for femoral neck fractures.

Background: Patients treated with hip hemiarthroplasty for low energy femoral neck fractures routinely undergo hip radiographs at each postoperative clinic visit regardless of history and physical findings. No studies to date have evaluated the effectiveness of this accepted practice. The goal of this study was to identify the postoperative utility of both history and physical (H/P) and hip radiographs in the treatment course of patients treated with hip hemiarthroplasty for low energy femoral neck fractures.

Implant cut-out following cephalomedullary nailing of intertrochanteric femur fractures: Are helical blades to blame?

Introduction: Implant cut-out remains a common cause of cephalomedullary nail (CMN) failure and patient morbidity following surgical treatment of intertrochanteric femur fractures. Recent studies have suggested an increased rate of CMN cut-out with helical blades as opposed to lag screws. We compared rates of overall cut-out between helical blades and lag screws and used bivariate and multivariate analysis to determine the role of proximal fixation method among other variables on risk for cut-out.

Does the Use of Locking Screws Decrease the Rate of Hardware Removal in Ankle Fractures?

While biomechanical characteristics of locking screw fixation versus traditional plating has been studied extensively in orthopaedic literature, clinical outcome studies are lacking. The goal of this study was to evaluate the efficacy and complications rate of locking versus traditional nonlocking screws in complex ankle fractures employing distal fibula internal fixation with 1/3 semitubular small fragment plates. A retrospective review was performed between January 2010 and June 2013 of all patients in whom internal fixation of the fibula in an ankle fracture (open or closed) was performed using only 1/3 semitubular small fragment fibular plates.

Effect of sarcopenia on clinical and surgical outcome in elderly patients with proximal femur fractures.

Purpose: To investigate the relationship between sarcopenia with short-term surgical outcome in elderly patients with proximal femur fractures.

Methods And Materials: Following Institutional Review Board approval, a database of patients receiving a pelvis CT scan for acute trauma between January 2000-August 2016 was screened for an isolated proximal femur fracture. Patients were excluded if they were: < 50 years old, had conditions predisposing to sarcopenia (renal failure, congestive heart failure, muscular dystrophies), had undergone no surgical treatment, had other major traumatic injuries, or had a pathologic femur fracture.

Time From Injury to Surgical Fixation of Diaphyseal Humerus Fractures Is Not Associated With an Increased Risk of Iatrogenic Radial Nerve Palsy.

Objectives: To determine whether time from injury to fixation of diaphyseal humeral fractures and nonunions is associated with the risk of iatrogenic radial nerve palsy.

Design: Retrospective review.

Setting: Two Level 1 trauma centers.

Revisiting Tension Band Fixation for Difficult Patellar Fractures.

Patella fractures with comminution, osteoporotic bone, and/or previously failed fixation are exceedingly difficult to reduce and fix. Moreover, the risk of symptomatic constructs and patients who are poorly compliant with postoperative activity restrictions can make these complex fracture patterns an even more challenging scenario. Although there is an array of techniques described for comminuted patella fractures, there lacks an accepted surgical technique for these difficult cases.

Mechanical Construct Characteristics Predisposing to Non-union After Locked Lateral Plating of Distal Femur Fractures.

Objectives: To identify discrete construct characteristics related to overall construct rigidity that may be independent predictors of nonunion after lateral locked plate (LLP) fixation of distal femur fractures.

Design: Retrospective case-control study.

Setting: Three level-1 urban trauma centers.

Diagnosis and treatment of acute extremity compartment syndrome.

Acute compartment syndrome of the extremities is well known, but diagnosis can be challenging. Ineffective treatment can have devastating consequences, such as permanent dysaesthesia, ischaemic contractures, muscle dysfunction, loss of limb, and even loss of life. Despite many studies, there is no consensus about the way in which acute extremity compartment syndromes should be diagnosed.

Predictive factors of distal femoral fracture nonunion after lateral locked plating: a retrospective multicenter case-control study of 283 fractures.

Introduction: Reported initial success rates after lateral locked plating (LLP) of distal femur fractures have led to more concerning outcomes with reported nonunion rates now ranging from 0 to 21%. Reported factors associated with nonunion include comorbidities such as obesity, age and diabetes. In this study, our goal was to identify patient comorbidities, injury and construct characteristics that are independent predictors of nonunion risk in LLP of distal femur fractures; and to develop a predictive algorithm of nonunion risk, irrespective of institutional criteria for clinical intervention variability.

Correlation of AO and Lauge-Hansen classification systems for ankle fractures to the mechanism of injury.

Background: Our aim was to assess whether the Lauge-Hansen (LH) and the Muller AO classification systems for ankle fractures radiographically correlate with in vivo injuries based on observed mechanism of injury.

Methods: Videos of potential study candidates were reviewed on YouTube.com.

Does late night hip surgery affect outcome?

Background: There is a perception that after-hours hip surgery may result in increased complication rates. Surgeon fatigue, decreased availability of support staff, and other logistical factors may play an adverse role. However, there are little data supporting this perception in the hip fracture literature.

Mitochondrial damage associated molecular patterns from femoral reamings activate neutrophils through formyl peptide receptors and P44/42 MAP kinase.

Hypothesis: Fractures and femoral reaming are associated with lung injury. The mechanisms linking fractures and inflammation are unclear, but tissue disruption might release mitochondria. Mitochondria are evolutionarily derived from bacteria and contain "damage associated molecular patterns" like formylated peptides that can activate immunocytes.

A novel methodology for the study of injury mechanism: ankle fracture analysis using injury videos posted on YouTube.com.

Purpose: An inherent deficiency in the understanding of the biomechanics of fractures is the reliance on cadaveric or other nonphysiological injury models resulting from the prohibitive ethical and practical considerations of conducting injury studies in live participants. We describe a novel methodology for studying injury mechanisms using in vivo injury videos obtained from Youtube.com demonstrating injuries as they occur in real time and correlating them with the resulting injury radiographs.