Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Trauma 147 articles


High Irritation and Removal Rates After Plate or Nail Fixation in Patients With Displaced Midshaft Clavicle Fractures

Martijn H. J. Hulsmans MD, Mark Heijl MD, PhD, R. Marijn Houwert MD, PhD, Eric R. Hammacher MD, PhD, Sven A. G. Meylaerts MD, PhD, Michiel H. J. Verhofstad PhD, Marcel G. W. Dijkgraaf MD, PhD, Egbert J. M. M. Verleisdonk

Studies comparing plate with intramedullary nail fixation of displaced midshaft clavicle fractures show faster recovery in the plate group and implant-related complications in both groups after short-term followup (6 or 12 months). Knowledge of disability, complications, and removal rates beyond the first postoperative year will help surgeons in making a decision regarding optimal implant choice. However, comparative studies with followup beyond the first year or two are scarce.

Do Patients Taking Warfarin Experience Delays to Theatre, Longer Hospital Stay, and Poorer Survival After Hip Fracture?

John E. Lawrence MA, MB, BChir, MRCS, Daniel M. Fountain BSc, Duncan J. Cundall-Curry MBBS, MRCS Dip Clin Ed, Andrew D. Carrothers MBChB, FRCS (Tr&Orth)

Patients sustaining a fractured neck of the femur are typically of advanced age with multiple comorbidities. As a consequence, the proportion of these patients receiving warfarin therapy is approximately 10%. There are currently few studies investigating outcomes in this subset of patients.

Classifications In Brief: The Tscherne Classification of Soft Tissue Injury

David A. Ibrahim MD, Alan Swenson MD, Adam Sassoon MD, Navin D. Fernando MD

Will My Tibial Fracture Heal? Predicting Nonunion at the Time of Definitive Fixation Based on Commonly Available Variables

Kevin O’Halloran MD, Max Coale BA, Timothy Costales BS, Timothy Zerhusen BS, Renan C. Castillo PhD, Jason W. Nascone MD, Robert V. O’Toole MD

Accurate prediction of tibial nonunions has eluded researchers. Reliably predicting tibial nonunions at the time of fixation could change management strategies and stimulate further research.

Variation in Resource Utilization for Patients With Hip and Pelvic Fractures Despite Equal Medicare Reimbursement

Andre M. Samuel BBA, Matthew L. Webb AB, Adam M. Lukasiewicz MSc, Bryce A. Basques MD, MHS, Daniel D. Bohl MD, MPH, Arya G. Varthi MD, Joseph M. Lane MD, Jonathan N. Grauer MD

Medicare currently reimburses hospitals for inpatient admissions with “bundled” payments based on patient Diagnosis-related Groups (DRGs) regardless of true hospital costs. At present, DRG 536 (fractures of the hip and pelvis) includes a broad spectrum of patients with orthopaedic trauma, likely with varying inpatient resource utilization. With the growing incidence of fractures in the elderly, inadequate reimbursements from Medicare for certain patients with DRG 536 may lead to growing financial strain on healthcare institutions caring for these patients with higher costs.

Can Vascular Injury be Appropriately Assessed With Physical Examination After Knee Dislocation?

Douglas S. Weinberg MD, Nicholas R. Scarcella BS, Joshua K. Napora MD, Heather A. Vallier MD

Knee dislocations are rare injuries with potentially devastating vascular complications. An expeditious and accurate diagnosis is necessary, as failing to diagnose vascular injury can result in amputation; however, the best diagnostic approach remains controversial.

To Cast, to Saw, and Not to Injure: Can Safety Strips Decrease Cast Saw Injuries?

Natalie C. Stork MD, Rachel L. Lenhart PhD, Blaise A. Nemeth MD, MS, Kenneth J. Noonan MD, Matthew A. Halanski MD

Placement and removal of fiberglass casts are among the more-common interventions performed in pediatric orthopaedic surgery offices. However, cast removal is associated with abrasive injuries and burns from the oscillating cast saw, and these injuries can occur even when the cast is removed by experienced personnel. It is unknown whether an added barrier, such as a safety strip, can mitigate injuries from blade-to-skin contact during cast removal with the oscillating saw.

Addition of a Medial Locking Plate to an In Situ Lateral Locking Plate Results in Healing of Distal Femoral Nonunions

Michael A. Holzman MD, Bryan D. Hanus MD, John W. Munz MD, Daniel P. O’Connor PhD, Mark R. Brinker MD

Nonunion of the distal femur after lateral plating is associated with axial malalignment, chronic pain, loss of ambulatory function, and decreased knee ROM. The addition of a medial locking plate with autogenous bone grafting can provide greater stability to allow bone healing and may be used to achieve union in these challenging cases.

Does Wrist Arthrodesis With Structural Iliac Crest Bone Graft After Wide Resection of Distal Radius Giant Cell Tumor Result in Satisfactory Function and Local Control?

Tao Wang MD, Chung Ming Chan MBBS, Feng Yu MD, Yuan Li MD, Xiaohui Niu MD

Many techniques have been described for reconstruction after distal radius resection for giant cell tumor with none being clearly superior. The favored technique at our institution is total wrist fusion with autogenous nonvascularized structural iliac crest bone graft because it is structurally robust, avoids the complications associated with obtaining autologous fibula graft, and is useful in areas where bone banks are not available. However, the success of arthrodesis and the functional outcomes with this approach, to our knowledge, have only been limitedly reported.

Large-magnitude Pelvic and Retroperitoneal Tissue Damage Predicts Organ Failure

Greg Gaski MD, Travis Frantz BS, Scott Steenburg MD, Teresa Bell PhD, Todd McKinley MD

Pelvic and retroperitoneal trauma is a major cause of morbidity and mortality in multiply injured patients. The Injury Severity Score (ISS) has been criticized for underrepresenting and inaccurately defining mechanical injury. The influence of pelvic injury volume on organ dysfunction and multiple organ failure (MOF) has not been described. Through the use of CT, this investigation sought to precisely define volumes of mechanical tissue damage by anatomic region and examine its impact on organ failure.