Fatigue Failure in Extra-Articular Proximal Tibia Fractures: Locking Intramedullary Nail Versus Double Locking Plates-A Biomechanical Study.

OBJECTIVES: The goal of this study is to compare the fatigue strength of a locking intramedullary nail (LN) construct with a double locking plate (DLP) construct in comminuted proximal extra-articular tibia fractures. METHODS: Eight pairs of fresh frozen cadaveric tibias with low bone mineral density [age: 80 ± 7 (SD) years, T-score: -2.3 ± 1.2] were used. One tibia from each pair was fixed with LN, whereas the contralateral side was fixed with DLP for complex extra-articular multifragmentary metaphyseal fractures (simulating OTA 41-A3.3). Specimens were cyclically loaded under compression simulating single-leg stance by staircase method out to 260,000 cycles. Every 2500 cycles, localized gap displacements were measured with a 3D motion tracking system, and x-ray images of the proximal tibia were acquired. To allow for mechanical settling, initial metrics were calculated at 2500 cycles. The 2 groups were compared regarding initial construct stiffness, initial medial and lateral gap displacements, stiffness at 30,000 cycles, medial and lateral gap displacements at 30,000 cycles, failure load, number of cycles to failure, and failure mode. Failure metrics were reported for initial and catastrophic failures. RESULTS: DLP constructs exhibited higher initial stiffness and stiffness at 30,000 cycles compared with LN constructs (P < 0.03). There were no significant differences between groups for loads at failure or cycles to failure. CONCLUSIONS: For the fixation of extra-articular proximal tibia fractures, a LN provides a similar fatigue performance to double locked plates. The locked nail could be safely used for fixation of proximal tibia fractures with the advantage of limited extramedullary soft tissue damage.

Mid-America Orthopaedic Association Physician in Training Award: Surgical technique: Pediatric supracondylar humerus fractures: a technique to aid closed reduction.

BACKGROUND: Anatomic reduction of some displaced pediatric supracondylar humerus fractures is not attainable via closed manipulation, thus necessitating open reduction. Open reduction has been associated with increased complications, including elbow stiffness, scarring, iatrogenic neurovascular injury, and longer hospital stays. Using a Schanz pin to aid in closed reduction may decrease the need for conversion to an open procedure, possibly reducing morbidity. DESCRIPTION OF TECHNIQUE: A percutaneously placed 2.5-mm Schanz pin was drilled into the posterior humeral diaphysis and used as a joystick to reduce anterior and posterior, varus and valgus, and rotational deformity. The fracture then was stabilized with 0.62-mm K-wires placed under fluoroscopy and the Schanz pin then was removed. METHODS: We retrospectively reviewed all displaced pediatric supracondylar humerus fractures treated by one surgeon from March 2002 through December 2010, with 143 fractures meeting criteria for inclusion. These fractures then were divided into two groups. Group 1 (90 fractures) included fractures treated before implantation of the Schanz pin. In this group, if successful reduction could not be achieved via closed manipulations, a formal open reduction was performed. In Group 2, (53 fractures) the Schanz pin technique was used to assist with reduction of fractures that were not reduced successfully by closed manipulations. All fractures were stabilized with the 0.62-mm K-wires after the reductions. To equalize group size, the 37 most remote fractures in Group 1 were removed, leaving a final 53 fractures in each group for analysis. Demographics, injury data, operative technique, complications, and radiographic reduction were analyzed. The minimum followup for both groups was 3.3 weeks (average, 13 weeks; range, 3.3-130 weeks). RESULTS: Fewer fractures in Group 2 (one of 53, 1.9%) compared with Group 1 (seven of 53, 13%) underwent open reduction. Ten fractures in Group 2 underwent the Schanz pin technique, and none of these had open reductions. We found no difference between the groups concerning fracture alignment at final followup or postoperative complications. CONCLUSIONS: A posteriorly placed Schanz pin aids in anatomic reduction and decreases the need for open treatment of displaced pediatric supracondylar humerus fractures, without compromising the complication rate or final radiographic outcome.

Friends of nursing: a community of caring to promote excellence in nursing practice, education, and research.

More than 25 years ago, the name "Friends of Nursing" was adopted by an academic, community Magnet(®) hospital to signify a model for community support of nursing. From inception, the intent was to recruit philanthropic dollars to promote recognition of and excellence in nursing practice, education, and research. Although philanthropy in health care settings is common, what is unique about this program is the long-standing, dedicated conceptual framework for nursing philanthropy and the very significant number of philanthropic dollars from literally thousands of donors to support a diverse range of activities to affect and advance the professional excellence of nurses and the quality of patient care. This model has been successfully replicated within a wide variety of other health care organizations and nursing services throughout the United States and abroad.

Refrigerated osteoarticular allografts to treat articular cartilage defects of the femoral condyles. A prospective outcomes study.

BACKGROUND: Because of concerns about infections with the use of fresh osteoarticular allografts, osteoarticular allografts are currently stored hypothermically for a minimum of fourteen days to allow for serologic and microbiologic testing prior to implantation. Refrigerated osteoarticular allograft transplants are often used to treat symptomatic chondral and osteochondral defects in young, active patients. Chondrocyte viability has been shown to decrease substantially when allografts are stored for longer than twenty-eight days. The purpose of this study was to examine the clinical and functional outcomes of patients receiving refrigerated osteoarticular allografts between fifteen and twenty-eight days after procurement. METHODS: Twenty-three consecutive patients (twenty-three knees) who underwent treatment of focal articular cartilage defects of the femoral condyles with refrigerated osteoarticular grafts were prospectively followed for an average of three years. The average age of the implanted refrigerated allografts was 20.3 days. The patients were assessed preoperatively and postoperatively with validated outcome surveys. RESULTS: The mean modified Cincinnati knee ratings significantly improved from baseline to the time of the final follow-up, with an increase from 27.3 to 36.5 on the subscale rating for function (p<0.01), from 21.9 to 32.5 on the subscale rating for symptoms (p<0.03), and from 49.2 to 69.0 for the overall score (p<0.02). The mean International Knee Documentation Committee subjective score improved from 52 points at baseline to 68.5 points at the time of the final follow-up (p<0.03). A significant improvement was also found for effusions and functional testing (the single-leg hop) (p<0.001 for both). Radiographic evaluation at the time of the final follow-up revealed that twenty-two of the twenty-three grafts were in stable position with good osseous incorporation into host bone. No graft failure was encountered. CONCLUSIONS: Transplantation of refrigerated osteoarticular allografts stored between fifteen and twenty-eight days provides significant functional and clinical improvement after an average follow-up of three years in patients treated for a full-thickness osteochondral defect of the femoral condyle, with similar outcomes to historical reports of patients with fresh allograft implants.