A Percutaneous Threaded Wire as a Clamp Technique for Avoiding Wedge Deformity While Nailing Intertrochanteric Femur Fractures.

Hip fractures are common injuries managed by the orthopaedic surgeon, and within the umbrella of hip fractures, intertrochanteric femur fractures constitute a significant portion of these injuries. Recent trends have shown an increased usage of cephalomedullary nails for these injuries. A known potential complication of this technique is the generation of a wedge deformity creating a varus alignment, especially when the cranial portion of the intertrochanteric fracture exits at or near the starting point of the nail. Although the biomechanics of this phenomenon are well described, few reports have shown techniques to help avoid this phenomenon. Here, we present a novel technique we have found useful to help prevent the wedge deformity incorporating commonly available instruments.

Outcomes of Surgical Treatment of Periprosthetic Acetabular Fractures.

Periprosthetic acetabular fractures sustained following acute trauma after total hip arthroplasty are rare and historically have poor outcomes. This article reviews 5 cases and the treatment algorithm used by a single orthopaedic surgeon specializing in acetabular fracture care with a co-surgeon specializing in arthroplasty. Team-based surgical management with arthroplasty- and fracture-trained surgeon(s) is paramount for optimal outcome. The following approach resulted in satisfactory outcomes without need for revision implants. In fracture patterns with columnar involvement, the columns were restored with plates and screws. In fracture patterns with wall involvement, the acetabular component functioned as a template for wall reconstruction with use of a buttress plate. The acetabular component was revised when deemed loose during stress of the component through the surgical approach used for fracture fixation.

Surgical Gowning Technique: Are We Contaminated Before We Cut?

OBJECTIVES: To assess possible breaches of sterility during the initial gowning step. DESIGN: Observational study. Twenty-seven gowning events were monitored for contamination during a simulated two-person gowning process in which a surgical technician assists a surgeon in the gowning process at the beginning of a surgical procedure. The lower portion of the technician's gown was coated with resin powder before the gowning process to simulate contamination. SETTING: Single-institution Level 1 trauma center. PARTICIPANTS: Three physicians and 3 tenured surgical technicians. INTERVENTION: Observed contaminated areas represented by ultraviolet resin powder under ultraviolet light on the gown of the surgeon after the two-person gowning step. MAIN OUTCOME MEASUREMENT: Number and surface area of contamination events. RESULTS: There was a 66.67% rate of contamination of the surgeon's gown sleeves while being gowned by a surgical technician. The overall median contamination for the short surgeon was 1.3 cm. For the medium height surgeon, the overall median contamination was 1.4 cm. The tall surgeon had an overall median contamination of 2.9 cm. Of the short, medium, and tall surgeons, the number of contamination events was 6, 5, and 7, respectively. The study suggested that the surgeon's height was a significant source of variation (P = 0.046). CONCLUSION: We present an observational pilot study that suggests that to reduce contamination in the operating room, the two-person method must be highly monitored. This study also proposes that the single-person gowning technique should be used to reduce contamination rate during the gowning process.

Arteriovenous Fistula Development After Nonoperative Treatment of a Clavicular Fracture: A Case Report.

CASE: We report a case of prominent venous dilation in the supraclavicular area with an underlying arteriovenous fistula following nonoperative management of a fracture in the medial third of the clavicle in an adult. The venous dilation indicated elevated venous pressures, likely caused by hypertrophic callus formation and/or fistula development. CONCLUSION: Arteriovenous fistula and prominent venous dilation are possible sequelae of nonoperative treatment of clavicular fractures. Surgeons should be aware of their possibility when planning either operative or nonoperative treatment. More information is needed to guide management of these issues when they occur.

Low Profile Mesh Plating for Patella Fractures: Video of a Novel Surgical Technique.

Patella fractures can be challenging to treat particularly in the presence of inferior pole comminution. In this video we present a novel surgical technique for the treatment of patella fractures using a small fragment low profile mesh plate. Key points are the surgical exposure with direct visualization of the articular reduction, the preparation of the mesh plate to accommodate patellar anatomy and the augmentation of the construct using Krackow sutures to address inferior pole comminution. Low profile mesh plating allows for multiplanar fixation of patella fractures while avoiding implant and fixation problems related to tension band fixation. Our early experience with this technique is encouraging and it appears that this technique is useful for the treatment of the majority of patella fractures.

Anterolateral Approach to the Pilon.

This video reviews the indications, surgical approach, and case examples of the anterolateral approach to a distal tibial plafond fracture. If this approach is used in a staged fashion, when the soft envelope is ready, it affords excellent visualization for fracture fixation through thick skin flaps. An associated article reviews a cohort of 44 mainly type C3 pilon injuries treated by 2 orthopaedic traumatologist using the anterolateral approach after staged external fixation. An anatomic or good fracture reduction was obtained in 41 fractures with 13.6% of patients undergoing a secondary surgical procedure for infection or nonunion.

Calcium Triglyceride Versus Polymethylmethacrylate Augmentation: A Biomechanical Analysis of Pullout Strength.

STUDY DESIGN: Biomechanical pullout study using calcium triglyceride (CTG) and polymethylmethacrylate (PMMA) for screw augmentation. OBJECTIVE: Compare the biomechanical performance of CTG augmentation versus the gold standard, PMMA, in primary and revision models, using a pedicle screw pullout model. BACKGROUND SUMMARY: CTG is a novel form of bone augmentation with several reported biocompatible properties compared with PMMA. PMMA is the standard of care for pedicle screw augmentation in osteoporotic spine. METHODS: Blocks of closed-cell rigid polyurethane foam of uniform density, representing subcortical layer in osteoporotic pedicle, were prepared according to ASTM standards. After the components of PMMA (n = 11) and CTG (n = 11) were individually mixed in a standardized fashion, 0.2 ml was injected from deep to superficial along a predrilled pilot hole followed by immediate insertion of the pedicle screw. An unaugmented group (n = 10) was also prepared. Blocks cured for 24 hrs, and screws were pulled out at a rate of 5 mm/min on materials testing equipment. For the revision model, the unaugmented group, after screw pullout, was augmented with 0.8 ml of PMMA (n = 5) or CTG (n = 5) as detailed above and screw pullout performed similarly. RESULTS: The mean pullout strengths (SD) for the intact models were as follows: unaugmented, 976.6 N (94.2 N); PMMA, 1,218.1 N (66.8 N); and CTG, 1,841.6 N (57.4 N). A one-way analysis of variance indicated a significant difference among the primary models (p < .0001). For the revision models, the pullout strength for PMMA was 1,939.2 N (108.9 N) and for CTG, 2,513.0 N (149.1 N), which were statistically different from each other (p < .0003). Stiffness of the constructs was increased with both PMMA and CTG augmentation over no augmentation (p < .0001) although no significant difference in stiffness was detected between the 2 forms of augmentation. CONCLUSION: We conclude that CTG augmentation of pedicle screws resulted in significantly higher axial pullout strength in primary (p < .0001) and revision (p < .0003) models compared with PMMA.