Early loss of fixation after surgical treatment of distal radius fractures: Does the number of screws matter?

Fixation methods in distal radius fractures has been studied biomechanically, but studies evaluating clinical correlation of that data are lacking. We hypothesize that the use of unthreaded pegs and decreased screw number would correlate with an early failure of fixation. There were 50 operatively treated distal radius fractures with initial post-operative radiographs that demonstrated loss of fixation. An age, BMI, and fracture-type matched cohort of 50 non-failed distal radius fractures was used for comparison. The average number of distal screws in the failed fixation group was 5.3 compared to 4.8 in the group with no loss of fixation (p = 0.07). The average number of proximal shaft screws used in the failed fixation group was 3.2 compared to 3.2 in the control group (p = 0.60). There was no difference between the use of pegs in either group. There was a significant difference between distal screw number between constructs that failed from distal screw pullout as compared to the control group, 5.6 vs. 4.8 (p = 0.0001). In conclusion, there was no difference in the number of proximal screws used in distal radius fractures that demonstrated loss of early fixation. Additionally, having more than five screws in the distal fragment had a higher rate of failure from distal screw pullout, however this was likely confounded by the more severe intra-articular fractures that had additional fixation applied in an attempt to increase stability. Finally, using smooth pegs or screws in the distal fragment made no difference in loss of fixation.

Operative Fixation of an Anterior Inferior Iliac Spine Apophyseal Avulsion Fracture Nonunion in an Adolescent Soccer Player: A Case Report.

CASE: A 14-year-old male competitive soccer player presented with a history of recurrent right hip pain for 18 months. He was diagnosed with an anterior inferior iliac spine (AIIS) apophyseal avulsion fracture nonunion with subspinal impingement, which was confirmed by radiographs, computed tomography, and magnetic resonance imaging. The patient underwent surgical fixation and subspinal decompression. He returned to competitive soccer 5 months postoperatively. CONCLUSION: AIIS apophyseal avulsion fractures occur in adolescent athletes and generally respond to nonoperative treatment. When such management is unsuccessful, surgical fixation can lead to resolution of pain with return of full function.

Hemoglobin A1c as a Predictor of Postoperative Infection Following Elective Forefoot Surgery.

BACKGROUND: There remains little evidence to support a perioperative hemoglobin A1c (HbA1c) level that could serve as a threshold for a significantly increased risk of postoperative surgical site infection (SSI) following forefoot surgery. METHODS: A national database was queried for patients who underwent elective forefoot surgery with diabetes. Patients with a perioperative HbA1c level within 3 months of surgery were identified and stratified based on HbA1c level in 0.5 mg/dL increments. The incidence of SSI was determined by either a diagnosis or procedure for SSI within 1 year and a receiver operating characteristic (ROC) curve and area under the curve (AUC) analysis was performed to determine an optimal threshold value of HbA1c. RESULTS: A total of 4630 patients who underwent forefoot surgery with diabetes with a perioperative HbA1c were included. The rate of SSI ranged from 2.3% to 11.8%. The inflection point of the ROC curve corresponded to an HbA1c level above 7.5 mg/dL ( P < .0001; 95% confidence interval [CI] = 0.58-0.67; AUC = 0.631; specificity = 75%; sensitivity = 46%). After multivariate analysis, patients with an HbA1c level of 7.5 mg/dL or greater had a significantly higher risk for postoperative wound infection compared to patients below this threshold (OR = 1.92; 95% CI = 1.5-2.4; P < .0001). CONCLUSIONS: The risk of postoperative SSI following forefoot surgery increased as the perioperative HbA1c increased. ROC analysis determined that a perioperative HbA1c above 7.5 mg/dL could serve as a threshold for a significantly increased risk of postoperative SSI following forefoot surgery. LEVEL OF EVIDENCE: Level III, comparative series.

A review of UHMWPE wear-induced osteolysis: the role for early detection of the immune response.

In a world where increasing joint arthroplasties are being performed on increasingly younger patients, osteolysis as the leading cause of failure after total joint arthroplasty (TJA) has gained considerable attention. Ultra-high molecular weight polyethylene wear-induced osteolysis is the process by which prosthetic debris mechanically released from the surface of prosthetic joints induces an immune response that favors bone catabolism, resulting in loosening of prostheses with eventual failure or fracture. The immune response initiated is innate in that it is nonspecific and self-propagating, with monocytic cells and osteoclasts being the main effectors. To date, detecting disease early enough to implement effective intervention without unwanted systemic side effects has been a major barrier. These barriers can be overcome using newer in vivo imaging techniques and modules linked with fluorescence and/or chemotherapies. We discuss the pathogenesis of osteolysis, and provide discussion of the challenges with imaging and therapeutics. We describe a positron emission tomography imaging cinnamoyl-Phe-(D)-Leu-Phe-(D)-Leu-Phe-Lys module, specific to macrophages, which holds promise in early detection of disease and localization of treatment. Further research and increased collaboration among therapeutic and three-dimensional imaging researchers are essential in realizing a solution to clinical osteolysis in TJA.