Reamer irrigator aspirator (RIA) reduces risk of fat embolism in bilateral pediatric femur shaft fractures: a case report.

A 14-year-old male patient was successfully treated with the reamer irrigator aspirator for femur intramedullary rod preparation after sustaining right and left closed femur fractures because of an all-terrain vehicle accident. In patients already categorized as high risk for fat embolism syndrome, such as those with bilateral femur fractures, reaming both femora greatly increases the likelihood of this complication. The reamer irrigator aspirator provides an effective tool that potentially mitigates the risk of fat embolism syndrome in pediatric patients with this type of orthopedic trauma.

Operative Versus Non-operative Treatment of Medial Epicondyle Fractures in Pediatric Athletes: A Systematic Review.

Treatment of medial epicondyle fractures is controversial in pediatric orthopaedics with a recent trend towards operative fixation in overhead athletes. We performed a systematic review to compare outcomes in operative and non-operatively overhead athletes. A systematic review of the literature was performed. Articles investing pediatric athletes with medial epicondyle fractures treated operatively and non-operatively that reported functional and radiographic outcomes were compiled. We identified 6 studies with a total of 99 patients (52 treated operatively and 47 treated non-operatively). We found a significantly higher union rate with operative treatment (100%) compared to non-operative treatment (76%, p = 0.0025), with equivalent return to sport time and rate. Non-operative treatment had a lower complication and repeat surgery rates (p = 0.009). This study demonstrates lower complication rates and equivalent functional outcomes between operative and non-operatively treated medial epicondyle fractures in athletes. Non-operative treatment is a valid option in these patients. (Journal of Surgical Orthopaedic Advances 32(1):009-013, 2023).

Common Finger Injuries: Treatment Guidelines for Emergency and Primary Care Providers.

INTRODUCTION: Finger and hand injuries are among the most common musculoskeletal conditions presenting to emergency departments and primary care providers. Many rural and community hospitals may not have immediate access to an orthopedic surgeon on-site. Furthermore, military treatment facilities, both within the continental United States and in austere deployment environments, face similar challenges. Therefore, knowing how to treat basic finger and hand injuries is paramount for patient care. MATERIALS AND METHODS: The Armed Forces Health Surveillance Branch operates the Defense Medical Surveillance System, a database that serves as the central repository of medical surveillance data for the armed forces. The Defense Medical Surveillance System was queried for ICD-10 codes associated with finger injuries from 2015 to 2019 among active duty service members across the major branches of the military. RESULTS: The most commonly reported finger injuries were open wounds to fingers without damage to nails, metacarpal fractures, phalanx fractures, and finger subluxation/dislocation. Emergency departments were the most commonly reported treatment facility type accounting for 35% of initial finger injuries, followed by 32.2% at orthopedic surgery clinics, 22.2% at family medicine clinics, and 10.8% at urgent care centers. CONCLUSIONS: Finger injuries are common in the military setting and presenting directly to an orthopedic surgeon does not appear the norm. Fingertip injuries, fractures within the hand, and finger dislocations can often be managed without the need for a subspecialist. By following simple guidelines with attention to "red flags," primary care providers can manage most of these injuries with short-term follow-up with orthopedics.

A future with no MVC patients? Impact of autonomous vehicles on orthopaedic trauma may be slow and steady.

INTRODUCTION: Orthopaedic trauma results in significant patient morbidity. Autonomous vehicle (AV) companies have invested over $100 billion in product development. Successful AVs are projected to reduce motor vehicle collision (MVC)-related injuries by 94%. The purpose of this study was to estimate the timing and magnitude of AV impact on orthopaedic trauma volume. METHODS: ICD 9 codes consistent with acetabulum (OTA 62), pelvis (OTA 61), hip (OTA 31), femur (OTA 32-33), tibia (OTA 41-43), ankle (OTA 44), and calcaneus (OTA 82) fractures and the proportion of cases caused by MVC were taken from the National Trauma Databank (NTDB) 2009-2016. Regression was performed on estimates of market penetration for autonomous vehicles taken from the literature. RESULTS: For NTDB years 2009 to 2016, 300,233 of 987,610 fractures of interest were the result of MVC (30.4%). However, the percentage of MVC mechanism of injury ranged from 9% to 53% depending on fracture type. Regression of estimates of AV market penetration predicted an increase of 2.2% market share per year. In the next 15 years we project 22% market penetration resulting in a 6% reduction in orthopaedic lower extremity trauma volume. CONCLUSION: Adoption of AVs will result in a projected 8% reduction in MVC-related orthopaedic trauma-related injuries over a 15-year period. Although this represents a significant reduction in morbidity, the advent of AVs will not eliminate the need for robust orthopaedic trauma programs. The gradual rate of injury reduction will allow hospitals to adapt and reallocate resources accordingly.

Orthopaedists Versus Radiologists: A Prospective Comparison of Radiographic Interpretation Between Orthopaedists and Radiologists at a Level I Trauma Center.

The purpose of this investigation was to evaluate the difference in response time, accuracy of radiographic interpretation, and frequency of changes in clinical management necessary after inaccurate reads when comparing orthopaedic and radiology providers. Data including provider response time, accuracy of radiographic interpretation and the frequency of changes in clinical management necessary after imaging reads was collected over a continuous two-month period at a Level I Trauma center. A total of 188 orthopedic injuries involving imaging were included. Orthopedic providers responded 203.2 minutes sooner than radiology providers. Accuracy of radiographic interpretation of the orthopaedic and radiology providers was 100% and 91%, respectively. Frequency of changes in clinical management after inaccurate interpretation of imaging by the orthopaedic and radiology provider was 0% and 7.6%, respectively. Based on our study, orthopaedic providers are significantly faster, more accurate, and make fewer mistakes affecting patient care while interpreting images of orthopaedic injuries than our radiology colleagues. (Journal of Surgical Orthopaedic Advances 30(2):093-096, 2021).

Incidence of Scaphoid Fractures and Associated Injuries at US Trauma Centers.

Backgound The scaphoid is the most commonly fractured carpal bone and often presents as a diagnostic challenge. Fractures can often go unnoticed on initial radiographic evaluation and clinical presentation can vary significantly among patients. Awareness of high-risk cohorts assists practitioners in making the appropriate clinical diagnosis of acute scaphoid fracture. Materials and Methods The National Trauma Data Bank is the world's largest trauma data repository. Utilizing the 2016 public use file, we isolated scaphoid fractures by anatomic fracture location by utilizing International Classification of Diseases, 10th revision coding. Reported cases of distal pole (S62.01), waist (S62.02), and proximal pole (S62.03) were included. This data was then queried to determine trends in mechanism of injury, demographic information, and associated injuries. Results There were a total of 968,665 patients with 2,769 cases of reported scaphoid fractures resulting in 286 scaphoid fractures per 100,000 person-years. Males were more likely to sustain a scaphoid fracture than females. The most commonly encountered associated injuries were distal radius fractures, distal ulnar fractures, and nonscaphoid carpal bone fractures, respectively. Conclusions Scaphoid fractures presenting to trauma centers are more commonly reported among males and those involved in motor vehicle accidents or falls. Appropriate scaphoid-specific radiographic imaging should be obtained as well as wrist and elbow images to evaluate for concomitant injuries, especially distal radius fractures.