Orthopaedic trauma care during a pandemic: initial responses in the United States and Canada.

As in other countries, COVID-19 had a significant impact on the delivery of Orthopaedic trauma care in North America. Both Canada and the United States had similar experiences and responses to the pandemic, while the burden of disease was significantly greater in the United States. There was significant uncertainty in the early phases of the pandemic, fueled by a lack of knowledge of the pathophysiology and spread of COVID-19, questions surrounding screening protocols, lack of guidelines for managing infected patients, and concern over limited supplies of personal protective equipment. As we gained knowledge and experience, changes were implemented to optimize the delivery of trauma care, some of which may have lasting effects. In this article, we share the experiences and lessons learned in Canada and the United States in response to the pandemic.

Hip fracture care and national systems: The United States and Canada.

While it is widely understood that management of hip fractures not only represents clinical decision making dilemmas for the individual orthopaedist, these increasingly common injuries present economic burdens to local and national systems as well. This supplement article looks at current clinical trends, as well as systems-based issues in the United States and Canada.

Isolated posterior cruciate ligament rupture presenting as a locked knee.

Mechanical symptoms in the knee, especially locking, are most commonly associated with meniscal pathology. We present an atypical case of locking of the knee secondary to an isolated posterior cruciate ligament tear.

Proximal femoral radiographic changes after lateral transtrochanteric intramedullary nail placement in children.

BACKGROUND: Recent reports have described osteonecrosis of the femoral head after intramedullary nailing of the femur through the piriformis fossa in children. Other reports have raised concerns about the development of femoral neck narrowing and valgus deformity of the proximal part of the femur after intramedullary nailing through the tip of the greater trochanter. We evaluated the radiographic changes in the proximal part of the femur following intramedullary nailing through the lateral trochanteric area at a minimum of two years postoperatively in twenty-five affected extremities. The mean age of the patients at the time of the index procedure was ten years and six months. METHODS: A retrospective radiographic review was performed to look for proximal femoral changes. Specifically, the radiographs were examined for evidence of osteonecrosis. The articulotrochanteric distance, femoral neck diameter, and neck-shaft angle were measured on the initial and final radiographs. RESULTS: No patient had evidence of osteonecrosis of the femoral head. The articulotrochanteric distance decreased by a mean of 0.4 mm, the femoral neck diameter increased by a mean of 4.9 mm, and the neck-shaft angle decreased by a mean of 1.4 degrees. Compared with a group of seventeen patients with adequate initial and final radiographs of the contralateral side, the final mean articulotrochanteric distance was 4.5 mm less on the involved side than on the uninvolved side, the mean femoral neck diameter was 0.7 mm less on the involved side than on the uninvolved side, and the mean neck-shaft angle was 3.2 degrees less on the involved side than on the uninvolved side. No patient had development of clinically important femoral neck narrowing or valgus deformity. Statistically, the likelihood that these data represent a group with a mean 3-mm increase in the articulotrochanteric distance is <1%. The likelihood that these data represent a group with a mean 3.2-mm decrease in the ultimate femoral neck diameter is <1%. The likelihood that these data represent a group with a mean 5 degrees increase in the neck-shaft angle is <1%. CONCLUSIONS: Lateral transtrochanteric intramedullary nailing in children who are nine years of age or older does not produce clinically important femoral neck valgus deformity or narrowing, and we did not observe osteonecrosis of the femoral head after this procedure.