Rate of skin and nerve complications as a result of cutaneous traction with modern foam boots.

INTRODUCTION: Cutaneous traction is used to temporize lower extremity fractures and relies on friction between the skin and surrounding material to apply a longitudinal force. This circumferential compressive force can lead to pressure sores, skin sloughing, or compressive neuropathies. These complications have been reported in up to 11% of patients when the cutaneous traction relies on adhesive tapes, plaster, and rubber bandages being in immediate contact with the skin. The rates of these complications are not well documented when using modern foam boots. METHODS: A retrospective chart review was performed on all orthopedic trauma patients who suffered pelvic or lower extremity injuries between March 1st, 2020 and April 30th, 2021 at a single Level-1 trauma center. We included all patients with femoral fractures, axially unstable pelvic ring and/or acetabular fractures, and unstable hip dislocations temporized with the use of cutaneous traction. All patients had intact skin and lower extremity nerve function prior to application. RESULTS: There were 138 patients identified with 141 lower extremities. The average patient age was 50.7 (6-100) years. Mean traction weight of 9.8 (5-20) pounds. Average traction duration was 20.9 (2.3-243.5) hours. At the time of traction removal, there was 1 (0.7%) new skin wound and 0 nerve palsies. The new skin wound was a stage one heel pressure sore and did not require further treatment. CONCLUSION: Cutaneous traction with a modern foam boot was found to have a skin complication rate of 0.7% and a nerve palsy complication rate of 0% for an overall complication rate of 0.7%, which has not been previously established and is lower than historically reported complication rates of 11% when utilizing adhesive and plaster directly on skin. Foam boot Cutaneous traction may be considered a safe option for traction placement.

Comparison of injuries among motorcycle, moped and bicycle traffic accident victims.

OBJECTIVE: Motorcycles, moped scooters and bicycles are commonly involved in traffic accidents and riders often suffer significant morbidity and mortality. The aim of this study is to compare and categorize the different injury patterns and fractures suffered by riders of each vehicle type after a traffic accident. METHODS: Data from a level 1 trauma center in Las Vegas, Nevada were analyzed. Traffic accident victims riding a motorcycle, moped, or bicycle from 2013 to 2017 were included. Injury location and fracture location were assigned to six and sixteen categorical locations, respectively. Descriptive statistics, including frequency counts for categorical data and mean for continuous data, were calculated for the full sample and for each of the vehicle types. Logistic regression was performed on race, categorized age, vehicle type and helmet use to calculate adjusted odds ratios for injury type between the three groups. RESULTS: Of the 2115 patients, 1372 were motorcyclists, 356 were moped scooter riders and 387 were bicyclists. Overall the vast majority of injuries reported were of the extremities or pelvic girdle (62.2%), and this was true regardless of vehicle type. Head and neck injuries were significantly more common in bicyclists (39.5%) and moped riders (34.6%), than in motorcyclists (22.7%). Helmet use was substantially lower in the moped (34%) and bicycle (20%) groups compared to the motorcycle group (85%). The most common fractures regardless of vehicle type were of the skull/face, rib, vertebral, and tibia/fibula with slight variations between vehicle groups. CONCLUSION: Similarities were seen in the most common fracture and injury patterns between the three groups. Head and neck injuries were much more common in moped and bicycle riders compared to motorcyclists. This is most likely due to the significantly higher percentage of motorcycle riders who wore a helmet. Counseling regarding helmet and protective equipment use, especially among moped and bicycle riders is essential to reduce head injuries.

Cadaveric Analysis of the Distal Tibiofibular Syndesmosis.

BACKGROUND: Unstable ankle fractures with syndesmotic injuries commonly occur and can result in significant morbidity. Although the need for an anatomic reduction is clear, there is still debate surrounding the optimal operative treatment. Recent literature shows an increasing interest in anatomic ligament repair or reconstruction in the acute and chronic syndesmosis injury. Despite this trend, there is insufficient literature detailing anatomy of the distal tibiofibular syndesmosis. In the literature that does exist, there is controversy regarding the ligamentous anatomy of the syndesmosis. None of the current literature describes an anatomic constant that may be used as an intraoperative reference for anatomic ligament reconstructions. METHODS: Ten sets of tibia and fibula free of all soft tissue were used to analyze osseous structures. Another 10 nonpaired, fresh-frozen specimens were used to study the distal tibiofibular syndesmosis. These were measured using a 3-dimensional tracking system. Measurement of each ligament width at origin and insertion, length, and distance from the tibial articular cartilage was performed. RESULTS: The superior and inferior insertions of the anterior inferior tibiofibular ligament measured 22.7 mm and 3.4 mm proximal to the distal articular cartilage of the tibia, respectively. The superior insertion of the posterior inferior tibiofibular ligament measured 15.2 mm proximal to the articular cartilage. The superior and inferior insertions of the interosseous ligament measured 31.8 mm and 9.2 mm proximal to the distal articular cartilage, respectively. The inferior transverse ligament was a prominent identifiable structure in 70% of specimens. CONCLUSIONS: The superior margin of the distal articular cartilage could serve as a consistent anatomic landmark for reconstruction. The inferior transverse ligament is an identifiable structure in 70% of the specimens studied. CLINICAL RELEVANCE: This article clarifies the anatomy and provides measurements from an anatomic constant that can guide reconstruction and intraoperative evaluation of the syndesmosis.

The prevalence of injury in Kendo.

OBJECTIVE: Kendo is a Japanese martial art analogous to fencing, which is becoming increasingly popular worldwide. The large number of participants creates a need to assess injury patterns to better train them. The purpose of this study is to describe current injury rates in kendo and compare these rates to other martial arts. METHODS: This retrospective study used an online questionnaire sent to 500 active members of the All United States Kendo Federation and World Kendo Federation. The questionnaire, based on the NCAA Injury Surveillance System, contains questions regarding location and type of injuries sustained during competition and practice, time lost to training, and competitor demographics. Statistical analyses between competitor demographics and injury rates are provided. Injury rates are expressed as injury rates/minute of competition or practice and by athlete exposures. 95% CIs were calculated. RESULTS: Responses from 307 of 500 kendo players were received (response rate = 61.4%). 41 (18%) male and 13 (16%) female participants reported injury to only one body region, while 16 (7%) men and one (1%) woman reported no injuries. 166 (74%) males and 70 (83%) females reported injuries to two or more body regions. The most common sites of injury involved the foot/ankle (65.1%), wrist/hand (53.5%) and elbow/forearm (48.8%). Most injuries occurred during practice (87.9% foot/ankle, 89.9% wrist/hand, elbow/forearm 92.2%). The most common injuries were contusions, abrasions, and sprains/strains. Injury rates were 121/1000 A-E (0.025 injuries/min) in tournaments versus 20.5/1000 A-E (0.011 injuries/min) in training. 26% of injuries resulted in time off of participation, with an average recovery time of 15 days (range = 1 day-1 year). CONCLUSIONS: Although more total injuries occurred in practice than in competition, there was a lower injury rate in kendo than in taekwondo and western-style fencing. This study demonstrates that kendo is a relatively safe sport compared to other martial arts sports.

Reduction of pullout strength caused by reinsertion of 3.5-mm cortical screws.

INTRODUCTION: Osteosynthesis of the tibia, tibial plafond, and calcaneus is commonly performed with plates and 3.5-mm self-tapping cortical screws. Screw insertion and reinsertion within the same hole in the bone may occur during surgery. Therefore, the purpose of this study was to evaluate the pullout strength of 3.5-mm self-tapping screws with up to 5 re-insertions in the diaphysis of the tibia, metaphysis of the distal tibia, calcaneus, and a polyurethane synthetic bone model. METHODS: Screws were inserted into a synthetic bone model and 5 pairs of human cadaveric diaphyseal tibiae, distal tibiae, and calcanei. The bone was predrilled, and then 3.5-mm cortical self-tapping 316 L stainless steel screws with a washer were inserted bicortically. Screws were inserted from 1 to 5 times at each location. The screws were grasped and subjected to 5-mm/min tensional force via the biaxial material testing systems machine. Statistical significance was determined using a paired 2-tailed t test. RESULTS: There was a significant difference in the pullout strength of the tibial diaphysis (1710 ± 550 N), tibial metaphysis (471 ± 266 N), and calcaneus (238 ± 90 N; P < 0.01). The tibial diaphysis pullout strength was 1710 ± 550 N for one insertion differing significantly relative to the groups with 4 (average 1030 ± 543 N, P = 0.004) or 5 (average 364 ± 209 N, P < 0.001) insertions. The tibial metaphyseal pullout strength for the single insertion group was 471 ± 266 N and differed significantly relative to the 3 (P = 0.026), 4 (P = 0.044), and 5 (P = 0.042) insertion groups. The calcaneal pullout strength for the single insertion group was 238 ± 90 N with a significant difference of the 1, 3, and 4, versus the 5 insertion group (P = 0.027, 0.040, and 0.033, respectively). The synthetic bone model pullout strength decreased significantly from the one insertion group relative to all other insertion groups (group 1, 1167 ± 263 N; group 2, 768 ± 199 N; group 3, 694 ± 295 N; group 4, 662 ± 356 N; and group 5, 154 ± 183 N; P < 0.02). CONCLUSIONS: There is a significant decrease in relative pullout strength of 3.5-mm self-tapping cortical screws when comparing the tibial diaphysis, tibial metaphysis, and calcaneus. There is also a significant decrease in 3.5-mm self-tapping screw pullout strength after repeated reinsertions in the synthetic bone model, mid-shaft tibia, metaphyseal tibia, and calcaneus. We recommend that during osteosynthesis, careful screw insertion, and minimal reinsertion be performed.