Use of Proximal Humerus Locking Plates for Fixation of Pediatric Femoral Neck Fractures: Technical Trick.

Displaced pediatric femoral neck fractures are uncommon and complex injuries which require urgent operative fixation. Owing to the small and variable size of the pediatric femur, implant selection and availability can be difficult. We present a novel technique for the stabilization of these fractures with commonly available implants which provides physeal sparing, fixed angle, and stable fixation.

True Cost of Operating Room Time: Implications for an Orthopaedic Trauma Service.

OBJECTIVE: To derive an accurate estimate of the operating cost per minute for an orthopaedic trauma room. STUDY DESIGN: Retrospective economic analysis. SETTING: Level II Trauma Center. INTERVENTION: Hospital cost-accounting system query. MAIN OUTCOME MEASUREMENTS: Direct fixed costs, direct variable costs, and hospital overhead. RESULTS: Operating room per minute costs include direct variable costs of $2.77, direct fixed costs of $2.47, and hospital overhead costs of $10.97. Total per minute costs amounted to $16.21. This does not include professional fees of anesthesiology or surgeons or the costs of soft goods or implants. CONCLUSIONS: This is the first published study to document the true per minute cost of an orthopaedic trauma operating room. Such information is valuable when defining the value of a dedicated operating room, negotiating employment contracts, defining call stipends, and brokering capital purchases for the orthopaedic trauma service. LEVEL OF EVIDENCE: Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Mountain pine beetle (Dendroctonus ponderosae) CYP4Gs convert long and short chain alcohols and aldehydes to hydrocarbons.

Hydrocarbon biosynthesis in insects involves the elongation of fatty acyl-CoAs to very-long chain fatty acyl-CoAs that are then reduced and converted to hydrocarbon, with the last step involving the oxidative decarbonylation of an aldehyde to hydrocarbon and carbon dioxide. Cytochromes P450 in the 4G family decarbonylate aldehydes to hydrocarbon. All insect acyl-CoA reductases studied to date reduce fatty acyl-CoAs to alcohols. The results of the work reported herein demonstrate that CYP4G55 and CYP4G56 from the mountain pine beetle, Dendroctonus ponderosae, expressed as fusion proteins with house fly cytochrome P450 reductase (CPR), convert both long chain aldehydes and long chain alcohols to hydrocarbons. CYP4G55 and CYP4G56 appear to prefer primary alcohols to aldehydes as substrates. These data strongly suggest that hydrocarbon biosynthesis in insects occurs by the two-step reduction of very long chain fatty acyl-CoAs to alcohols, which are then oxidized to aldehydes and then oxidatively decarbonylated to hydrocarbon by CYP4G enzymes. In addition, both CYP4G55 and CYP4G56 fusion proteins convert C10 alcohols and aldehydes to hydrocarbons, including the conversion of (Z)-7-decenal, a putative intermediate in the exo-brevicomin pheromone biosynthetic pathway, to (Z)-3-nonene. These data demonstrate that the highly conserved CYP4G enzymes accept a broad range of carbon chain lengths, including C10 and C18, and have evolved to function in cuticular hydrocarbon biosynthesis and pheromone production.

Operating Room Supply Costs in Orthopaedic Trauma: Cost Containment Opportunities.

In the current health care environment, cost containment is more important than ever. Most physicians currently are unaware of the cost of operating room supplies. A large amount of waste occurs secondary to lack of knowledge and absence of physician incentives for cost saving. Many of the decisions for supply use can be based on good scientific evidence, which supports specific cost saving measures. Careful attention to blood utilization and use of tranexamic acid has the potential to save millions in the hip fracture treatment and arthroplasty treatments. Standardization of surgical preparation and draping can decrease costs and prevent costly surgical site infections. Following protocols and guidelines for bone graft and orthobiologics is critical. The clinical and legal repercussions of retained instruments and costs associated with dropped implants is a huge source of wasted health care dollars. Reprocessing programs for external fixators and tourniquets have been extremely successful. A myriad of opportunities for intraoperative cost savings exist that could be applied to nearly every orthopaedic surgery performed in the United States. It is incumbent on all surgeons to put aside the choices made out of habit and take part in reducing operating room waste for the benefit of hospitals, patients, and the health care system. When applied to the 5.3 million orthopaedic surgeries performed annually in the United States, billions of dollars could easily be saved with no adverse effect on patient care.

The Clinical and Economic Impact of Generic Locking Plate Utilization at a Level II Trauma Center.

OBJECTIVES: In today's climate of cost containment and fiscal responsibility, generic implant alternatives represent an interesting area of untapped resources. As patents have expired on many commonly used trauma implants, generic alternatives have recently become available from a variety of sources. The purpose of this study was to examine the clinical and economic impact of a cost containment program using high quality, generic orthopaedic locking plates. The implants available for study were anatomically precontoured plates for the clavicle, proximal humerus, distal radius, proximal tibia, distal tibia, and distal fibula. DESIGN: Retrospective review. SETTING: Level II Trauma center. PATIENTS: 828 adult patients with operatively managed clavicle, proximal humerus, distal radius, proximal tibia, tibial pilon, and ankle fractures. INTERVENTION: Operative treatment with conventional or generic implants. RESULTS: The 414 patients treated with generic implants were compared with 414 patients treated with conventional implants. There were no significant differences in age, sex, presence of diabetes, smoking history or fracture type between the generic and conventional groups. No difference in operative time, estimated blood loss or intraoperative complication rate was observed. No increase in postoperative infection rate, hardware failure, hardware loosening, malunion, nonunion or need for hardware removal was noted. Overall, our hospital realized a 56% reduction in implant costs, an average savings of $1197 per case, and a total savings of $458,080 for the study period. CONCLUSIONS: Use of generic orthopaedic implants has been successful at our institution, providing equivalent clinical outcomes while significantly reducing implant expenditures. Based on our data, the use of generic implants has the potential to markedly reduce operative costs as long as quality products are used. LEVEL OF EVIDENCE: Therapeutic Level III.

Clinical and economic impact of using generic 7.3-mm cannulated screws at a level II trauma center.

We retrospectively studied the clinical and economic impact of a cost-containment program using high quality generic 7.3-mm screws for fixation of femoral neck fractures and pelvic ring injuries at a level II trauma center. Included in the study were 174 patients with femoral neck fractures or posterior pelvic ring injuries. These injuries were managed with 203 conventional and 178 generic implants. Study results showed no significant differences in age, sex, American Society of Anesthesiologists status, or fracture pattern; no differences in operative time, estimated blood loss, or complication rates; no increase in varus collapse, shortening, screw cutout, screw deformation, loosening, or conversion to arthroplasty; and no differences in hospital complications of deep venous thrombosis, pulmonary embolism, urinary tract infection, or pressure sores. Overall, our hospital realized a 70% reduction in implant costs, resulting in calendar-year savings of $50,531. At our institution, use of generic 7.3-mm cannulated screws has been a success. Hospital implant costs decreased significantly without any associated increase in complication rate or change in radiographic outcome. Generic implants have the potential to markedly reduce operative costs as long as quality products are used.