Tibia Stress Fracture and Subsequent Nonunion Associated With High Morbidity Following Vascularized Fibula Graft Harvest.

There is little in the literature about tibial stress fracture after partial fibulectomy. As fibula strut grafting and vascularized fibula flap grafting becomes more common in the field of reconstructive surgery, the incidence of this complication will likely rise. The authors present the case of a 54-year-old woman with tibial stress fracture and subsequent nonunion following vascularized fibula graft harvest. The aim of this case report is to present a unique tibial stress fracture and nonunion following vascularized fibula flap for mandibular reconstruction and a discussion of the orthopedic management of this uncommon injury. The authors' goal is to educate both surgeons and patients about the altered biomechanics and subsequent risks associated with fibula strut graft harvest, from an orthopedic surgery perspective. By increasing physician awareness and obtaining better informed consent preoperatively, better health care outcomes associated with fibular graft harvesting can be obtained. [Orthopedics. 2021;44(2):e306-e308.].

Detection of traumatic elbow arthrotomies: computed tomography scan vs. saline load test.

BACKGROUND: Traumatic elbow arthrotomies are common injuries evaluated for by orthopedic services; however, failed identification of a traumatic arthrotomy leads to a high risk of developing septic arthritis. Currently these injuries are evaluated by either a saline load test or a computed tomography (CT) scan, yet there is little published evidence regarding detection of traumatic elbow arthrotomies. HYPOTHESIS: In our study, we hypothesized better sensitivity and specificity of detecting a traumatic elbow arthrotomy with a CT scan over a saline load test. STUDY DESIGN: Descriptive cadaveric laboratory study. METHODS: Ten fresh-frozen cadaveric transhumeral upper extremity amputation specimens were thawed for trial. Specimens were brought through CT scan prior to arthrotomy, arthrotomy was made, and then post arthrotomy a repeat CT scan was performed. A saline load test was then performed after all CT scans were completed. RESULTS: Zero CT scans before (0/10) and after (0/10) the arthrotomies were positive for intra-articular air in the elbow joint with a 0% sensitivity and specificity. The saline load test had an average positive test at 19 mL with a 100% sensitivity and 100% specificity. CONCLUSION: After our study and based on the recommendations of the brief literature on this topic, we advise evaluating for traumatic elbow arthrotomies with a saline load test as the primary method of detection.

Traumatic Hemipelvectomy with a Contralateral Unstable Pelvis and Acetabular Fracture: A Case Report and Review of the Literature.

CASE: A traumatic hemipelvectomy (THP) is a rare life-threatening injury, with limited reports in the civilian population. We present the case of a patient who sustained a massive pelvic injury with an incomplete unilateral THP, a contralateral unstable pelvis, and a fracture of the acetabulum. CONCLUSION: With advancements in resuscitative techniques, carefully timed and planned surgical interventions, and a coordinated multidisciplinary approach, a greater number of patients may be able to survive a massive pelvic injury.