Treatment of Adult Distal Humerus Fracture with Fishtail Deformity: A Case Report.

CASE: We report a single case of a closed intra-articular distal humerus fracture in a 28-year-old man with a preexisting fishtail deformity characterized by concavity of the central trochlea and corresponding deformity of the olecranon. The patient was treated with open reduction and internal fixation. CONCLUSION: The case highlights the diagnosis and challenges of treatment. Conventional fixation choices and imaging techniques may need to be altered when treating a fracture with this deformity.

Topical Antibiotic Powder and Nonunion Risk in Surgically Treated Tibial Plateau and Pilon Fractures.

INTRODUCTION: High-energy periarticular tibia fractures are challenging injuries with a significant risk of complications. Postoperative infection rates, although improved, remain unacceptable. Intrawound topical antibiotic (TA) application has been popularized to reduce postoperative infections. Although TA may minimize infections, it remains unclear whether TAs have any impact on the development of nonunion. Recent investigations of TA use in fracture care have questioned its efficacy in vivo and suggested a potentially deleterious effect on fracture healing. This study investigates the impact of TA on nonunion rates in surgically treated high-energy periarticular tibia fractures. METHODS: Retrospective analysis of surgically treated periarticular tibia fractures at a single Level 1 trauma center was conducted. Intervention in question was the clinical effect of intrawound TA powder application at definitive closure. A total of 222 high-energy periarticular tibia fractures were included, 114 with TA use and 108 without. The primary outcome was the occurrence of nonunion, with secondary outcomes being superficial and deep postoperative surgical site infections. RESULTS: Twenty-seven patients (12.1%) were diagnosed with nonunions (14 pilons and 13 plateaus). There was no statistically significant difference in nonunion rates among patients who received topical antibiotics (15.8%) versus the group of patients who did not (8.3%) ( P = 0.23). Odds of developing nonunion was significant for open injuries (odds ratio 6.16, P < 0.001) and patients with a provisional external fixator (odds ratio 8.72, P = 0.03) before definitive fixation. No notable difference in the number of superficial and deep infections was identified between groups. CONCLUSION: The use of TA in high-energy periarticular tibia fractures showed no statistically significant increase in nonunion rates but did not conclusively rule out nonunion as a possible effect of intrawound TA. Additional large-scale multicenter prospective studies are needed to confirm these findings. The current body of literature regarding high-energy periarticular tibia fractures does suggest that TAs lower the risk of postoperative infections, but the nonunion risk remains unclear. LEVEL OF EVIDENCE: Level III, Retrospective Cohort Study.

Tranexamic Acid Use in Open Reduction and Internal Fixation of Fractures of the Pelvis, Acetabulum, and Proximal Femur: A Randomized Controlled Trial.

OBJECTIVE: To assess the safety and efficacy of tranexamic acid (TXA) use in fractures of the pelvic ring, acetabulum, and proximal femur. DESIGN: Prospective, randomized controlled trial. SETTING: Single Level 1 trauma center. PATIENTS: Forty-seven patients were randomized to the study group, and 46 patients comprised the control group. INTERVENTION: The study group received 15 mg/kg IV TXA before incision and a second identical dose 3 hours after the initial dose. MAIN OUTCOME MEASUREMENTS: Transfusion rates and total blood loss (TBL) [via hemoglobin-dilution method and rates of venous thromboembolic events (VTEs)]. RESULTS: TBL was significantly higher in the control group (TXA = 952 mL, no TXA = 1325 mL, P = 0.028). The total transfusion rates between the TXA and control groups were not significantly different (TXA 1.51, no TXA = 1.17, P = 0.41). There were no significant differences between the TXA and control groups in inpatient VTE events (P = 0.57). CONCLUSION: The use of TXA in high-energy fractures of the pelvis, acetabulum, and femur significantly decreased calculated TBL but did not decrease overall transfusion rates. TXA did not increase the rate of VTE. Further study is warranted before making broad recommendations for the use of TXA in these fractures. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Anatomic Parameters for Instrumentation of the Sacrum and Pelvis: A Systematic Review of the Literature.

INTRODUCTION: Multiple cadaver and radiographic analyses have been performed to define the surgical anatomy of the sacrum and pelvis. We provide a comprehensive review of this information, creating an accurate anatomic guide for practice and research. METHODS: A systematic review was performed to identify publications citing sacral or iliac morphometric parameters based on cadaver or radiographic anatomy. RESULTS: A total of 780 abstracts were evaluated. Fifty-six articles were included for final review and grouped into four sections: (1) bone density, (2) bony corridors, (3) screw length and trajectory, and (4) neurovascular and alimentary anatomy. CONCLUSION: A systematic analysis of the radiographic and gross anatomic features of the sacrum has yet to be published. This review includes details on the spatial arrangement of the S1 and S2 pedicle screws, sacroiliac screws, iliac screws, S2 alar iliac screws, and pelvic neurovascular anatomy. The study can be referenced by clinicians for sacral dissection, implant application, and ongoing advances in orthopaedic research. STUDY DESIGN: Systematic review. LEVEL OF EVIDENCE: Level IV.

Transection of the anterior tibial artery during minimally invasive plate osteosynthesis of the proximal tibia.

Minimally invasive plate osteosynthesis (MIPO) techniques have been developed to protect the blood flow to tissues surrounding fractures and reduce the risk of non-union. Typically, MIPO involves the insertion of a plate through a small incision and fixation with percutaneously applied screws targeted fluoroscopically. Here we present a case of a transected anterior tibial artery during routine minimally invasive plate osteosynthesis of a tibial plateau fracture to highlight a rare complication of this type of surgery and discuss relevant anatomical considerations. LEVEL OF EVIDENCE: According to the OCEBM Levels of Evidence Working Group, this study is graded as a Level of Evidence IV.