Primary total talus arthroplasty for Hawkins type IV talar neck fracture dislocation.

A woman in her 40s was involved in a motor vehicle collision and sustained a closed Hawkins type IV talar neck fracture dislocation. The injury was treated with reduction, percutaneous pinning and spanning external fixation, followed by definitive treatment with total talus arthroplasty (TTA) 2 months following injury. This is a unique example of definitive management for a severe talar neck fracture dislocation with arthroplasty in the subacute setting. TTA is perhaps a primary option for these injuries at high risk for avascular necrosis, non-union, malunion and post-traumatic arthritis.

Erratum to 'Life-Threatening, Bleeding Pseudoaneurysm of the External Iliac Artery in the Setting of an Infected Total Hip Arthroplasty From Pasteurella multocida' [Arthroplasty Today 6 (2020) 560-565].

[This corrects the article DOI: 10.1016/j.artd.2020.06.014.].

Periarticular screws: what's in and what's out of the joint?

Periarticular hardware placement can be challenging and a source of angst for orthopaedic surgeons due to fear of penetrating the articular surface and causing undue harm to the joint. In recent years, many surgeons have turned to computed tomography (CT) and other intraoperative or postoperative modalities to determine whether hardware is truly extraarticular in areas of complex anatomy. Yet, these adjuncts are expensive, time consuming, and often unnecessary given the advancement in understanding of intraoperative fluoroscopy. We present a review article with the goal of empowering surgeons to leave the operating room, with fluoroscopy alone, assured that all hardware is beneath the articular surface that is being worked on. By understanding a simple concept, surgeons can extrapolate the information in this article to any joint and bony surface in the body. While targeted at both residents and surgeons who may not have completed a trauma fellowship, this review can benefit all orthopaedic surgeons alike.

Septic Dislocation of Hip After Cephalomedullary Nail Fixation of Intertrochanteric Fractures of Femur: A Case Report.

CASE: We describe 3 cases of septic hip arthritis with a dislocation after failed, cephalomedullary nail (CMN) fixation following fragility intertrochanteric (IT) hip fractures that were treated with antibiotic spacer placement. CONCLUSION: Septic hip arthritis and compromised hip abductors can contribute to dislocation of the hip after CMN for IT fractures. This case report presents a treatment plan to address this rare complication, not yet reported after CMN for IT fractures in the literature, to control infection and optimize function.

Do Acetabular Buttress Augment Pose Risk to the Superior Gluteal Nerve? A Cadaveric Study.

BACKGROUND: Management of acetabular defects in total joint reconstruction can be challenging. Various algorithmic approaches have been developed, with some recommending using posterosuperior acetabular buttress augments for severe defects. The superior gluteal nerve lies in close proximity to their application, and damage to it results in deterioration of hip stability and gait mechanics. There has been investigation into the relationship of the superior gluteal nerve to various anatomic points. To our knowledge, no study exists examining the relationship between the acetabular rim and the superior gluteal nerve for the application of these particular devices. METHODS: Ten adult cadaver specimens were examined. A reproducible technique in relation to the typical placement of a buttress augment was used. From a distance of 20 millimeters (mm) lateral to the greater sciatic notch, the distance from the superior gluteal nerve to the posterosuperior acetabular rim was measured. RESULTS: The average distance between the posterosuperior acetabular rim and the superior gluteal nerve was found to be 52 mm, ranging from 48 mm to 60 mm. CONCLUSION: With proprietary acetabular augments measuring up to 68 mm in length, the superior gluteal nerve could be at substantial risk with placement of these devices. Surgeons should take great care with dissection for and intraoperative placement of these devices, and particularly strive for optimized prosthetic hip stability to mitigate the risk of dislocation from nerve injury. To our knowledge, this study is the first of its kind and provides valuable anatomic and operative knowledge during these highly complex cases.

Life-Threatening, Bleeding Pseudoaneurysm of the External Iliac Artery in the Setting of an Infected Total Hip Arthroplasty from Pasteurella multocida.

We present a bleeding, infected (mycotic) pseudoaneurysm from the organism Pasteurella multocida. The patient presented septic from an infected total hip arthroplasty and was treated with surgical debridement, component retention, and antibiotics. She re-presented with hip pain and a marked hemoglobin decrease. Vascular studies revealed a pseudoaneurysm of the external iliac artery and large hematoma secondary to contiguous spread of her hip infection. The pseudoaneurysm was treated with an endovascular stent before further debridement surgery to avoid exsanguinating hemorrhage with surgical release of her tamponade. This case demonstrates the utmost importance of recognizing and treating vascular pathology in a patient with an infected prosthetic hip, large hematoma, and decreased hemoglobin.

The Dislocated Hip on CT Scan: An Argument for the Initial Pelvic Radiograph in Trauma Patients.

This study evaluated the frequency in which a hip dislocation is first diagnosed by computed tomography (CT) scan. A retrospective review was conducted of orthopaedic trauma patients presenting with hip dislocation to a Level 1 trauma center over three years. We recorded whether the patient first received pelvic radiograph (PXR) or CT scan of the pelvis, if the patient underwent closed reduction of the hip prior to CT scan, and if repeat pelvis CT scan was done. Of 83 hip dislocations, 64 patients were sent to CT scanner dislocated; 19 patients first had PXR and underwent closed reduction of the hip prior to CT scan. By obtaining a PXR, reducing the hip prior to CT, the incidence of repeat CT scan decreased from 37% to 11% (p = 0.046). By diagnosing hip dislocation, reducing prior to CT scan, repeat scans can be reduced, thus decreasing cost and radiation exposure to patients. (Journal of Surgical Orthopaedic Advances 29(1):4345, 2020).

Does Traction Decrease the Need for Open Reduction in Femoral Shaft Fractures Treated Within 24 Hours?

This study evaluates whether preoperative skeletal traction reduces the need for open reduction in femoral shaft fractures treated with intramedullary nailing (IMN) within 24 hours. A retrospective review was conducted of femoral shaft fractures undergoing IMN within 1 day of admission. Primary outcome was an open reduction at the time of IMN. Secondary outcomes were blood loss and transfusion requirements. One hundred eighty-four patients were analyzed, 106 in the knee immobilizer group and 78 in the skeletal traction group. Skeletal traction did not reduce the need for an open reduction. The knee immobilizer group required open reduction in 13% (14/106) compared with 14% (11/78) in the skeletal traction group, which was not significant (p $=$ .89). Blood loss and transfusion rates were similar between groups. Skeletal traction does not appear to reduce the need for open reduction at the time of IMN for femoral shaft fractures treated within 1 day of admission. (Journal of Surgical Orthopaedic Advances 27(4):303-306, 2018).

Iatrogenic Femoral Neck Fracture After Closed Reduction of Anterior Hip Dislocation in the Emergency Department.

This is a case report detailing an iatrogenic femoral neck fracture (FNF) after closed reduction of an anterior hip dislocation. While iatrogenic FNF is a known complication of closed reduction, there are few published reports of the circumstances surrounding these fractures, and there has been no discussion of possible risk factors predisposing to this injury. This case report and review of the literature identifies the current incidence of FNF with closed reduction of anterior dislocations of the hip, as well as possible antecedent risk factors for this complication. As a result of this case report, we have changed our protocol for treatment of these injuries.