Epidemiology of Ankle Dislocations in the United States: 2009 to 2018.

BACKGROUND: Injuries to the ankle joint are common and often sustained during participation in athletic activities. There is little information regarding the overall epidemiology of ankle dislocation, both with and without associated fracture. DESIGN AND METHODS: The National Electronic Injury Surveillance System (NEISS) database was queried to characterize ankle dislocation presentations to U.S. Emergency Departments (ED) from 2009-2018. Ankle dislocations were analyzed by age, sex, mechanism, and race. RESULTS: From 2009-2018, 30,477 patients with ankle dislocations presented to U.S. EDs with a majority (59.8%) occurring in male patients. The overall incidence of ankle dislocations increased by 54% from 2009-2018 (p = 0.017). Over half (53%) of ankle dislocations occurred in association with sports. Ankle dislocations peaked in the third decade of life at 16.94 per million person-years. For male, the age at which ankle dislocation peaked was 33.33, whereas for females, ankle dislocations peaked at 39.27. CONCLUSION: Preventive strategies are necessary to decrease the risk of sustaining ankle dislocations in the adult population participating in jumping sports.

Effect of Skeletal Maturity on Fixation Techniques for Tibial Eminence Fractures.

BACKGROUND: Several fixation methods have been reported for the operative treatment of tibial eminence fractures. Previous biomechanical studies have demonstrated that suture fixation may be a stronger construct; however, the maturity status of these specimens was not scrutinized. PURPOSE: To examine if suture fixation remains a biomechanically superior fixation method to screw fixation in both skeletally mature and immature specimens. STUDY DESIGN: Controlled laboratory study. METHODS: Sixteen total matched porcine (Yorkshire) knees (8 skeletally immature knees and 8 skeletally mature knees) were procured, and a standardized tibial eminence fracture was created. In each age-matched group of knees, 4 knees underwent randomization to fixation with 2 screws while 4 knees were randomized to fixation using a dual-suture technique. Once fixation was complete, the specimens underwent cyclic loading (200 cycles) in the anteroposterior plane of the tibia and load-to-failure testing, both with the knee positioned at 30° of flexion. Relevant measurements were recorded, and data were analyzed. RESULTS: Among mature specimens, load to failure was 1.9 times higher in the suture fixation group compared with the screw fixation group (1318.84 ± 305.55 vs 711.66 ± 279.95 N, respectively; P = .03). The load to failure was not significantly different between the groups in immature specimens (suture: 470.00 ± 161.91 N vs screw: 348.79 ± 102.46; P = .08). CONCLUSION: These findings suggest that suture fixation may represent a better construct choice for fixation of tibial eminence fractures in the skeletally mature population. However, in the skeletally immature population, fixation with screws or suture may be equivalent. Displacement after cyclic loading did not appear to differ by fixation method, nor did stiffness. CLINICAL RELEVANCE: A stronger fixation construct may be beneficial and allow for earlier range of motion to help potentially decrease postoperative stiffness. Clinical studies are warranted to see if these results may be replicated in humans.

Infected Hematoma in the Setting of Nonoperatively Treated Proximal Humerus Fracture: A Report of Two Cases.

CASE: Two patients presented with infections of their recent proximal humerus fracture sites. These immunocompromised patients were being treated nonoperatively for their proximal humerus fractures; however, both were taken to the operating room for surgical debridement. CONCLUSIONS: These 2 cases demonstrate the need for further investigation into infection of closed fracture sites. Attention should be paid to immunocompromised patients who present with proximal humerus fractures, especially displaced 2-part surgical neck fractures with anterior deltoid injury and subsequent hematoma formation. These patients may develop an infection with potential rapid progression to life-threatening septic shock.

Radiation safety education as a component of orthopedic training.

Fluoroscopy poses an occupational hazard to orthopedic surgeons. The purpose of this study was to examine resident and faculty understanding of radiation safety and to determine whether or not a radiation safety intervention would improve radiation safety knowledge. An anonymous survey was developed to assess attitudes and knowledge regarding radiation safety and exposure. It was distributed to faculty and residents at an academic orthopedic program before and after a radiation safety lecture. Pre- and post-lecture survey results were compared. 19 residents and 22 faculty members completed the pre-lecture survey while 11 residents and 17 faculty members completed the post-lecture survey. Pre-lecture survey scores were 48.3% for residents and 49.5% for faculty; post-lecture survey scores were 52.7% and 46.1% respectively. Differences between pre and post-survey scores were not significant. This study revealed low baseline radiation safety knowledge scores for both orthopedic residents and faculty. As evidence by our results, a single radiation safety information lecture did not significantly impact radiation knowledge. Radiation safety training should have a formal role in orthopedic surgery academic curricula.

Open Surgical Stabilization of Glenohumeral Dislocations.

Traumatic anterior shoulder dislocations are the most common dislocations of the shoulder, and the recurrence rate is high when they are treated nonoperatively in young patients (<30 years old). This has led to a trend toward early surgical stabilization. Originally open Bankart repair was considered the standard of care, with good clinical outcomes and a low recurrence rate. However, the majority of Bankart repairs are now performed with newer arthroscopic techniques because of their potential advantages and similar results. Both open and arthroscopic repairs have been shown to decrease the recurrence rate to 6% to 23%. Although arthroscopic Bankart repair is now more common, open repair should be considered for younger patients participating in contact sports or military activity, osseous Bankart lesions, revision cases, shoulder instability with "subcritical" (20% to 25%) glenoid bone loss, ligamentous laxity, or cases not considered repairable with arthroscopic techniques. Therefore, knowing how to perform an open Bankart repair is essential. The major steps of the procedure are (1) preoperative planning, (2) induction of anesthesia, (3) patient positioning and setup, (4) examination under anesthesia, (5) possible arthroscopic examination of the shoulder, (6) incision along the anterior axillary fold, (7) exposure using the deltopectoral interval, (8) clavipectoral fascia incision, (9) vertical tenotomy of the subscapularis tendon, (10) dissection of the capsule from the subscapularis, (11) assessment of the quality of the capsule, (12) "T" capsulotomy, (13) repair of the Bankart lesion, (14) anterior capsulorrhaphy, (15) subscapularis repair, (16) possible closure of the rotator interval, (17) wound closure, and (18) postoperative rehabilitation. Studies have shown that surgical stabilization after traumatic anterior shoulder instability decreases the recurrence rate, and open and arthroscopic techniques have similar clinical outcomes.