Notes

On the significance of adding relative body structure and something Well being viewpoints inside anatomy training.
To determine the frequency of fixation failure after transsacral-transiliac (TS) screw fixation of vertical shear (VS) pelvic ring injuries (OTA/AO 61C1) and to describe the mechanism of failure of TS screws.

Retrospective cohort study.

Level 1 academic trauma center.

Twenty skeletally mature patients with unilateral, displaced, unequivocal VS injuries were identified between May 1, 2009 and April 31, 2016. Mean age was 31 years and mean follow-up was 14 months. Twelve had sacroiliac dislocations (61C1.2) and eight had vertical sacral fractures (61C1.3).

Operative treatment with at least one TS screw.

Radiographic failure, defined as a change of >1 cm of combined displacement of the posterior pelvis compared with the intraoperative position on inlet and outlet radiographs.

Radiographic failure occurred in 4 of 8 (50%) vertical sacral fractures. Posterior fixation was comprised of a single TS screw in 3 of these 4 failures. The dominant mechanism of screw failure was bending. learn more All of these failures occurred early in the postoperative period. No fixation failures occurred among the sacroiliac dislocations. There were no deep infections or nonunions.

This is the first study to describe the mechanism of failure of TS screws in a clinical setting after VS pelvic injuries. We caution surgeons from relying on single TS screw fixation for vertically unstable sacral fractures. Close radiographic monitoring in the first few weeks after surgery is advised.

Level IV.
Level IV.
Most patients can tolerate a hemoglobin (Hgb) > 8 g per deciliter. In some cases, however, transfusion will delay physical therapy and hospital discharge. This study aims to review Hgb and transfusion data for a large volume of recent hip fracture patients in order to identify new opportunities for decreasing the length of hospital stay. Our hypotheses are that in some cases, earlier transfusion of more blood will be associated with shorter hospital stays, and that Hgb levels consistently decrease for more than 3 days postoperatively.

Retrospective chart review.

Two academic medical centers with Geriatric Fracture Programs.

Data was collected from patients 50 years and older with hip fractures April 2015 and October 2017.

Operative stabilization of the hip fractures according to standard of care for the fracture type and patient characteristics. Transfusion according to established standards.

Electronic records were retrospectively reviewed for demographic information, Hgb levels, and transfusinsfusion earlier (
 = 0.005).

Our findings do not support earlier transfusion of more blood. Although in some cases, there is an association between earlier transfusion of more blood and shorter hospital stay, routine transfusion of more blood would incur higher transfusion risks in some patients who would not otherwise meet criteria for transfusion. After hip fracture surgery, the Hgb usually decreases for 5 days and does not begin to increase until POD 6. This information will provide utility in the population health management of hip fracture patients.

Level III, Retrospective Cohort Study.
Level III, Retrospective Cohort Study.The authors present the case of a patient who developed an Aspergillosis flavus (A flavus) superficial cutaneous infection which was identified at the time of cast removal, 2 weeks after immobilization of a closed distal third humerus fracture. Clinical and microbiological findings, as well as the treatment of this patient, are reported. link2 An otherwise healthy 27-year-old male presented to the orthopaedic surgery clinic 2 weeks after a closed distal humerus fracture, which was initially immobilized with a functional removable brace. Upon cast removal, the patient was noted to have significant brown hyperkeratotic patches and plaques, studded with pustules in an annular configuration on his left posterior and lateral arm. Fungal culture later grew A flavus. The patient was started on both oral and topical antifungals and operative management of the displaced fracture was delayed until skin lesions resolved. Once clinical examination and negative repeat bedside potassium hydroxide were confirmed, open reduction and internal fixation was performed. The fracture healed uneventfully, and the patient did not develop any signs or symptoms of postoperative infection.
To identify predictors of functional outcomes following treatment of ankle fracture in patients 55 years or older.

Level 1 Trauma Center.

Four hundred twenty-nine patients with torsional ankle fractures (44A-C) 233 patients (54%) were ages 55 to 64, 25% were between the ages 65 and 74; 21% were 75 years or older.

Operative or nonoperative management of ankle fracture.

Early complications were assessed for all patients after minimum of 6 months, and functional outcome scores as assessed by the Foot Function Index (FFI; n = 166, 39%) and Short Musculoskeletal Function Assessment (SMFA; n = 168, 39%) after median 57 months follow-up.

Surgical management was elected in 67% of patients. Nonoperative management became more common with advancing age and was associated with fewer unplanned operations (12% vs 3%,
 < .01) and complications (21% vs 13%,
 = .07). African American race was associated with worse pain on the FFI (
 = .002) and BMI was associated with worse (higher) scores on all categories of the FFI and SMFA (all
 < .05). Diabetes, neuropathy, and mental illness were also predictive of worse scores on various categories of both surveys. Assistive device use or nonambulatory status at the time of injury was associated with worse disability/dysfunction, activity, and mobility scores on both the FFI and SMFA (all
 > 15,
 < .05). Sex, Hispanic ethnicity, tobacco use, open fracture, dislocation, fracture pattern, and operative management were not independent predictors in this regression model.

Baseline health and ambulatory capacity at injury were more predictive of outcomes following ankle fracture than were fracture characteristics or type of treatment.
Baseline health and ambulatory capacity at injury were more predictive of outcomes following ankle fracture than were fracture characteristics or type of treatment.Contemporary methods for open reduction and internal fixation of displaced distal clavicle fractures have excellent rates of union and high rates of reoperation for symptomatic implant removal. The authors describe their preferred surgical technique and case series of patients with Neer Type-II and -V distal clavicle fractures treated with lower profile dual mini-fragment plates using interdigitating screws placed into the distal segment to enhance fixation.
Tissue plasminogen activator (tPA) is a thrombolytic agent increasingly being employed for the treatment of acute frostbite. Although tPA has been shown with success to increase digit salvage rates, data on potential complications, including risk of hemorrhage, is limited. As a result, acute trauma is considered a contraindication to use in many institution-based protocols. Currently, there is a paucity in the literature regarding use of tPA for frostbite in patients with concomitant extremity fractures.

We report the case of a 36-year-old male treated with tPA for frostbite to digits of his bilateral hands in the setting of a concomitant diaphyseal tibia fracture. He subsequently developed acute compartment syndrome in his lower extremity. This was followed by emergent fasciotomy and staged fracture fixation with serial wound debridement and subsequent closure. Despite this complication, the patient went on to early radiographic and clinical union of his tibia fracture. His frostbite wounds healed without functional deficits.

In patients with severe frostbite injury with digital perfusion defects, tPA for thrombolysis may be indicated. Use of thrombolytics for frostbite in trauma patients or those with concomitant extremity fractures requires a multidisciplinary discussion regarding potential risks. Contingency planning is essential to ensure that potential bleeding complications, including development of compartment syndrome, are diagnosed and treated early. Given the paucity in the current literature regarding use of thrombolytics in trauma patients, further study is warranted to inform the surgical community on instances in which the benefits of tPA administration may outweigh the risks.

Case report; Level V.
Case report; Level V.
To identify comorbidities and injury characteristics associated with surgical site infection (SSI) following internal fixation of malleolar fractures in an urban level 1 trauma setting.

Retrospective.

Level 1 trauma center.

Seven-hundred seventy-six consecutive patients with operatively managed malleolar fractures from 2006 to 2016.

Open reduction internal fixation.

Superficial SSI (erythema and drainage treated with oral antibiotics and wound care) or deep SSI (treated with surgical debridement and antibiotics).

Fifty-six (7.2%) patients developed SSI, with 17 (30%) of these being deep infections. An a-priori power analysis of n = 325 (α=0.05, β=0.2) was tabulated for differences in univariate analysis. Univariate analysis identified categorical associations (
 < .05) between SSI and diabetes mellitus, drug abuse, open fracture, and renal disease but not tobacco abuse, body mass index, or neuropathy. Multivariate logistic regression identified categorical associations between diabetes (OR = 2.2, 95% CI 1.1-4.3), drug abuse (OR = 3.9, 95% CI 1.2-12.7), open fracture (OR = 4.1, 95% CI 1.3-12.8), and renal disease (OR = 2.7, 95% CI 1.4-5.0) and any (superficial or deep) SSI. A separate multivariate logistic regression analysis found categorical associations between deep SSI requiring reoperation and diabetes (OR = 4.4, 95% CI 1.6-12.2) and open fracture (OR = 4.1, 95% CI 1.3-12.8). link3 Furthermore, American society of anesthesiologists classification (ASA) Class 4 patients were (OR = 9.2, 95% CI 2.0-41.79) more likely to experience an SSI than ASA Class 1 patients.

Factors associated with SSI following malleolar fracture surgery in a single urban level 1 trauma center included diabetes, drug abuse, renal disease, and open fracture. The presence of diabetes or open type fractures were associated with deep SSI requiring reoperation.

Level 3 prognostic retrospective cohort study.
Level 3 prognostic retrospective cohort study.
To determine whether patients with AO/OTA 43-B anterior impaction tibial plafond fractures have worse clinical outcomes, and an increased risk of progression to ankle arthrodesis.

Retrospective cohort study.

Level 1 academic trauma center.

One hundred sixty-eight patients were included in the study, all of whom had tibial plafond fractures.

Study patients underwent external fixation and/or open reduction internal fixation (ORIF) as indicated by fracture/injury pattern.

Arthrodesis rate.

AO 43-B Anterior impaction tibial plafond fractures have an increased risk of progression to arthrodesis when compared to AO 43-B nonanterior impaction type fractures (19.4% vs 8%).

AO 43-B anterior impaction tibial plafond fractures have a worse clinical outcome compared to AO 43-B nonanterior impaction fractures. These fractures also confer increased risk of progression to arthrodesis.

The authors have no conflict of interests to declare.
The authors have no conflict of interests to declare.
Website: https://www.selleckchem.com/products/sf1670.html