Notes

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the setting of an articular fracture, in which absolute stability and primary bone healing are desirable, parallel fixation should be considered even in fractures with a separate capitellar fragment if the size of fragment and fracture orientation allows.
To clarify the incidence, associated conditions, and timing of fasciotomy for compartment syndrome (CS) in children with a supracondylar (SC) fracture of the humerus.

A retrospective trauma system database study.

Accredited trauma centers in Pennsylvania.

A statewide trauma database was searched for children age 2-12 years old admitted with a SC fracture between 1/2001 and 12/2015. 4308 children met inclusion criteria.

Treatment of a SC fracture.

Diagnosis of CS /performance of a fasciotomy.

During the study period 21 (0.49%) children admitted with a SC fracture of the humerus were treated with fasciotomy. CS / fasciotomy was more likely in males (p = 0.031), those with a nerve injury (p = 0.049), and /or ipsilateral forearm fracture (p < 0.001). Vascular procedure, performed in 18 (0.42%), was strongly associated with CS / fasciotomy (p < 0.001). Closed reduction and fixation of a forearm fracture was associated with CS (p = 0.007). Timing of SC fracture treatment did not influence outcome. Smad family Fasciotomy was performed subsequent to reduction in 13 subjects, mean interval between procedures was 23.4 hrs. (r 4.5 - 51.3).

Risk factors for CS exist, however are not required for the condition to develop. CS may develop subsequent to admission and /or SC fracture treatment. In terms of timing of operative management and hospitalization, the results support contemporary practice.

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
To compare piriformis fossa to greater trochanteric entry cephalomedullary implants in an evaluation of femoral neck load to failure when the device is used for femoral shaft fractures with prophylaxis of an associated femoral neck fracture.

Thirty fourth-generation synthetic femur models were separated into 5 groups; intact femora, entry sites alone at the piriformis fossa or greater trochanter, and piriformis fossa and greater trochanteric entry sites after the insertion of a cephalomedullary nail. Each model was mechanically loaded with a flat plate against the superior femoral head along the mechanical axis and load to failure was recorded.

Mean load to failure was 5487 ± 376 N in the intact femur, 3126 ± 387 N in the piriformis fossa entry site group, 3772 ± 558 N in the piriformis entry nail, 5332 ± 292 N for the greater trochanteric entry site, and 5406 ± 801 N for the greater trochanteric nail group. Both piriformis groups were significantly lower compared to the intact group. Both greater trochanteric groups were similar to the intact group and were statistically higher than the piriformis groups.

A piriformis fossa entry site with or without an intramedullary implant weakens the femoral neck in load to failure testing. A greater trochanteric entry yields a load to failure equivalent to that of an intact femoral neck. Instrumentation with a greater trochanteric cephalomedullary nail is significantly stronger than a piriformis fossa cephalomedullary nail during axial loading in a composite femur model.
A piriformis fossa entry site with or without an intramedullary implant weakens the femoral neck in load to failure testing. A greater trochanteric entry yields a load to failure equivalent to that of an intact femoral neck. Instrumentation with a greater trochanteric cephalomedullary nail is significantly stronger than a piriformis fossa cephalomedullary nail during axial loading in a composite femur model.
To compare the volume of embolic load during intramedullary fixation of femoral and tibial shaft fractures. Our hypothesis was that tibial IM nails would be associated with less volume of intravasation of marrow than IM nailing of femur fractures.

Prospective observational study.

Urban Level I trauma center.

Twenty-three patients consented for the study 14 with femoral shaft fractures and 9 with tibial shaft fractures.

All patients underwent continuous transesophageal echocardiography (TEE), and volume of embolic load was evaluated during five distinct stages post induction, initial guidewire, reaming, nail insertion, and postoperative.

Volume of embolic load was measured based on previously described luminosity scores. The embolic load based on fracture location and procedure stage was evaluated using a mixed effects model.

The IMN procedure increased the embolic load by 215% (-12 - 442%, p=0.07) in femur patients relative to tibia patients after adjusting for baseline levels. Of the five steps measured, reaming was associated with the greatest increase in embolic load relative to the guide wire placement and controlling for fracture location (421%, 95% CI 169 - 673%, p<0.01) CONCLUSIONS Femoral shaft IMN fixation was associated with a 215% increase in embolic load in comparison to tibial shaft IMN fixation, with the greatest quantitative load during the reaming stage, however both procedures produce embolic load.

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
To determine if the relative distance between the acetabular teardrops on unstressed and lateral compressive stress exam under anesthesia (EUA) pelvic fluoroscopic images is reproduceable between independent reviewers.

Retrospective database review.

Level-1 trauma center.

Fifty-eight patients with a lateral compression type-1 (LC1) pelvic ring injury who underwent EUA.

Validation of EUA objective measurements between blinded, independent reviewers using inter- and intra-class correlation coefficients (ICC).

There was excellent inter- and intra-observer reliability between all reviewers. Values for each ICC (including 95% confidence intervals) were between 0.96 (0.95-.098) and 0.99 (0.99-0.99) for all measurements. P-values were <0.0001 for all measured parameters CONCLUSIONS The relative change in distance between the acetabular tear drops during lateral compressive EUA of LC1 type pelvic injuries is reliable between independent reviewers. This allows for accurate, objective measurement of pelvic motion independent of patient size or body habitus.
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