Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: Current Issues in Orthopaedic Trauma: Tribute to Clifford H. Turen 10 articles


Will My Tibial Fracture Heal? Predicting Nonunion at the Time of Definitive Fixation Based on Commonly Available Variables

Kevin O’Halloran MD, Max Coale BA, Timothy Costales BS, Timothy Zerhusen BS, Renan C. Castillo PhD, Jason W. Nascone MD, Robert V. O’Toole MD

Accurate prediction of tibial nonunions has eluded researchers. Reliably predicting tibial nonunions at the time of fixation could change management strategies and stimulate further research.

The Radiographic Union Score for Hip (RUSH) Identifies Radiographic Nonunion of Femoral Neck Fractures

Tym Frank MD, Georg Osterhoff MD, Sheila Sprague PhD, Alisha Garibaldi MSc, Mohit Bhandari MD, PhD, Gerard P. Slobogean MD, MPH

The Radiographic Union Score for Hip (RUSH) is a previously validated outcome instrument designed to improve intra- and interobserver reliability when describing the radiographic healing of femoral neck fractures. The ability to identify fractures that have not healed is important for defining nonunion in clinical trials and predicting patients who will likely require additional surgery to promote fracture healing. We sought to investigate the utility of the RUSH score to define femoral neck fracture nonunion.

Large-magnitude Pelvic and Retroperitoneal Tissue Damage Predicts Organ Failure

Greg Gaski MD, Travis Frantz BS, Scott Steenburg MD, Teresa Bell PhD, Todd McKinley MD

Pelvic and retroperitoneal trauma is a major cause of morbidity and mortality in multiply injured patients. The Injury Severity Score (ISS) has been criticized for underrepresenting and inaccurately defining mechanical injury. The influence of pelvic injury volume on organ dysfunction and multiple organ failure (MOF) has not been described. Through the use of CT, this investigation sought to precisely define volumes of mechanical tissue damage by anatomic region and examine its impact on organ failure.

Does Postoperative Radiation Decrease Heterotopic Ossification After the Kocher-Langenbeck Approach for Acetabular Fracture?

Jason A. Davis MD, Brennan Roper BS, John W. Munz MD, Timothy S. Achor MD, Matthew Galpin RC, Andrew M. Choo MD, Joshua L. Gary MD

Controversy regarding heterotopic ossification (HO) prophylaxis exists after Kocher-Langenbeck for treatment of acetabular fracture. Prophylaxis options include antiinflammatory oral medications, single-dose radiation therapy, and débridement of gluteus minimus muscle. Prior literature has suggested single-dose radiation therapy as the best prophylaxis to prevent HO formation. However, recent reports have emerged of radiation-induced sarcoma after radiotherapy for HO prophylaxis, which has led many surgeons to reconsider the risks and benefits of single-dose radiation therapy. We set out to determine if radiotherapy, in addition to standard débridement of gluteus minimus muscle, affected postoperative HO formation after a Kocher-Langenbeck approach for acetabular fracture.

Do Transsacral-transiliac Screws Across Uninjured Sacroiliac Joints Affect Pain and Functional Outcomes in Trauma Patients?

John Heydemann MD, Braden Hartline MD, Mary Elizabeth Gibson MD, Catherine G. Ambrose PhD, John W. Munz MD, Matthew Galpin RC, Timothy S. Achor MD, Joshua L. Gary MD

Patients with pelvic ring displacement and instability can benefit from surgical reduction and instrumentation to stabilize the pelvis and improve functional outcomes. Current treatments include iliosacral screw or transsacral-transiliac screw, which provides greater biomechanical stability. However, controversy exists regarding the effects of placement of a screw across an uninjured sacroiliac joint for pelvis stabilization after trauma.

Does Early versus Delayed Spanning External Fixation Impact Complication Rates for High-energy Tibial Plateau and Plafond Fractures?

Justin M. Haller MD, David Holt MD, David L. Rothberg MD, Erik N. Kubiak MD, Thomas F. Higgins MD

High-energy tibial plateau and tibial plafond fractures have a high complication rate and are frequently treated with a staged approach of spanning external fixation followed by definitive internal fixation after resolution of soft tissue swelling. A theoretical advantage to early spanning external fixation is that earlier fracture stabilization could prevent further soft tissue damage and potentially reduce the occurrence of subsequent infection. However, the relative urgency of applying the external fixator after injury is unknown, and whether delay in this intervention is correlated to subsequent treatment complications has not been examined.

Allogeneic and Autogenous Bone Grafts Are Affected by Historical Donor Environmental Exposure

Caleb Behrend MD, Jonathon Carmouche MD, Paul W. Millhouse MD, Lauren Ritter MPH, Joseph Moskal MD, Paul Rubery MD, Edward Puzas PhD

Bone graft materials are routinely evaluated for infectious agents; however, data regarding contamination of bone graft from environmental exposure of the donors to osteotoxic substances such as lead are not routinely available. In animal models, stored lead in bone has been shown to impair fracture healing and osteocyte function. In clinical studies, lead is linked to skeletal disease at relatively low concentrations. Presumably the levels of lead in allografts mirror the level of lead in bone in the population; however, the degree to which processing might decrease this and the frequency with which potentially osteotoxic levels appear in bone grafts have not been studied.

Does Surgical Stabilization of Lateral Compression-type Pelvic Ring Fractures Decrease Patients’ Pain, Reduce Narcotic Use, and Improve Mobilization?

Jennifer Hagen MD, Renan Castillo PhD, Andrew Dubina MD, Greg Gaski MD, Theodore T. Manson MD, Robert V. O’Toole MD

Debate remains over the role of surgical treatment in minimally displaced lateral compression (Young-Burgess, LC, OTA 61-B1/B2) pelvic ring injuries. Lateral compression type 1 (LC1) injuries are defined by an impaction fracture at the sacrum; type 2 (LC2) are defined by a fracture that extends through the posterior iliac wing at the level of the sacroiliac joint. Some believe that operative stabilization of these fractures limits pain and eases mobilization, but to our knowledge there are few controlled studies on the topic.

Does Open Reduction and Internal Fixation versus Primary Arthrodesis Improve Patient Outcomes for Lisfranc Trauma? A Systematic Review and Meta-analysis

Nicholas Smith MD, MSc, Craig Stone MD, MSc, FRCSC, Andrew Furey MD, MSc, FRCSC

Although Lisfranc injuries are uncommon, representing approximately 0.2% of all fractures, they are complex and can result in persistent pain, degenerative arthritis, and loss of function. Both open reduction and internal fixation (ORIF) and primary fusion have been proposed as treatment options for these injuries, but debate remains as to which approach is better.