Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Trauma 147 articles

Articles

Intramedullary Nails Result in More Reoperations Than Sliding Hip Screws in Two-part Intertrochanteric Fractures

Kjell Matre MD, Leif Ivar Havelin MD, PhD, Jan-Erik Gjertsen MD, PhD, Birgitte Espehaug MSc, PhD, Jonas Meling Fevang MD, PhD

Sliding hip screws (SHSs) and intramedullary (IM) nails are well-documented implants for simple two-part intertrochanteric fractures; however, there is no consensus regarding which type of implant is better.

Surgical Technique: Supine Patient Position With the Contralateral Leg Elevated for Femoral Intramedullary Nailing

Ahmet Firat MD, Osman Tecimel MD, Alper Deveci MD, Ali Ocguder MD, Murat Bozkurt

Intramedullary nailing can be performed with a fracture table or manual traction. Manual traction can be applied with the patient in either the supine or lateral decubitus (LD) position. However, in either of these positions, the reduction can be difficult because the fractured extremity is not positioned parallel to the floor and the contralateral leg on the operating room table overlaps the fractured limb while the fractured extremity is in full adduction. Therefore fluoroscopy time may be increased. Accordingly, we developed a technique with the patient supine and the contralateral leg elevated (SCLE).

Charlson Comorbidity Indices and In-hospital Deaths in Patients with Hip Fractures

Valentin Neuhaus MD, John King BA, Michiel G. Hageman MD, David C. Ring MD, PhD

The Charlson Comorbidity Index (CCI) and its modifications are comorbidity-based measures that predict mortality. It was developed for patients without trauma and inconsistently predicted mortality and adverse events in several previous studies of patients with trauma.

Convergence of Outcomes for Hip Fracture Fixation by Nails and Plates

Foster Chen BS, Zhong Wang PhD, MPH, Timothy Bhattacharyya MD

Recent popularity of intramedullary nails over sliding hip screws for treatment of intertrochanteric fractures is concerning given the absence of evidence for clinical superiority for nailing yet the presence of reimbursement differences.

Hemiarthroplasty for Humeral Four-part Fractures for Patients 65 Years and Older: A Randomized Controlled Trial

Harm W. Boons MD, Jon H. Goosen MD, PhD, Susan Grinsven MSc, Job L. Susante MD, PhD, Corné J. Loon MD, PhD

Four-part fractures of the proximal humerus account for 3% of all humeral fractures and are regarded as the most difficult fractures to treat in the elderly. Various authors recommend nonoperative treatment or hemiarthroplasty, but the literature is unclear regarding which provides better quality of life and function.

Does PFNA II Avoid Lateral Cortex Impingement for Unstable Peritrochanteric Fractures?

George A. Macheras MD, PhD, Stefanos D. Koutsostathis MD, PhD, Spyridon Galanakos MD, Konstantinos Kateros MD, PhD, Stamatios A. Papadakis MD, PhD

Proximal femoral nail antirotation devices (PFNAs) are considered biomechanically superior to dynamic hip screws for treating unstable peritrochanteric fractures and reportedly have a lower complication rate. The PFNA II was introduced to eliminate lateral cortex impingement encountered with the PFNA. However, it is unclear whether the new design in fact avoids lateral cortex impingement without compromising stability of fixation and fracture healing.

What Is the Infection Rate of the Posterior Approach to Type C Pelvic Injuries?

Michael D. Stover MD, Stephen Sims MD, Joel Matta MD

Pelvic ring injuries with complete disruption of the posterior pelvis (AO/OTA Type C) benefit from reduction and stabilization. Open reduction in early reports had high infectious complications and many surgeons began using closed reduction and percutaneous fixation. Multiple smaller studies have reported low infection rates after a posterior approach, but these rates are not confirmed in larger series of diverse fractures.

Is Fixation Failure After Plate Fixation of the Symphysis Pubis Clinically Important?

Stephen A. C. Morris FRCS, Jeremy Loveridge FRCS, David K. A. Smart FRCS, Anthony J. Ward FRCS, Tim J. S. Chesser FRCS (Orth)

Plate fixation is a recognized treatment for pelvic ring injuries involving disruption of the pubic symphysis. Although fixation failure is well known, it is unclear whether early or late fixation failure is clinically important.

Bisphosphonate-associated Femur Fractures Have High Complication Rates with Operative Fixation

Mark L. Prasarn MD, Jaimo Ahn MD, PhD, David L. Helfet MD, Joseph M. Lane MD, Dean G. Lorich MD

Bisphosphonate-associated femur fractures have been well described but the preoperative patient factors, treatment modalities, and complications of treatment are unclear.

What Are the Patterns of Injury and Displacement Seen in Lateral Compression Pelvic Fractures?

Michael J. Weaver MD, Wendy Bruinsma MD, Eugene Toney MD, Erica Dafford MD, Mark S. Vrahas MD

Lateral compression (LC)-type pelvic fractures encompass a wide spectrum of injuries. Current classification systems are poorly suited to help guide treatment and do not adequately describe the wide range of injuries seen in clinical practice.