Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Trauma 147 articles


Do Inflammatory Markers Portend Heterotopic Ossification and Wound Failure in Combat Wounds?

Jonathan A. Forsberg MD, Benjamin K. Potter MD, Elizabeth M. Polfer MD, Shawn D. Safford MD, Eric A. Elster MD

After a decade of war in Iraq and Afghanistan, we have observed an increase in combat-related injury survival and a paradoxical increase in injury severity, mainly because of the effects of blasts. These severe injuries have a devastating effect on each patient’s immune system resulting in massive upregulation of the systemic inflammatory response. By examining inflammatory mediators, preliminary data suggest that it may be possible to correlate complications such as wound failure and heterotopic ossification (HO) with distinct systemic and local inflammatory profiles, but this is a relatively new topic.

Fracture Reduction and Primary Ankle Arthrodesis: A Reliable Approach for Severely Comminuted Tibial Pilon Fracture

Douglas N. Beaman MD, Richard Gellman MD

Posttraumatic arthritis and prolonged recovery are typical after a severely comminuted tibial pilon fracture, and ankle arthrodesis is a common salvage procedure. However, few reports discuss the option of immediate arthrodesis, which may be a potentially viable approach to accelerate overall recovery in patients with severe fracture patterns.

Is Preoperative Radiation Therapy as Effective as Postoperative Radiation Therapy for Heterotopic Ossification Prevention in Acetabular Fractures?

Michael T. Archdeacon MD, MSE, Albert d’Heurle MD, Nicole Nemeth MD, Bradley Budde MD

Prophylactic approaches to prevent heterotopic ossification after acetabular fracture surgery have included indomethacin and/or single-dose external beam radiation therapy administered after surgery. Although preoperative radiation has been used for heterotopic ossification prophylaxis in the THA population, to our knowledge, no studies have compared preoperative and postoperative radiation therapy in the acetabular fracture population.

Task-specific Fall Prevention Training Is Effective for Warfighters With Transtibial Amputations

Kenton R. Kaufman PhD, PE, Marilynn P. Wyatt MA, PT, Pinata H. Sessoms PhD, Mark D. Grabiner PhD

Key factors limiting patients with lower extremity amputations to achieve maximal functional capabilities are falls and fear of falling. A task-specific fall prevention training program has successfully reduced prospectively recorded trip-related falls that occur in the community by the elderly. However, this program has not been tested in amputees.

How Does Ankle-foot Orthosis Stiffness Affect Gait in Patients With Lower Limb Salvage?

Elizabeth Russell Esposito PhD, Ryan V. Blanck CPO, Nicole G. Harper MS, Joseph R. Hsu MD, Jason M. Wilken PT, PhD

Ankle-foot orthoses (AFOs) are commonly prescribed during rehabilitation after limb salvage. AFO stiffness is selected to help mitigate gait deficiencies. A new custom dynamic AFO, the Intrepid Dynamic Exoskeletal Orthosis (IDEO), is available to injured service members but prescription guidelines are limited.

Opioid Use After Fracture Surgery Correlates With Pain Intensity and Satisfaction With Pain Relief

Arjan G. J. Bot MD, PhD, Stijn Bekkers BSc, Paul M. Arnstein PhD, R. Malcolm Smith MD, David Ring MD, PhD

In 2012, Medicare began to tie reimbursements to inpatient complications, unplanned readmissions, and patient satisfaction, including satisfaction with pain management.

Modifier 22 for Acetabular Fractures in Morbidly Obese Patients: Does It Affect Reimbursement?

Patrick F. Bergin MD, Christopher Kneip MD, Christine Pierce MD, Stephen T. Hendrix MD, Scott E. Porter MD, Matthew L. Graves MD, George V. Russell MD

Modifier 22 in the American Medical Association’s Current Procedural Terminology (CPT) book is a billing code for professional fees used to reflect an increased amount of skill, time, and work required to complete a procedure. There is little disagreement that using this code in the setting of surgery for acetabulum fractures in the obese patient is appropriate; however, to our knowledge, the degree to which payers value this additional level of complexity has not been determined.

A Surgical Approach Algorithm for Transverse Posterior Wall Fractures Aids in Reduction Quality

Yelena Bogdan MD, Shashank Dwivedi MS, Paul Tornetta MD

Transverse posterior wall fractures are difficult to treat and historically have been associated with stiffness, posttraumatic arthritis, and pain, which correlate with the reduction. The Kocher–Langenbeck approach is used most often, whereas the extended iliofemoral approach has been reserved for more complex injury patterns. The latter approach has substantially more risks. No data to our knowledge exist on the use of sequential anterior and posterior approaches for this pattern.

Transfemoral Amputations: Is There an Effect of Residual Limb Length and Orientation on Energy Expenditure?

Johanna C. Bell MSE, Erik J. Wolf PhD, Barri L. Schnall MPT, John E. Tis MD, Benjamin K. Potter MD

Energy cost of ambulation has been evaluated using a variety of measures. With aberrant motions resulting from compensatory strategies, persons with transfemoral amputations generally exhibit a larger center of mass excursion and an increased energy cost. However, few studies have analyzed the effect of residual femur length and orientation or energy cost of ambulation.

Do Patients With Bone Bridge Amputations Have Improved Gait Compared With Patients With Traditional Amputations?

Trevor Kingsbury MA, Nancy Thesing MS, John David Collins MA, ATC, Joseph Carney MD, Marilynn Wyatt MA, PT

Two surgical techniques for performing a transtibial amputation include a traditional approach and a bone bridge approach. To date, there is no conclusive evidence of superiority of either technique in terms of temporal-spatial, kinetic, and mechanical work parameters.