Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Trauma 147 articles


Can an Integrated Orthotic and Rehabilitation Program Decrease Pain and Improve Function After Lower Extremity Trauma?

Katherine M. Bedigrew MD, Jeanne C. Patzkowski MD, Jason M. Wilken PhD, MPT, Johnny G. Owens MPT, Ryan V. Blanck LCPO, Daniel J. Stinner MD, Kevin L. Kirk DO, Joseph R. Hsu MD

Patients with severe lower extremity trauma have significant disability 2 years after injury that worsens by 7 years. Up to 15% seek late amputation. Recently, an energy-storing orthosis demonstrated improved function compared with standard orthoses; however, the effect when integrated with rehabilitation over time is unknown.

Does Targeted Nerve Implantation Reduce Neuroma Pain in Amputees?

Mitchell A. Pet MD, Jason H. Ko MD, Janna L. Friedly MD, Pierre D. Mourad PhD, Douglas G. Smith MD

Symptomatic neuroma occurs in 13% to 32% of amputees, causing pain and limiting or preventing the use of prosthetic devices. Targeted nerve implantation (TNI) is a procedure that seeks to prevent or treat neuroma-related pain in amputees by implanting the proximal amputated nerve stump onto a surgically denervated portion of a nearby muscle at a secondary motor point so that regenerating axons might arborize into the intramuscular motor nerve branches rather than form a neuroma. However, the efficacy of this approach has not been demonstrated.

Fluid Collections in Amputations Are Not Indicative or Predictive of Infection

Elizabeth M. Polfer MD, Benjamin W. Hoyt BS, Lien T. Senchak MD, Mark D. Murphey MD, Jonathan A. Forsberg MD, Benjamin K. Potter MD

In the acute postoperative period, fluid collections are common in lower extremity amputations. Whether these fluid collections increase the risk of infection is unknown.

Bone Marrow Aspirate Concentrate and Platelet-rich Plasma Enhanced Bone Healing in Distraction Osteogenesis of the Tibia

Dong Hoon Lee MD, PhD, Keun Jung Ryu MD, Jin Woo Kim MD, Kyung Chung Kang MD, PhD, Young Rak Choi MD

During lower limb lengthening, poor bone regeneration is a devastating complication. Several local or systemic applications have been used to promote osteogenesis, and biologic stimulations are gaining attention, but their utility has not been proven in this setting.

Complications of the Intramedullary Skeletal Kinetic Distractor (ISKD) in Distraction Osteogenesis

Dong Hoon Lee MD, PhD, Keun Jung Ryu MD, Hae Ryong Song MD, PhD, Soo-Hong Han MD, PhD

The Intramedullary Skeletal Kinetic Distractor (ISKD) (Orthofix Inc, Lewisville, TX, USA) is an intramedullary device designed for more comfortable limb lengthening than that with external fixators; lengthening is achieved with this nail using rotational oscillation between two telescoping sections. However, the degree to which this device achieves this goal and its complication rate have not been fully documented.

Bilateral Transfemoral/Transtibial Amputations Due to Battle Injuries: A Comparison of Vietnam Veterans with Iraq and Afghanistan Servicemembers

Paul J. Dougherty MD, Lynne V. McFarland PhD, Douglas G. Smith MD, Gayle E. Reiber PhD

Multiple limb loss from combat injuries has increased as a proportion of all combat-wounded amputees. Bilateral lower-extremity limb loss is the most common, with bilateral transfemoral amputations being the most common subgroup followed by bilateral amputations consisting of a single transfemoral amputation and a single transtibial amputation (TFTT). With improvements in rehabilitation and prostheses, we believe it is important to ascertain how TFTT amputees from the present conflicts compare to those from the Vietnam War.

Targeted Muscle Reinnervation: A Novel Approach to Postamputation Neuroma Pain

Jason M. Souza MD, Jennifer E. Cheesborough MD, Jason H. Ko MD, Mickey S. Cho MD, Todd A. Kuiken MD, PhD, Gregory A. Dumanian MD

Postamputation neuroma pain can prevent comfortable prosthesis wear in patients with limb amputations, and currently available treatments are not consistently effective. Targeted muscle reinnervation (TMR) is a decade-old technique that employs a series of novel nerve transfers to permit intuitive control of upper-limb prostheses. Clinical experience suggests that it may also serve as an effective therapy for postamputation neuroma pain; however, this has not been explicitly studied.

Injury Patterns and Outcomes of Open Fractures of the Proximal Ulna Do Not Differ From Closed Fractures

Paul H. Yi BA, Alexander A. Weening MD, Sangmin R. Shin MD, Khalil I. Hussein BA, Paul Tornetta MD, Andrew Jawa MD

The incidence and injury patterns of open fractures of the proximal ulna are poorly elucidated and little evidence exists to guide management.

Does a Microprocessor-controlled Prosthetic Knee Affect Stair Ascent Strategies in Persons With Transfemoral Amputation?

Jennifer M. Aldridge Whitehead MS, Erik J. Wolf PhD, Charles R. Scoville PT, DPT, Jason M. Wilken MPT, PhD

Stair ascent can be difficult for individuals with transfemoral amputation because of the loss of knee function. Most individuals with transfemoral amputation use either a step-to-step (nonreciprocal, advancing one stair at a time) or skip-step strategy (nonreciprocal, advancing two stairs at a time), rather than a step-over-step (reciprocal) strategy, because step-to-step and skip-step allow the leading intact limb to do the majority of work. A new microprocessor-controlled knee (Ottobock X2) uses flexion/extension resistance to allow step-over-step stair ascent.

Managing Acetabular Fractures in the Elderly With Fixation and Primary Arthroplasty: Aiming for Early Weightbearing

Mark Rickman MD, MBChB, FRCS, James Young MBBS, MRCS(Eng), Alex Trompeter MBBS, BSc, FRCS(Tr&Orth), Rachel Pearce RGN, BSc, Mark Hamilton FRCA

Osteoporotic acetabular fractures in the elderly are becoming more common. Regardless of treatment, most patients are managed with a period of protected weightbearing, even if a THA has been performed. We have tried to treat these patients analogously to geriatric femoral neck fractures in a way that allows immediate full weightbearing.