Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 469 | Issue 12 | Dec, 2011

Proximal Humerus Fractures in the Elderly Can Be Reliably Fixed With a “Hybrid” Locked-plating Technique

Jonathan D. Barlow MD, Joaquin Sanchez-Sotelo MD, PhD, Michael Torchia MD

Controversy exists regarding the best treatment of proximal humerus fractures in the elderly. Recent studies of open reduction and internal fixation have demonstrated high complication rates.

Three- and Four-part Fractures Have Poorer Function Than One-part Proximal Humerus Fractures

Crispin Ong MD, Christopher Bechtel BA, Michael Walsh PhD, Joseph D. Zuckerman MD, Kenneth A. Egol MD

Locking plates have become a commonly used fixation device in the operative treatment of three- and four-part proximal humerus fractures. Examining function in patients treated nonoperatively and operatively should help determine whether and when surgery is appropriate in these difficult-to-treat fractures.

Endosteal Strut Augment Reduces Complications Associated With Proximal Humeral Locking Plates

Andrew S. Neviaser MD, Carolyn M. Hettrich MD, Brandon S. Beamer MD, Joshua S. Dines MD, Dean G. Lorich MD

Locking-plate technology has renewed interest in plate fixation for treating proximal humerus fractures. Complications associated with these devices, including loss of reduction, screw cutout, and intra-articular penetration, are frequent. Establishing a second column of support may reduce complications and improve clinical outcome scores.

Locked Plating of Proximal Humeral Fractures: Is Function Affected by Age, Time, and Fracture Patterns?

Clifford B. Jones MD, FACS, Debra L. Sietsema PhD, Daniel K. Williams MD

Locking plate fixation of proximal humeral fractures improves biomechanical stability. It has expanded the indications of traditional open reduction internal fixation and become increasingly common for treating unstable, displaced proximal humeral fractures. Despite improved stability it is unclear whether these improve function and if so for which patients.

Shoulder Arthroplasty for Fracture: Does a Fracture-specific Stem Make a Difference?

Sumant G. Krishnan MD, John R. Reineck MD, Philip D. Bennion MD, Leanne Feher BS, Wayne Z. Burkhead MD

Arthroplasty for shoulder fractures is a technically challenging and unpredictable procedure and its use is controversial.

Is Reverse Shoulder Arthroplasty Appropriate for the Treatment of Fractures in the Older Patient?: Early Observations

Christopher Lenarz MD, Yousef Shishani MD, Christopher McCrum, Robert J. Nowinski DO, T. Bradley Edwards MD, Reuben Gobezie MD

The treatment of comminuted proximal humerus fractures in older patients is challenging. Variable values of functional outcomes scores, ROMs, patient satisfaction, and bony healing have been reported with conventional techniques, including open reduction and internal fixation, percutaneous pinning, and hemiarthroplasty. Another alternative is reverse total shoulder arthroplasty, although it is unclear whether this provides better ROM or function.

Thromboembolic Events Are Uncommon After Open Treatment of Proximal Humerus Fractures Using Aspirin and Compression Devices

Benjamin J. Widmer MD, Rocco Bassora MD, William J. Warrender BS, Joseph A. Abboud MD

Thromboembolic phenomena have long been recognized as a major cause of morbidity and mortality in hospitalized patients, especially those undergoing reconstructive surgery. We have been empirically treating patients with aspirin, early ambulation, and mechanoprophylaxis after operative management of proximal humerus fractures. However, we have not established the incidence of postoperative deep vein thrombosis and pulmonary embolism in this population.

Precontoured Plating of Clavicle Fractures: Decreased Hardware-related Complications?

Corinne VanBeek MD, Karen J. Boselli MD, Edwin R. Cadet MD, Christopher S. Ahmad MD, William N. Levine MD

Operative treatment of displaced midshaft clavicle fractures reportedly decreases the risk of symptomatic malunion, nonunion, and residual shoulder disability. Plating these fractures, however, may trade these complications for hardware-related problems. Low-profile anatomically precontoured plates may reduce the rates of plate prominence and hardware removal.

Precontoured Superior Locked Plating of Distal Clavicle Fractures: A New Strategy

Jaron R. Andersen MD, Matt P. Willis MD, Ryan Nelson DO, Mark A. Mighell MD

The ideal management of fractures of the distal third of the clavicle remains a topic of debate. Locked plating is a new treatment method but is not yet widely studied.

Function Plateaus by One Year in Patients With Surgically Treated Displaced Midshaft Clavicle Fractures

Laura A. Schemitsch, Emil H. Schemitsch MD, FRCS(C), Christian Veillette MD, MSc, FRCS(C), Rad Zdero PhD, Michael D. McKee MD, FRCS(C)

Based on short-term (1 year or less) followup, primary fixation of displaced midshaft clavicle fractures reportedly results in better function compared with that reported for nonoperative methods. Whether better function persists beyond 1 year is unclear.

Can Complications of Titanium Elastic Nailing With End Cap for Clavicular Fractures Be Reduced?

Arno Frigg MD, Paavo Rillmann MD, Christian Ryf MD, Richard Glaab MD, Lisa Reissner MD

We found treatment of clavicular midshaft fractures using titanium elastic nails (TENs) in combination with postoperative free ROM was associated with a complication rate of 78%. The use of end caps reduced the rate to 60%, which we still considered unacceptably high. Thus, we explored an alternative approach.

Excessive Complications of Open Intramedullary Nailing of Midshaft Clavicle Fractures With the Rockwood Clavicle Pin

Christopher D. Mudd MD, Kevin J. Quigley MD, Lyndon B. Gross MD, PhD

Intramedullary clavicle fixation is a potential alternative to plate fixation. Previous studies documenting the complication rates of intramedullary clavicle fixation have demonstrated variable rates of soft tissue complications and fracture healing.

A Reliable Radiographic Measurement Technique for Extra-articular Scapular Fractures

Jack Anavian MD, Joseph M. Conflitti MD, Gaurav Khanna MD, S. Trent Guthrie MD, Peter A. Cole MD

Currently, neither well-defined nor standardized measurement techniques exist for assessing deformity of extra-articular scapular fractures. To properly evaluate these injuries, compare observations across studies, and make clinical decisions, a validated measurement protocol for evaluating scapular fractures is needed.

Analysis of Operative versus Nonoperative Treatment of Displaced Scapular Fractures

Clifford B. Jones MD, FACS, Debra L. Sietsema PhD

Operative indications for displaced scapular fractures have been controversial and inconsistent. Surgeons have been dissuaded to operate on these uncommon fractures because of the complex anatomy, approaches, and fracture patterns. It is unclear whether return to work, pain, or complications differ in patients with scapular fractures treated nonoperatively or operatively.

Surgical Technique: A Minimally Invasive Approach to Scapula Neck and Body Fractures

Erich M. Gauger MD, Peter A. Cole MD

The approach of choice for open reduction internal fixation of displaced fractures involving the scapula neck or body is from posterior. We describe a new approach that minimizes the surgical insult to the soft tissues but preserves the ability to restore alignment and stability to the fracture.

Diagnostic Performance Tests for Suspected Scaphoid Fractures Differ with Conventional and Latent Class Analysis

Geert A. Buijze MD, Wouter H. Mallee MD, Frank J. P. Beeres MD, PhD, Timothy E. Hanson PhD, Wesley O. Johnson PhD, David Ring MD, PhD

Evaluation of the diagnostic performance characteristics of radiographic tests for diagnosing a true fracture among suspected scaphoid fractures is hindered by the lack of a consensus reference standard. Latent class analysis is a statistical method that takes advantage of unobserved, or latent, classes in the data that can be used to determine diagnostic performance characteristics when there is no consensus reference (gold) standard.

Superiority of the Bryan® Disc Prosthesis for Cervical Myelopathy: A Randomized Study with 3-year Followup

Lei Cheng MD, PhD, Lin Nie MD, Mu Li MD, Yong Huo MD, Xin Pan MD

The current standard of care for cervical myopathy is anterior discectomy and fusion (ACDF). Although well tolerated in the short term, this treatment might ultimately result in progressive degeneration of adjacent motion segments. Artificial disc arthroplasty offers the theoretical advantage of preservation of motion at the operative level with consequent stress reduction at adjacent levels.

Polyethylene Wear is Related to Patient-specific Contact Stress in THA

Robert Košak MD, PhD, Veronika Kralj-Iglič PhD, Aleš Iglič PhD, Matej Daniel PhD

General numerical models of polyethylene wear and THA simulators suggest contact stresses influence wear. These models do not account for some patient-specific factors. Whether the relationship between patient-specific contact stress and wear apply in vivo is unclear.

Deep Venous Thrombosis and Pulmonary Embolism are Uncommon in East Asian Patients after Total Hip Arthroplasty

Bun Jung Kang MD, Young-Kyun Lee MD, Hee Joong Kim MD, Yong-Chan Ha MD, Kyung-Hoi Koo MD

In Western countries, deep vein thrombosis (DVT) and pulmonary embolism (PE), are relatively common after THA and many surgeons recommend routine pharmacologic thromboprophylaxis. There is some suggestion in the literature that the incidences of DVT and PE may be lower in East Asian patients. Therefore, it would be important to establish the incidences in a large number of East Asian patients who did not receive pharmacologic thromboprophylaxis.

Cannulated Screw and Cable are Superior to Modified Tension Band in the Treatment of Transverse Patella Fractures

Yun Tian MD, Fang Zhou MD, Hongquan Ji MD, Zhishan Zhang MD, Yan Guo MD

Although the modified tension band technique (eg, tension band supplemented by longitudinal Kirschner wires) has long been the mainstay for fixation of transverse fractures of the patella, it has shortcomings, such as bad reduction, loosening of implants, and skin irritation.

Can Computer Assistance Improve the Clinical and Functional Scores in Total Knee Arthroplasty?

Daniel Hernández-Vaquero MD, PhD, Abelardo Suarez-Vazquez MD, PhD, Susana Iglesias-Fernandez MD

Surgical navigation in TKA facilitates better alignment; however, it is unclear whether improved alignment alters clinical evolution and midterm and long-term complication rates.

Residual Varus Alignment does not Compromise Results of TKAs in Patients with Preoperative Varus

Robert A. Magnussen MD, Florent Weppe MD, Guillaume Demey MD, Elvire Servien MD, PhD, Sébastien Lustig MD, PhD

Postoperative varus alignment has been associated with lower IKS scores and increased failure rates. Appropriate positioning of TKA components therefore is a key concern of surgeons. However, obtaining neutral alignment can be challenging in patients with substantial preoperative varus deformity and it is unclear whether residual deformity influences revision rates.

Standardized Diagnostic Criteria for Developmental Dysplasia of the Hip in Early Infancy

Andreas Roposch MD, MSc, FRCS, Liang Q. Liu MBBS, PhD, Fritz Hefti MD, Nicholas M. P. Clarke ChM, FRCS, John H. Wedge OC, MD, FRCS(C)

Clinicians use various criteria to diagnose developmental dysplasia of the hip (DDH) in early infancy, but the importance of these various criteria for a definite diagnosis is controversial. The lack of uniform, widely agreed-on diagnostic criteria for DDH in patients in this age group may result in a delay in diagnosis of some patients.

Cost Analysis of a Falls-prevention Program in an Orthopaedic Setting

John G. Galbraith MRCS, Joseph S. Butler MRCS, Adeel R. Memon MRCS, Mark A. Dolan FRCS, James A. Harty FRCS

Falls by orthopaedic patients may lead to negative outcomes such as injury, prolonged hospitalization, delayed rehabilitation, and increased costs.

Surgical Technique: Static Intramedullary Nailing of the Femur and Tibia Without Intraoperative Fluoroscopy

Neil J. White MD, FRCS(C), Anthony T. Sorkin MD, Geoffrey Konopka MPH, Todd O. McKinley MD

On a recent mission directed at definitive care for victims of the Haitian earthquake, the orthopaedic team developed a technique for freehand distal locking of femoral and tibial nails without intraoperative fluoroscopy or proximally mounted targeting jigs.

Treatment of Early Postoperative Infections after THA: A Decision Analysis

Hany Bedair MD, Nicholas Ting MD, Kevin J. Bozic MD, MBA, Craig J. Della Valle MD, Scott M. Sporer MD

The treatment for an early postoperative periprosthetic infection after cementless THA that results in the highest quality of life after the control of infection is unknown. Although common treatments include irrigation and débridement with component retention, a one-stage exchange, or a two-stage exchange, it is unclear whether any of these provides a higher quality of life after the control of infection.

Are Bone and Serum Cefazolin Concentrations Adequate for Antimicrobial Prophylaxis?

Koji Yamada MD, Kunihiro Matsumoto PhD, Fumiaki Tokimura MD, Hiroshi Okazaki MD, PhD, Sakae Tanaka MD, PhD

Antimicrobial prophylaxis is considered beneficial for preventing surgical-site infections in clean orthopaedic surgery. However, whether tissue concentrations of cefazolin achieve the minimum inhibitory concentration for the targeted contaminants have yet to be clarified.

Stiffness and Thickness of Fascia Do Not Explain Chronic Exertional Compartment Syndrome

Morten Dahl MD, Philip Hansen PhD, Per Stål DSc, David Edmundsson PhD, S. Peter Magnusson DSc

Chronic exertional compartment syndrome is diagnosed based on symptoms and elevated intramuscular pressure and often is treated with fasciotomy. However, what contributes to the increased intramuscular pressure remains unknown.

Improvement in Reflux Gastroesophagitis in a Patient with Spinal Muscular Atrophy after Surgical Correction of Kyphoscoliosis: A Case Report

Jae Hyuk Yang MD, Niraj Sharad Kasat MD, Seung Woo Suh MD, PhD, Seung Young Kim MD, PhD

Scoliosis, a three-dimensional deformity, has secondary effects on the gastrointestinal system. Reflux gastroesophagitis with hiatus hernia in patients with scoliosis is difficult to manage. We present a patient in whom primary correction of a spinal deformity was associated with resolution of symptoms of reflux.

Erratum to: Infirmity and Injury Complexity are Risk Factors for Surgical-site Infection after Operative Fracture Care

Abdo Bachoura MD, Thierry G. Guitton MSc, R. Malcolm Smith MD, Mark S. Vrahas MD, David Zurakowski PhD, David Ring MD, PhD

In Brief: Closed Tibial Shaft Fractures

P. Maxwell Courtney MD, Joseph Bernstein MD, Jaimo Ahn MD, PhD

Emerging Ideas: Prevention of Posttraumatic Arthritis Through Interleukin-1 and Tumor Necrosis Factor-alpha Inhibition

J. Todd R. Lawrence MD, PhD, James Birmingham MD, Alison P. Toth MD

Despite surgical and mechanical stabilization of an acutely injured joint through ligament reconstruction, meniscus repair, or labral repair, the risk of posttraumatic arthritis remains high. Joint injury triggers three phases of pathogenic events: the early (acute) phase involves joint swelling, hemarthrosis, expression of inflammatory cytokines (especially interleukin-1 [IL-1] and tumor necrosis factor-α [TNF-α]), and biomarkers of cartilage catabolism; an intermediate phase is characterized by reduction of joint inflammation, ongoing joint catabolism, but no evidence yet for typical features of radiographic osteoarthritis (OA); and a late phase characterized by radiographic OA.

Orthopaedic Case of the Month: A 50-year-old Woman with Persistent Knee Pain

Brian E. Walczak DO, MPT, Dorothy M. Halperin MD, Rabei W. Bdeir MD, Ronald B. Irwin MD
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