Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 470 | Issue 8 | Aug, 2012

What are Predictors of Mortality in Patients with Pelvic Fractures?

Joerg H. Holstein MD, Ulf Culemann MD, Tim Pohlemann MD

Our knowledge of factors influencing mortality of patients with pelvic ring injuries and the impact of associated injuries is currently based on limited information.

Initial Experience Using a Pelvic Emergency Simulator to Train Reduction in Blood Loss

Tim Pohlemann MD, Ulf Culemann MD, Joerg H. Holstein MD

Because the average exposure of surgeons to pelvic injuries with life-threatening hemorrhage is decreasing, training opportunities are necessary to prepare surgeons for the rare but highly demanding emergency situations. We have developed a novel pelvic emergency simulator to train surgeons in controlling blood loss.

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.

Is Application of an Internal Anterior Pelvic Fixator Anatomically Feasible?

David J. Merriman MD, William M. Ricci MD, Christopher M. McAndrew MD, Michael J. Gardner MD

Spinal hardware has been adapted for fixation in the setting of anterior pelvic injury. This anterior subcutaneous pelvic fixator consists of pedicle screws placed in the supraacetabular region connected by a contoured connecting rod placed subcutaneously and above the abdominal muscle fascia.

Surgical Technique: A Percutaneous Method of Subcutaneous Fixation for the Anterior Pelvic Ring: The Pelvic Bridge

Timothy G. Hiesterman DO, Brian W. Hill MD, Peter A. Cole MD

Management of pelvic ring injuries using minimally invasive techniques may be desirable if reduction and stability can be achieved. We present a new technique, the anterior pelvic bridge, which is a percutaneous method of fixing the anterior pelvis through limited incisions over the iliac crest(s) and pubic symphysis.

Complications of Anterior Subcutaneous Internal Fixation for Unstable Pelvis Fractures: A Multicenter Study

Rahul Vaidya MD, Erik N. Kubiak MD, Patrick F. Bergin MD, Derek G. Dombroski MD, Ren J. Critchlow MD, Anil Sethi MD, Adam J. Starr MD

Stabilization after a pelvic fracture can be accomplished with an anterior external fixator. These devices are uncomfortable for patients and are at risk for infection and loosening, especially in obese patients. As an alternative, we recently developed an anterior subcutaneous pelvic internal fixation technique (ASPIF).

Can Lumbopelvic Fixation Salvage Unstable Complex Sacral Fractures?

Clifford B. Jones MD, Debra L. Sietsema RN, PhD, Martin F. Hoffmann MD

Traditional screw or plate fixation options can be used to fix the majority of sacral fractures. However, these techniques are unreliable with dysmorphic upper sacral segments, U-fractures, osseous compression of neural elements, and previously failed fixation. Lumbopelvic fixation can potentially address these injuries but is a technically demanding procedure requiring spinal and pelvic fixation and it is unclear whether it reliably corrects the deformity and restores function.

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.

Radiographic Changes of Implant Failure After Plating for Pubic Symphysis Diastasis: An Underappreciated Reality?

Cory Collinge MD, Michael T. Archdeacon MD, Elizabeth Dulaney-Cripe MD, Berton R. Moed MD

Implant failure after symphyseal disruption and plating reportedly occurs in 0% to 21% of patients but the actual occurrence may be much more frequent and the characteristics of this failure have not been well described.

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.

Persistent Impairment After Surgically Treated Lateral Compression Pelvic Injury

Martin F. Hoffmann MD, Clifford B. Jones MD, Debra L. Sietsema RN, PhD

Recently, fixation of lateral compression (LC) pelvic fractures has been advocated to improve patient comfort and to allow earlier mobilization without loss of reduction, thus minimizing adverse systemic effects. However, the degree of acceptable deformity and persistence of disability are unclear.

High Rates of Sexual and Urinary Dysfunction After Surgically Treated Displaced Pelvic Ring Injuries

Adekoyejo A. Odutola FRCS(Orth), Omar Sabri FRCS(Orth), Ruth Halliday, Timothy J. S. Chesser FRCS(Orth), Anthony J. Ward FRCS

Pelvic ring injuries may be associated with genitourinary injury (GUI) and result in urinary or sexual dysfunction.

Are Shoulders with A Reverse Shoulder Prosthesis Strong Enough? A Pilot Study

Tjarco D. W. Alta MD, H. E. J. Veeger PhD, Thomas W. J. Janssen PhD, W. Jaap Willems MD, PhD

It has been suggested that limited active ROM of reverse shoulder prostheses relates to lack of strength. However, the postoperative strength has not been quantified.

Subscapularis Release in Shoulder Replacement Determines Structural Muscular Changes

Lieven Franciscus Wilde MD, PhD, Tineke Coninck BSc, Francis Neve MD, Bart M. Berghs MD

Osteotomy of the lesser tuberosity in shoulder arthroplasty allows bony healing of the subscapularis tendon but does not prevent fatty degeneration in its muscle. Occurrence or increase in fatty degeneration may depend on the surgical technique.

The Impact of Digit-related Radiographic Osteoarthritis of the Hand on Grip-strength and Upper Extremity Disability

Hyuk Jin Lee MD, Nam-Jong Paik MD, Jae-Young Lim MD, Ki Woong Kim MD, Hyun Sik Gong MD

Interpreting the impact of hand osteoarthritis (OA) on hand function is complicated owing to the multiple digits and joints in the hand.

Prevention of Nerve Injury After Periacetabular Osteotomy

Rafael J. Sierra MD, Paul Beaule MD, Ira Zaltz MD, Michael B. Millis MD, John C. Clohisy MD, Robert T. Trousdale MD

The Bernese periacetabular osteotomy (PAO) is the preferred pelvic osteotomy in many centers treating symptomatic acetabular dysplasia in the young adult. Major nerve injury has been reported as a complication that can occur with this complex procedure, but the incidence and circumstances associated with such injury are not well known.

Reliability of a Complication Classification System for Orthopaedic Surgery

Ernest L. Sink MD, Michael Leunig MD, Ira Zaltz MD, Jennifer Claire Gilbert MS, John Clohisy MD

Quality of health care and safety have been emphasized by various professional and governmental groups. However, no standardized method exists for grading and reporting complications in orthopaedic surgery. Conclusions regarding outcomes are incomplete without a standardized, objective complication grading scheme applied concurrently. The general surgery literature has the Clavien-Dindo classification that meets the above criteria.

Minimally Invasive Total Hip Arthroplasty Using a Transpiriformis Approach: A Preliminary Report

Douglas J. Roger MD, David Hill PA‐C

Continuing efforts have been made to develop minimally invasive surgery techniques for THA. One of the most commonly performed of these techniques is the mini-posterior approach. All reported series using this approach describe surgical detachment of the short external rotators of the hip. In 2008, Penenberg et al. described an innovative surgical technique that preserves the short external rotators. We present the results of a single-incision modification of this technique in 135 patients.

Total Hip Arthroplasty Versus Hemiarthroplasty for Displaced Femoral Neck Fractures: Meta-analysis of Randomized Trials

Ligang Yu MM, Yan Wang MD, Jiying Chen MD

Most patients with displaced femoral neck fractures are treated by THA and hemiarthroplasty, but it remains uncertain which if either is associated with better function and lower risks of complications.

Reason for Revision Influences Early Patient Outcomes After Aseptic Knee Revision

Paul Baker MBBS, MSc, FRCS (Trauma & Orthop), Paul Cowling MBBS, MRCS, Steven Kurtz PhD, Simon Jameson MBBS, MRCS, Paul Gregg MD, FRCS (Ed), FRCS, David Deehan MD, MSc, FRCS (Trauma & Orthop)

Revision TKA less consistently produces improvements in clinical function and quality of life when compared with primary TKA. The reasons for this difference are unclear.

Does Landmark Selection Affect the Reliability of Tibial Tubercle–Trochlear Groove Measurements Using MRI?

Jason J. Wilcox MD, Brian J. Snow MD, Stephen K. Aoki MD, Man Hung PhD, Robert T. Burks MD

A lateralized tibial tubercle is one potential cause of patellar instability. The tibial tubercle–trochlear groove (TT-TG) distance using CT is a reliable measure and considered the gold standard. Using MRI for this purpose has increased, although the reliability of doing so is not well studied.

Current Treatments of Isolated Articular Cartilage Lesions of the Knee Achieve Similar Outcomes

Hong-Chul Lim MD, PhD, Ji-Hoon Bae MD, Sang-Heon Song MD, Young-Eun Park MD, Seung-Ju Kim MD

Many surgical techniques, including microfracture, periosteal and perichondral grafts, chondrocyte transplantation, and osteochondral grafts, have been studied in an attempt to restore damaged articular cartilage. However, there is no consensus regarding the best method to repair isolated articular cartilage defects of the knee.

MRI is Unnecessary for Diagnosing Acute Achilles Tendon Ruptures: Clinical Diagnostic Criteria

David N. Garras MD, Steven M. Raikin MD, Suneel B. Bhat MD, MPhil, Nicholas Taweel DPM, PT, Homyar Karanjia DPM

Achilles tendon ruptures are common in middle-aged athletes. Diagnosis is based on clinical examination or imaging. Although MRI is commonly used to document ruptures, there is no literature supporting its routine use and we wondered whether it was necessary.

Clinical Stability of Slipped Capital Femoral Epiphysis does not Correlate with Intraoperative Stability

Kai Ziebarth MD, Stephan Domayer MD, Theddy Slongo MD, Young-Jo Kim MD, PhD, Reinhold Ganz MD

The most important objective of clinical classifications of slipped capital femoral epiphysis (SCFE) is to identify hips associated with a high risk of avascular necrosis (AVN) — so-called unstable or acute slips; however, closed surgery makes confirmation of physeal stability difficult. Performing the capital realignment procedure in SCFE treatment we observed that clinical estimation of physeal stability did not always correlate with intraoperative findings at open surgery. This motivated us to perform a systematic comparison of the clinical classification systems with the intraoperative observations.

2011 Mid-America Orthopaedic Association Dallas B. Phemister Physician in Training Award: Can Musculoskeletal Tumors be Diagnosed with Ultrasound Fusion-Guided Biopsy?

Jad G. Khalil MD, Michael P. Mott MD, Theodore W. Parsons MD, Trevor R. Banka MD, Marnix Holsbeeck MD

Percutaneous biopsy for musculoskeletal tumors commonly relies on imaging adjuncts including ultrasound (US), CT, or MRI. These modalities however have disadvantages (US) or are cumbersome, not universally available, and costly (CT and MRI). US fusion is a novel technique that fuses previously obtained CT or MRI data with real-time US, which allows biopsies to be performed in an US suite. It has proven useful in various body systems but musculoskeletal applications remain scarce. Our goal is to evaluate the fusion technology and determine its ability to diagnose musculoskeletal tumors.

Anti-TGF-β Antibody Combined with Dendritic Cells Produce Antitumor Effects in Osteosarcoma

Masanori Kawano MD, PhD, Ichiro Itonaga MD, PhD, Tatsuya Iwasaki MD, Hiroyuki Tsuchiya MD, PhD, Hiroshi Tsumura MD, PhD

We previously reported the combination of tumor cryotreatment with dendritic cells to promote antitumor immunity. The effect of the combination treatment with dendritic cells and antitransforming growth factor-β (anti-TGF-β) antibody on the elimination of regulatory T cells and the inhibition of tumor growth was investigated.

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.

Is Helical Blade Nailing Superior to Locked Minimally Invasive Plating in Unstable Pertrochanteric Fractures?

Matthias Knobe MD, Wolf Drescher MD, PhD, Nicole Heussen MD, Richard Martin Sellei MD, Hans-Christoph Pape MD

Technical advancements have produced many challenges to intramedullary implants for unstable pertrochanteric fractures. Helical blade fixation of the femoral head has the theoretical advantages of higher rotational stability and cutout resistance and should have a lower rate of reoperation than a locked plating technique.

Representation of Developing Countries in Orthopaedic Journals: A Survey of Four Influential Orthopaedic Journals

Edward E. Aluede BSc, Jonathan Phillips BA, Jamie Bleyer BA, Harry E. Jergesen MD, Richard Coughlin MD, MSc

The developing world contains more than ¾ of the world’s population, and has the largest burden of musculoskeletal disease. Published studies provide crucial information that can influence healthcare policies. Presumably much information regarding burden in the developing world would arise from authors from developing countries. However, the extent of participation of authors from the developing world in widely read orthopaedic journals is unclear.

Has Diversity Increased in Orthopaedic Residency Programs since 1995?

Eldra W. Daniels BS, Keisha French BS, Laurie A. Murphy MBA, MPH, Richard E. Grant MD

Diversity among health professionals is believed to be an important step toward improving patient communication and addressing health disparities. Orthopaedic surgery traditionally has been overly represented by Caucasian males, and it remains one of the least racially and gender-diversified surgical subspecialties. As the US population becomes increasingly diverse, a concomitant increase in ethnic diversity and gender diversity is needed to ensure that all Americans receive high-quality, culturally competent health care.

Case Report: High Chromium and Cobalt Levels in a Pregnant Patient with Bilateral Metal-on-Metal Hip Arthroplasties

Juliane Fritzsche PhD, Cornelia Borisch MD, Christof Schaefer MD, PhD

Metal-on-metal bearings frequently are used in young patients leading to the concern that disseminated metals such as chromium (Cr) and cobalt (Co) as the main constituents could affect pregnancies.

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