Faculty Bibliography

Long-bone deformity may be significantly symptomatic. A uniplanar corrective osteotomy uses a single cut to correct coronal, sagittal, and axial plane deformity simultaneously. Careful preoperative planning is required in addition to a comprehensive understanding of the magnitude and plane of the true deformity of the bone. With precise operative technique and intraoperative assessment of correction, good results can be achieved.

Valgus intertrochanteric osteotomy is an effective method of treating femoral neck nonunion by reducing shear forces at the fracture and correcting the neck-shaft angle. Good outcomes have been reported in the literature. Through careful preoperative planning and a precise operative technique, reliable healing of both the osteotomy and nonunion can be achieved.

Introduction The optimal surgical treatment of isolated lumbar foraminal stenosis has not been defined. Minimally invasive decompression of the foramen from a far lateral tubular decompression (FLTD) approach has been shown to not only have minimal morbidity but also highly variable success rates at short-term follow-up. It is important to quantify improvement and define the demographic and radiographic parameters that predict failure in this promising, minimally invasive surgical technique. This study investigates pain and disability score improvement following FLTD at 12 and 24 months and investigates associations with failure. Methods All patients who underwent lumbar FLTD by a single surgeon at a single institution from September 2015 to January 2018 were included in this prospective case series. Visual analog scale (VAS) for back pain and leg pain and Oswestry Disability Index (ODI) were collected preoperatively and at the 12- and 24- month follow-ups. Outcomes between visits were fitted to a linear mixed-effects model. The univariate analysis investigated demographic, radiographic, and operative associations with subsequent open revision. Results A total of 42 patients were included in this study. Back pain (VAS 5.84 to 3.32, p<0.001), leg pain (VAS 7.33 to 2.71, p<0.001), and ODI (48.97 to 28.50, p<0.001) demonstrated significant improvements at the 12-month follow-up. Back pain (VAS 3.71, p=0.004), leg pain (VAS 3.04, p<0.001), and ODI (30.63, p<0.001) improvements were maintained at 24-month follow-up. Four patients (9.5%) required subsequent open revision. Subsequent open revision was associated with prior spine surgery (RR=2.85 (2.07-3.63), p=0.045) and scoliosis ≥10° (RR=6.33 (4.87-7.80), p=0.013). Conclusion Back pain, leg pain, and ODI showed significant improvement postoperatively. Improvement is maintained at two years. Prior spine surgery and scoliosis ≥ 10° may be relative contraindications to FLTD.

OBJECTIVES/OBJECTIVE:To report on our results using a proximal femoral locking plate for the treatment of peritrochanteric femur fractures. DESIGN/METHODS:Retrospective study. SETTING/METHODS:Level I Academic Medical Center. PATIENTS/METHODS:Sixty-eight patients with 68 fractures. INTERVENTION/METHODS:Demographics, fracture morphology, preoperative imaging, rationale against nailing, and outcomes were collected. MAIN OUTCOME MEASUREMENTS/METHODS:Outcomes were grouped into no complication, minor complication, or major complication. Minor complications included healed fractures with implant failure or change in alignment from immediate postoperative radiographs, which did not require intervention or elective implant removal. Major complications included any case that required revision for nonunion or implant failure. RESULTS:Nine patients were lost to follow-up. Of the 59 fractures, 16 had complications (27%): 9 minor and 7 major. Active tobacco use (P = 0.020) and fractures with an associated intracapsular femoral neck component (P = 0.006) correlated with complications. CONCLUSIONS:Proximal femoral locking plates continue to be associated with a high complication rate. However, based on our experience, proximal femoral locking plates may be considered in highly selected cases when absolutely no other implant is deemed appropriate, based on the degree of comminution and the complexity of the fracture pattern. Patients must be informed about the possibility of revision surgery based on the inherent limitations of these devices. LEVEL OF EVIDENCE/METHODS:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Femoral neck fractures in the physiologically young patient are challenging injuries to manage. A tenuous blood supply and the intrasynovial nature of the fracture create a challenging biological environment. To make matters worse, the biomechanics are equally problematic. Frequently, these fractures in younger populations are high Pauwel angle fractures that see considerable force, especially shear. These factors combine to make nonunion and avascular necrosis all too common. In the current study, we will highlight the challenges inherent to managing these injuries and will discuss techniques and implants that may help mitigate some of these challenges.

Therapeutic arthroscopy with microfracture leads to fibrocartilaginous repair and is an effective treatment of osteochondral lesions of the talus. A full diagnostic arthroscopy is performed, and then attention is turned to the osteochondral defect. We describe in detail patient positioning, ankle distraction, portal placement, steps of the diagnostic arthroscopy, and the technique of microfracture. We then discuss the special considerations to be taken regarding the use of a distractor, protection of neurovascular structures, and the indications for microfracture.

We hypothesized that systemic ceftriaxone and high concentration local antibiotics might eradicate peri-implant sepsis. Experiment 1: Eighty-four implants inoculated with biofilm-forming Staphylococcus aureus were treated in vitro with gentamicin, vancomycin, gentamicin + rifampin, or vancomycin + rifampin for 2, 4, or 8 days. Experiment 2: Forty-five implants were wired in vivo to rat femurs and inoculated with 1 × 10(6) CFU S. aureus. After 48 h, rats were treated once daily for 5 days with systemic ceftriaxone, local tobramycin or ceftriaxone, and tobramycin. Experiment 3: Forty implants with established S. aureus biofilms were wired in vivo to rat femurs. After 48 h, rats were treated with systemic ceftriaxone alone or in combination with local gentamicin, gentamicin and rifampin, or vancomycin. Experiment 1: 100% of implants treated in vitro with gentamicin were sterile after 48 h. The other treatments did not become sterile until 4 days. Experiment 2: No implant was culture negative. The combination of systemic ceftriaxone and local tobramycin was significantly better than others (p < 0.008). Experiment 3: Systemic ceftriaxone alone was ineffective. All implants treated with systemic ceftriaxone and local gentamicin were sterile (p < 0.001), the other groups were less effective.