Faculty Bibliography

Purpose/UNASSIGNED:To assess risk factors and associated outcomes of acute kidney injury (AKI) in hip fracture patients. Methods/UNASSIGNED:Risk factors for AKI were identified by multivariate logistic regression. AKI patients were matched to patients who did not experience AKI using a validated trauma triage score. Comparative analyses between matched groups were performed. Results/UNASSIGNED:Risk factors of AKI included increasing Charlson Comorbidity Index and use of anticoagulation medications. AKI was associated with increased likelihood of medical complications and longer, more costly hospital stays. Discussion/UNASSIGNED:

»:Tranexamic acid (TXA) is a drug used to control hemorrhage by preventing the breakdown of fibrin. »:TXA is a cost-effective treatment for trauma patients across a variety of economic settings. »:Concerns of TXA causing thromboembolic events (TEEs) in orthopaedic trauma patients are not supported by evidence. »:TXA has been shown to reduce blood loss in hip fracture surgery.

SUMMARY:High-energy tibial plateau fractures are associated with knee fracture dislocations and concomitant ligamentous injury. Both bony and ligamentous injuries can require surgical fixation, often requiring a multidisciplinary team and staged treatment. This article and accompanying video describe the workup and treatment of a Moore type 4 tibial plateau rim compression fracture with posterolateral corner and anterior cruciate ligament rupture that underwent open reduction internal fixation of the tibial plateau with posterolateral corner reconstruction and then staged anterior cruciate ligament reconstruction with quad tendon autograft.

This case presentation and surgical technique demonstrates a complete distal triceps tendon rupture repair with single-row suture anchor fixation through a posterior midline approach to the elbow in a 17-year-old male rugby player. Key procedure points include complete triceps mobilization for adequate excursion to facilitate repair, identification of the ulnar nerve, isolation and sharp debridement of torn tissue to healthy tendon, thorough debridement of the olecranon reattachment site, suture construct, and order of fixation to optimize tendon-bone apposition.

SUMMARY:There are a variety of ways to treat chronic elbow dislocations, including repeat closed reduction and immobilization, transarticular pinning, temporary bridge plating, hinged or rigid external fixation, and internal fixator application. Although each have distinct advantages and disadvantages, avoiding recurrent instability is critical. The internal-fixator is a relatively new option to maintain a stable, concentric reduction and facilitate early range of motion. This article and accompanying video describe the surgical technique of using an internal joint stabilizer for treatment of a chronically unstable ulnohumeral joint.

SUMMARY:A 58-year-old woman with a proximal 1/3 humeral shaft nonunion presented 2 years after initial injury. We present a technique for nonunion repair, including nonunion site preparation, direct compression of the fracture site using plate osteosynthesis, and iliac crest bone graft harvest and utilization. The purpose of this video is to review humeral shaft nonunion literature and describe our management technique.

SUMMARY:There are a variety of treatment options available for proximal humerus fractures, including nonoperative management, open reduction internal fixation with screws, locking plates, intramedullary nailing, or suture fixation, and arthroplasty, including hemiarthroplasty and total shoulder replacements. Fracture characteristics, including the number of fracture parts and involvement of the humeral head and glenoid and the patient's functional status and postoperative goals help dictate the optimal choice. Although the indications for hemiarthroplasty as treatment for severe proximal humerus fractures have narrowed, the authors believe that there is a still a place for this technique in practice.

»:The induced membrane technique (IMT) takes advantage of an osteoinductive environment that is created by the placement of a cement spacer into a bone defect. »:Most commonly, a polymethylmethacrylate (PMMA) spacer has been used, but spacers made from other materials have emerged and achieved good clinical outcomes. »:The IMT has demonstrated good results for long-bone repair; however, more research is required in order to optimize union rates as well as delineate more precise indications and surgical timing.

CASE:A 41-year-old man presented with a transverse patella fracture and proximal patellar tendon avulsion after a fall from standing. Disruption of the extensor mechanism of the knee at multiple points is rare. He was treated operatively for his patella fracture and patellar tendon avulsion but experienced early failure of the patellar tendon fixation requiring reoperation. Both components of injury ultimately healed, and he returned to function. CONCLUSION:This case describes a rare presentation of an uncommon injury pattern affecting the extensor mechanism. This is the first report to describe multifocal failure of the extensor chain from a low-energy mechanism.

Purpose/UNASSIGNED:To evaluate outcomes for a combined osteoligamentous reconstruction technique for Neer Type IIB clavicle fractures. Methods/UNASSIGNED:Patients with Neer Type IIB clavicle fractures treated with combined clavicular locking plate and coracoclavicular ligament suture reconstruction were identified. Demographics, clinical outcomes, and radiographic outcomes were collected. Results/UNASSIGNED:Twenty-four patients with mean 13 months of follow-up were included. Bony union and normal radiographic coracoclavicular relationship were achieved in 23 (96%) patients. The mean UCLA Shoulder score was 33.3. Three (13%) complications occurred. Discussion/UNASSIGNED:The combined osteoligamentous reconstruction approach as described is a successful option for treating Neer Type IIB clavicle fractures.