Faculty Bibliography

The history of limb-lengthening surgery can be traced back to the 19th Century. Since that time, the orthopaedic community has made tremendous progress in performing successful lengthening procedures. Among the important contributors to the field is Dr. Gavril Ilizarov. Because of advancements over the past century, limb lengthening has become a viable method of treating severe bony deformities and defects. This article, the second of a two-part series, reviews the principles of distraction osteosynthesis, including a thorough discussion of indications, instrumentation, and surgical technique.

Post-traumatic ankle arthritis can be a very disabling condition especially in young patients. Localization of the pain is important to allow appropriate treatment. Non-surgical treatment options include anti-inflammatory medications and use of bracing. Multiple surgical options range from joint sparing procedures for the younger patient to total ankle replacement for the older, less active patient. Arthrodesis remains the gold standard and is the procedure of choice for younger patients who are heavy laborers and in patients with severe arthritis who are not candidates for a total ankle replacement. Joint sparing operations include allograft resurfacing, arthroscopic debridement and osteophyte resection, joint distraction arthroplasty, and supramalleolar osteotomy. In older low demand patients, the surgeon may consider a total ankle arthroplasty as an alternative to arthrodesis.

Because communication is something that is often taken for granted, many people do not consciously think about communication habits and behaviors. When patients are questioned concerning important attributes of a doctor, they say they want someone who respects and listens to them. In a time of increasing malpractice litigation, physicians need to examine their communication skills. In an increasingly more diverse world, social and cultural beliefs, attitudes, and behaviors have a considerable effect on the health of communities. Patient safety, satisfaction, and successful outcomes rely on understanding the patient's medical and cultural needs. The concept of becoming a "cultural anthropologist" is improbable, but becoming aware of the demographics of the community in which the physician serves will improve communication and lead to improved patient and physician satisfaction, better patient compliance, and improved health outcomes.

This is a case of a 32-year-old man who developed intra- and periarticular heterotopic ossification (HO) after sustaining a low-velocity gunshot wound to the femur treated with intramedullary nailing of the fracture using a retrograde technique. The association between HO after a high-velocity gunshot wounds is well established. In addition, there have been two case reports of intra-articular HO after retrograde intramedullary femoral nailing. However, HO in and around the knee after a low-velocity gunshot wound has not been reported and may be more common than initially thought

We present a case report of an individual who sustained a locked proximal radioulnar joint fracture-translocation after a mechanical fall. After a failed attempt at closed reduction, intraoperative exploration revealed that the dislocated and fractured radial head was incarcerated along the medial aspect of the coronoid. After open reduction and internal fixation, the patient went on to uneventful healing and return of adequate function. To our knowledge, this is the first case report documenting an incarcerated fracture-translocation along the radiocapitellar and proximal radioulnar joints that required operative treatment

BACKGROUND: This study investigated which variables influence patients' return to sports after operative fixation of an unstable ankle fracture. MATERIALS AND METHODS: Over a 5-year period, 488 patients underwent surgical repair of an unstable ankle fracture. 243 patients preoperatively identified themselves as participating in vigorous activity. Clinical evaluation, functional outcome scores, and radiographic findings were reviewed retrospectively. RESULTS: At 3 months postoperatively, only 3% of all patients had returned to full sports. At 6 months, 14% of patients had returned, while at one year, only 24% of patients had returned. Younger age was predictive of return to sports by 3 months (p = 0.02), 6 months (p = 0.02) and 12 months (p = 0.0001). Males were more likely to return to sports at 6 (p = 0.001) and 12 months (p = 0.040). At 1 year, 88% of recreational athletes had returned to sports, while only 11.6% of competitive athletes had returned to sports (p = 0.043). At 12 months, bimalleolar injuries were more likely to return to sports than unimalleolar ankle fractures (p = 0.042). Furthermore, patients without an associated syndesmotic injury were more likely to return to athletic activities at 12 months (p = 0.011). A patient with an ASA of one or two was ten times more likely to return to sports versus a patient with an ASA of three or four (odds ratio > 10, p = 0.010). CONCLUSION: Predictors of return to sporting activities at one year include younger age, male gender, no or mild systemic disease, and a less severe ankle fracture. Negative predictors include older age, female gender, and the presence of severe medical comorbidities

OBJECTIVE: To compare the strength and stiffness of standard double-plate fixation with that of a single-locking plate for comminuted extra-articular distal humeral fractures. MATERIALS: Eight matched pairs of humeri were used. One of each pair was fixed with two 3.5-mm standard reconstruction plates applied dorsally; the other was fixed with one precontoured locking plate applied to the posterior aspect of the lateral column. A 1-cm gap was created to simulate a distal fracture model with 100% metaphyseal comminution with no bony apposition. Stiffness testing of these constructs was performed in axial compression, anterior, posterior and lateral bending, and torsion. They were then cyclically loaded for 4000 cycles with 60 N in posterior bending and the stiffnesses retested. Finally, each construct was posteriorly loaded to failure to determine its ultimate strength. RESULTS: The double-plate construct was significantly stiffer than the one locking plate construct in anterior bending (39%; p = 0.02), posterior bending (23%; p = 0.04), and lateral bending (60%; p = 0.01). No significant stiffness differences were seen in axial compression and torsion (p = 0.64 and 0.25, respectively). After cyclic loading, all construct stiffnesses were relatively unchanged. Both construct types had similar failure strengths (p = 0.76) of approximately 400 N. CONCLUSIONS: Double-plating provides a more rigid fixation than a single-locked plate for fixation of extra-articular comminuted distal humeral fractures. This could be clinically relevant in situations with 100% comminution as seen in gun shot injuries

Complex pertrochanteric fractures, such as those with reverse obliquity and subtrochanteric extension, represent a subset of hip fractures that sometimes is difficult to treat. Critical assessment of the available literature and a review of treatment indications, implant recommendations, and technical pitfalls will provide insight to physicians to enable better care of patients with these complex injuries

Ankle syndesmosis injuries frequently occur with ankle fractures, but their treatment remains controversial. Although specific clinical and radiographic diagnostic measures are generally well-accepted, there remains a lack of consensus with respect to the treatment of these injuries. Controversy arises at almost every phase of treatment including: type of fixation (screw size, type of implant), number of cortices required for fixation, and need for hardware removal. Regardless of fixation technique chosen, the most important goal should be anatomic reduction and restoration of the syndesmosis and ankle mortise as this is the only significant predictor of functional outcome