Faculty Bibliography

PURPOSE: Operative fixation of displaced patella fractures is considered to be standard of care. However, patients with inferior pole patella fractures have limited options in terms of fixation. This video demonstrates the repair of an inferior pole patella fracture using nonabsorbable suture fixation. METHODS: Suture repair of patella fractures is a clinically acceptable technique, yielding similar functional results to patella fractures treated with K-wires or cannulated screws while reducing the rates of removal of hardware after fixation. RESULTS: This video features the repair of a displaced, comminuted inferior pole patella fracture using 5 Ethibond and Fiberwire. Postoperative radiographs confirm bony union. CONCLUSIONS: Suture fixation for pole patella fractures provides reliable fixation and reduces the risk of postoperative complications secondary to hardware irritation. This case highlights the success of this technique.

PURPOSE: Bilateral posterior fracture dislocation is a rare injury commonly associated with seizures. When the humeral head defect (reverse Hill-Sachs lesion) is between 20% and 45%, operative fixation using a modified McLaughlin procedure is recommended. This video demonstrates a case of bilateral posterior fracture dislocation after a drug-induced seizure treated with a modified McLaughlin procedure. METHODS: The original McLaughlin procedure involved transfer of the subscapularis tendon from the lesser tuberosity to the reverse Hill-Sachs defect. However, the modified McLaughlin procedure is more commonly described in the literature as of late and involved the transfer of the lesser tuberosity along with the subscapularis. RESULTS: This video demonstrates the modified McLaughlin technique for a posterior fracture dislocation. Computerized tomography confirms the articular impression fractures of the proximal humerus. Through a deltopectoral approach, the lesser tuberosity along with the subscapularis tendon was transferred into the defect. CONCLUSIONS: The modified McLaughlin procedure demonstrates excellent clinical and radiographic results after posterior fracture dislocation of the shoulder with a reverse Hill-Sachs lesion between 25% and 45%.

INTRODUCTION: This video demonstrates the technique of intramedullary nailing for a humeral shaft fracture. METHODS: The patient is a 30-year-old man who sustained a gunshot wound to his right arm. The patient was indicated for humeral nailing given the comminuted nature of the diaphysis and to allow for minimal skin incisions. Other relative indications include soft-tissue compromise about the arm precluding a large surgical exposure. RESULTS: This video presents a case of a comminuted humeral shaft fracture treated with an intramedullary nail. Anatomic reduction and stable fixation was obtained with this technique. CONCLUSION: This case demonstrates a soft-tissue sparing technique of humeral shaft fixation using a humeral intramedullary nail. The technique is easy to perform and has significant benefits in minimizing surgical exposure, decreasing operative time, and decreasing blood loss. In the correct clinical setting, humeral nailing provides an expeditious form of fixation that restores length, alignment, and rotation of the fracture humeral diaphysis.

The internet is a popular resource for orthopedic fellowship applicants. We conducted a study to assess the accessibility of orthopedic trauma fellowship (OTF) program websites and to evaluate the content on the sites. We queried the online database of the Orthopaedic Trauma Association (OTA) and the online Fellowship and Residency Electronic Interactive Database (FREIDA) to assess available OTF program links. We used Google to assess how accessible the sites are from outside the databases. We then analyzed accessible sites for content pertinent to OTF applicants. Of the 49 OTF programs identified, 42 (86%) had their websites accessible from Google and FREIDA links. The OTA database had no OTF website links. Analysis of the 42 accessible OTF sites revealed they had an average of 40% (range, 0%-75%) of assessed content, with operative experience on 88% of sites and a program description on 93% of sites. OTF programs with >1 fellow had significantly more education content (48% vs 33%; P = .043) and total content (46% vs 37%; P = .01) on their sites than OTF programs with 1 fellow. Accessibility and content of OTF websites are highly variable and largely deficient. OTF programs should focus on improving their website accessibility and content.

BACKGROUND: The number of hip fractures is rising as life expectancy increases. As such, the number of centenarians sustaining these fractures is also increasing. The purpose of this study was to determine whether patients who are >/=100 years old and sustain a hip fracture fare worse in the hospital than those who are younger. METHODS: Using a large database, the New York Statewide Planning and Research Cooperative System (SPARCS), we identified patients who were >/=65 years old and had been treated for a hip fracture over a 12-year period. Data on demographics, comorbidities, and treatment were collected. Three cohorts were established: patients who were 65 to 80 years old, 81 to 99 years old, and >/=100 years old (centenarians). Outcome measures included hospital length of stay, estimated total costs, and in-hospital mortality rates. RESULTS: A total of 168,087 patients with a hip fracture were identified, and 1,150 (0.7%) of them had sustained the fracture when they were >/=100 years old. Centenarians incurred costs and had lengths of stay that were similar to those of younger patients. Despite the similarities, centenarians were found to have a significantly higher in-hospital mortality rate than the younger populations (7.4% compared with 4.4% for those 81 to 99 years old and 2.6% for those 65 to 80 years old; p < 0.01). Male sex and an increasing number of medical comorbidities were found to predict in-hospital mortality for centenarians sustaining extracapsular hip fractures. No significant predictors of in-hospital mortality were identified for centenarians who sustained femoral neck fractures. An increased time to surgery did not influence the odds of in-hospital mortality. CONCLUSIONS: Centenarians had increased in-hospital mortality, but the remaining short-term outcomes were comparable with those for the younger cohorts with similar fracture patterns. For this extremely elderly population, time to surgery does not appear to affect short-term mortality rates, suggesting a potential benefit to preoperative optimization. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

OBJECTIVES: To examine 1-year functional and clinical outcomes in patients with tibial plateau fractures with tibial eminence involvement. DESIGN: Retrospective analysis of prospectively collected data. SETTING: Academic Medical Center. PATIENTS/PARTICIPANTS: All patients who presented with a tibial plateau fracture (Orthopaedic Trauma Association (OTA) 41-B and 41-C). INTERVENTION: Patients were divided into fractures with a tibial eminence component (+TE) and those without (-TE) cohorts. All patients underwent similar surgical approaches and fixation techniques for fractures. No tibial eminence fractures received fixation specifically. MAIN OUTCOME MEASUREMENTS: Short musculoskeletal functional assessment (SMFA), pain (Visual Analogue Scale), and knee range-of-motion (ROM) were evaluated at 3, 6, and 12 months postoperatively and compared between cohorts. RESULTS: Two hundred ninety-three patients were included for review. Patients with OTA 41-C fractures were more likely to have an associated TE compared with 41-B fractures (63% vs. 28%, P < 0.01). At 3 months postoperatively, the +TE cohort was noted to have worse knee ROM (75.16 +/- 51 vs. 86.82 +/- 53 degree, P = 0.06). At 6 months, total SMFA and knee ROM was significantly worse in the +TE cohort (29 +/- 17 vs. 21 +/- 18, P