Faculty Bibliography

To determine which of 2 techniques for the treatment of periprosthetic femoral shaft fractures is of greater stiffness. DESIGN: A laboratory study using 8 pairs of matched, embalmed femurs. METHODS: Femurs implanted with a cemented total hip prosthesis had a simulated periprosthetic femur fracture created distal to the implant. Fractures were fixed with a plate with locked screws or a plate with cables (Ogden construct). Fixation stability was compared in various loading modalities before and after cycling. Failure in torsional loading was then determined. The cement mantle was tested for crack propagation that may have occurred secondary to locked screw insertion and loading. OUTCOME MEASUREMENTS: Fixation stiffness (the ratio of applied load to displacement at the fracture site), torsional strength, mode of failure for each system, and cement mantle evaluation for cracks after screw insertion. RESULTS: Locked plating was stiffer than the Ogden construct in pre- and post-cyclic axial loading and torsion. There was no difference in lateral bending stability or torsional failure loads. CONCLUSIONS: Locked plating constructs were stiffer than the Ogden construct in axial loading and torsion. Although no differences in loads to failure during torsion were noted, locked plating constructs exhibited catastrophic failure not observed with the Ogden construct

The high incidence of preoperative silent pulmonary embolisms (PEs) among elderly patients with hip fractures has led some authors to recommend making acquisition of arterial blood gas (ABG) levels a routine part of the preoperative workup. In the study reported here, we retrospectively reviewed 254 patients in our hip-fracture database and determined that ABG levels have poor positive predictive value for PEs and add little to the positive predictive value or negative predictive value of careful clinical examination. Therefore, we do not recommend making acquisition of ABG levels a routine part of the preoperative evaluation

The type II Monteggia (posterior) lesion is a rare injury which is sometimes associated with ulnohumeral instability. We have reviewed 23 of 28 patients with this injury. A clinical and radiographic assessment was undertaken at follow-up. Functional outcome scores, including the Broberg and Morrey Index and the Disabilities of the Arm, Shoulder or Hand (DASH), were used. The results from the six patients with associated posterior ulnohumeral dislocation were compared with 17 without ulnohumeral injury. Those with dislocation had reduced movement of the elbow and had outcome scores indicative of greater disability compared to those without associated dislocation

OBJECTIVE: This study was designed to determine 1) how ankle position affects the medial clear space by using stress radiographs, 2) which medial clear space measurement, overall width or increase in width, better predicts deep deltoid ligament disruption after Weber type-B distal fibular fracture, and 3) what value of medial clear space is most predictive of deep deltoid ligament disruption after Weber type-B distal fibular fracture. DESIGN: Cadaveric fracture model. SETTING: Biomechanics laboratory. INTERVENTION: Fluoroscopic mortise views were taken of 6 fresh cadaveric ankles mounted in a fixture permitting both positioning in neutral flexion, dorsiflexion, and plantarflexion, and the application of internal and external rotational forces. After destabilizing the ankles according to the supination-external rotation mechanism of Lauge-Hansen, repeat radiographs were taken with the same combination of flexion and applied rotational stress. MAIN OUTCOME MEASURE: Radiographic measurements of medial clear space width and changes in medial clear space were made. RESULTS: A medial clear space of > or =5 mm on radiographs taken in dorsiflexion with an external rotational stress was most predictive of deep deltoid ligament transection after distal fibular fracture. In dorsiflexion-external rotation, medial clear spaces of > or =4 mm yielded lower specificity and positive predictive value, whereas > or =6 mm yielded lower sensitivity and negative predictive value. All other stress conditions and increases in medial clear space of 2 or 3 mm were less predictive. CONCLUSIONS: Ankle stress radiographs taken in dorsiflexion-external rotation were most predictive of deep deltoid ligament disruption after distal fibular fracture. Under this stress condition, a medial clear space of > or =5 mm was the most reliable predictor of deep deltoid ligament status

PURPOSE: To identify trends in industry sponsorship of orthopaedic trauma research presented at the annual meetings of the Orthopaedic Trauma Association since the establishment of conflict of interest (COI) reporting policies in 1993. BACKGROUND: Industry plays a large role in funding orthopaedic basic science and clinical research. The purpose of this study was to analyze the role of industrial support in orthopaedic research as documented in the final programs of the annual meetings of the Orthopaedic Trauma Association (OTA), determine the incidence and nature of COI in the papers and posters accepted for OTA presentation, and report any changes in the frequency of reporting since disclosure policies were enacted in 1993. METHODS: This paper analyzes COI for all years since the adoption of the reporting policies 1993-2002. From 1993-1998, presenters of posters and papers presented at the Orthopaedic Trauma Association annual meetings were required to disclose COI greater than dollar 500, the type of monetary distribution was not recorded. From 1999-2002, presenters of posters and papers were required to acknowledge the type of COI: 1. research grant, 2. miscellaneous non-income support, 3. royalties, 4. stock, and 5. consultant fees. All COI categories were recorded for each year Linear regression was used to determine significance of trends in the pooled data. RESULTS: There was an increase in the percentage of papers accepted and presented at the OTA between 1993 and 2002 with COI. The number of papers reporting COI rose from 7.6% in 1993 to 12.6% in 2002 (p = 0.0129). There was no significant increase in posters with COI over that same time period. No changes were observed in the nature of industrial involvement since the change in reporting enacted in 1999. There were no observed trends in NIH or OTA grant distribution between 1993 and 2002. DISCUSSION AND CONCLUSION: Industry is playing an increasing role in the funding oforthopaedic research. The majority of industrial support is in the form of research grants. The increasing industrial support of scientific research in the public sector is to be applauded as long as it does not lead to the sequestering and suppression of information that may be disadvantageous to the industrial sponsor

Posttraumatic elbow stiffness can impose severe functional limitations on the performance of activities of daily living. Prevention is key to avoiding a motion-limiting condition. Fractures should be anatomically reduced and stabilized with active and active-assisted range of motion exercises instituted as early as possible to minimize the development of stiffness. Established contractures should be treated initially with physical therapy and static-progressive splinting. Patients who have failed a minimum of six months of nonsurgical management and who are motivated to comply with postoperative rehabilitation are candidates for surgical release. There are several effective surgical approaches and techniques available. The choice of surgical approach and technique is dictated by the location of the pathology, condition of the skin, and degree of arthritic changes. A major challenge to care is the management of the young patient with posttraumatic elbow contracture and advanced degenerative changes for which there is currently no reliable long-term surgical treatment

Ipsilateral femoral neck and femoral shaft fractures are rarely reported in the literature and represent a diagnostic and treatment challenge. Due to the possibility of missing a nonunion at either site, we recommend a high clinical suspicion and careful radiographic examination of both fracture sites. Because the development of nonunion at both sites is exceedingly rare, we report three cases of concomitant ipsilateral femoral neck and shaft nonunions that were treated by the senior author (KAE). Two patients were treated with a Pauwels osteotomy and a blade plate for the femoral neck nonunion and a reamed retrograde intramedullary nail for the shaft. One patient was treated with an antegrade reamed cephalomedullary intramedullary nail. All three patients' fractures united at a mean of 4.6 months and they are currently pain free and without physical limitations