Faculty Bibliography

SUMMARY: We present the previously unreported complication of symptomatic heterotopic ossification of the quadriceps following placement of a large-diameter Steinmann pin for the purpose of temporary skeletal traction. Following the development of distal quadriceps heterotopic bone formation in three patients, we conducted a comprehensive search of the literature using the Medline database from 1966 to the present. A variety of publications, including review articles, case reports, and randomized prospective studies, were used for the literature review. This potential complication should be considered when using a large-diameter Steinmann pin in the distal femur for skeletal traction

Instrument wear and tear, mishandling, and abuse can lead to instrument damage, particularly closely machined mating surfaces, which then prevents them from functioning properly. Simple refinishing of these damaged surfaces often resolves these problems. The electrocautery scratch pad can be an excellent means of rapidly refinishing damaged instruments

The accuracy of measuring angulation of stable proximal humerus fractures using the axillary lateral projection was investigated. A closing wedge osteotomy with apex anterior angulation was performed on two cadaveric humeri to simulate a stable surgical neck fracture. One specimen was fixed at 30 degrees angulation and the other at 55 degrees. Axillary radiographs were taken with each specimen articulating with the glenoid of a cadaveric scapula. The humerus was held in neutral rotation. Abduction was set at 30 degrees, 60 degrees, and 90 degrees. In each position of abduction, an axillary lateral radiograph was taken in 30 degrees forward flexion, neutral, and 30 degrees extension to simulate various arm positions. A total of nine radiographs were taken for each specimen. The axillary view is not accurate for measurement of proximal humerus angulation at the arm positions commonly encountered in the trauma setting

OBJECTIVE: To compare the screw sliding characteristics and biomechanical stability of four-part intertrochanteric hip fractures stabilized with an intramedullary nail using either one large-diameter lag screw (intramedullary hip screw [IMHS]; Smith & Nephew, Memphis, TN) or two small-diameter lag screws (trochanteric antegrade nail [TAN]; Smith & Nephew, Memphis, TN). DESIGN: Laboratory investigation using eight matched pairs of cadaveric human femurs with simulated, unstable intertrochanteric hip fractures. INTERVENTION: One femur of each matched pair was stabilized with an IMHS intramedullary nail, and the other was stabilized with a TAN intramedullary nail. Femurs were statically, then cyclically loaded on a servohydraulic materials testing machine. Finally, all specimens were loaded to failure. MAIN OUTCOME MEASURES: Screw sliding and inferior and lateral head displacements were measured for applied static loads from 500N to 1250N. The same measurements were obtained before and after cyclically loading the specimens at 1250N. Ultimate failure strength of the implant constructs also was determined. RESULTS: There was no significant difference between the TAN and IMHS in static or cyclical loading with respect to screw sliding or inferior and lateral head displacements. There was a statistically significant difference (P < 0.02) in failure strength, with the IMHS construct failing at an average of 2162N and the TAN construct failing at an average of 3238N. CONCLUSION: The two constructs showed equivalent rigidity and stability in all parameters assessed in elastic and cyclical tests. The TAN had a greater ultimate failure load

Computer assisted fluoroscopic surgery is at the forefront of the ability to continue and pursue minimally invasive surgical options in orthopaedic surgery. Many systems afford the surgeon three-dimensional views and biplanar imaging for placement of orthopaedic implants in difficult areas. The current literature regarding these techniques is limited. The indications are poorly defined. The common thread of all techniques, however, is the preservation of the soft tissue attachments and the biology of the fracture hematoma. Currently we are using first generation implants. It appears that malalignment is the biggest problem with any of these techniques and long-term prospective studies will be required to evaluate whether or not these theoretical advantages become clinically viable and functional for patient care

Geriatric fracture patients deserve special considerations in the perioperative period. The goal of geriatric fracture management is restoring mobility and limiting a prolonged recumbency period. A comprehensive multidisciplinary approach involving surgical, medical, rehabilitation, and social work specialists is advocated. Indications, surgical timing, and optimization of comorbid conditions are important issues to be addressed. In addition, anesthesia and postoperative pain control require individual attention in this population. Serving as the background to all these issues are the varied social needs of the elderly who could have a limited support network. This review focuses on the current recommendations for perioperative management of the geriatric patient with a hip fracture

BACKGROUND: Tape blisters after hip surgery can be a source of postoperative morbidity and can increase patient discomfort. The purpose of this prospective study was to compare two different types of tape to determine whether the type of tape influences the rate of blister formation. METHODS: Ninety-nine patients (100 hips) were enrolled in the study. Patients were randomized into one of two treatment groups: one treated with a nonstretchable silk tape and one treated with a perforated, stretchable cloth tape. After surgery, the assigned tape was applied over the postoperative dressing with care not to produce skin tension. At the first dressing change, the presence or absence of blisters was recorded as were the number, size, location, and type of any blisters. The presence or absence of tape blisters was recorded at the time of each subsequent dressing change. RESULTS: A tape blister developed on twenty-five hips in twenty-five patients. The risk of a blister developing was 41% (twenty of forty-nine patients) when the nonstretchable silk tape was used and 10% (five of fifty patients) when the perforated cloth tape was used (relative risk = 4.08, 95% confidence interval = 1.53 to 10.87, p = 0.005). We found no association between formation of tape blisters and the age or gender of the patient, number of medical comorbidities, smoking history, results of nutritional assessment, or type of surgery. CONCLUSIONS: The prevalence of tape blisters was significantly lower when perforated cloth tape was used than it was when nonstretchable silk tape was used

In order to determine the clinical usefulness of teleradiology in the initial treatment of musculoskeletal injury, a panel of orthopedic trauma surgeons developed a survey that was presented to participants at the annual meeting of the Orthopedic Trauma Association. Selected orthopedic trauma cases from a level-1 trauma and a tertiary care center were presented orally (including a description and interpretation of the radiographic findings) to volunteer participants. Questions related to treatment and patient management were then asked prior to and following the participants' viewing of digital radiographic images. Overall, 90% of respondents found telemedicine useful. They disagreed with the verbal radiographic report 49% of the time. Respondents changed their mind with regard to the need for admission 17% of the time; surgical indications, 22% of the time; and need for more information, 30% of the time

BACKGROUND: The purpose of this study was to determine when patients recover the ability to safely operate the brakes of an automobile following operative repair of an ankle fracture. METHODS: A computerized driving simulator was developed and tested. Eleven healthy volunteers were tested once to establish normal mean values (Group I), and a group of thirty-one volunteers with a fracture of the right ankle were tested at six, nine, and twelve weeks following operative repair (Group II). The subjects were tested with a series of driving scenarios (city, suburban, and highway). Scores on the Short Form Musculoskeletal Assessment were recorded at six, nine, and twelve weeks and were compared with the results of the driving test. We investigated the effect of the time of the visit and of the testing condition on the braking times. RESULTS: The total braking time was 1079 msec for Group I and 1330, 1172, and 1160 msec for Group II at six, nine, and twelve weeks, respectively, postoperatively (p = 0.0094). The total braking time consistently improved for each of the driving scenarios at each successive data point (p = 0.05). The increase in the total braking time at six weeks meant an increase in the distance traveled by the automobile before braking of 22 ft (6.7 m) at 60 mph (96.6 km/hr), and the increase at nine weeks meant an increase of 8 ft (2.4 m) at 60 mph. The functional outcome improved at each successive visit, although no significant association was found between the functional scores and normalization of total braking time. CONCLUSION: By nine weeks, the total braking time of patients who have undergone fixation of a displaced right ankle fracture returns to the normal, baseline value