Faculty Bibliography

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

OBJECTIVE: To determine gender-specific differences in prefracture status and postoperative outcome in elderly hip fracture patients who were ambulatory, community-dwelling, and cognitively intact prior to fracture. DESIGN: Retrospective analysis of prospectively collected data. SETTING: Urban orthopedic referral hospital. PATIENTS: A total of 983 consecutive patients (206 males and 777 females) who sustained a nonpathologic hip fracture were followed for a minimum of 12 months. INTERVENTION: Operative treatment of a proximal femur fracture. MAIN OUTCOME MEASUREMENTS: Postoperative medical complications, place of discharge, 1-year mortality, and postoperative recovery of ambulation, basic activities of daily living, and instrumental activities of daily living. RESULTS: Men were more likely to be married or living with someone else, and they were more dependent in instrumental activities of daily living than women prior to hip fracture. Furthermore, men were sicker as evidenced by a higher American Society of Anesthesiologists rating of preoperative risk. Postoperatively, men were more likely to sustain a medical complication and had a higher mortality at 1 year compared to women. There were no statistically significant gender differences in patient age, fracture type, prefracture level of help, ambulation, or dependence in basic activities of daily living, place of discharge, and postoperative recovery of ambulation as well as basic and instrumental activities of daily living. CONCLUSIONS: Male gender was a risk factor for sustaining a postoperative complication as well as a higher mortality at 1 year post hip fracture

BACKGROUND: Operative treatment of tibial fractures in children requires implants that do not violate open physes while maintaining tibial length and alignment. Both elastic stable intramedullary nails and external fixation can be utilized. We retrospectively reviewed our experience with these two techniques to determine if one is superior to the other. METHODS: We retrospectively reviewed the operative records and trauma registries of three institutions within our hospital system and identified thirty-five consecutive patients with open physes who had undergone operative treatment of a tibial fracture between April 1997 and June 2004. Four patients were excluded because they had been managed with locked intramedullary nails or with pins and plaster. Of the thirty-one remaining patients, sixteen had been managed with elastic stable intramedullary nails and fifteen had been managed with unilateral external fixation. The clinical and radiographic outcomes were compared. The functional outcomes were compared with use of the Pediatric Outcomes Data Collection Instrument. Complications related to treatment, such as malunion, delayed union, nonunion, infection, and the need for subsequent surgical treatment also were compared. RESULTS: Thirty-one patients with thirty-one operatively treated tibial fractures were available for evaluation. Fifteen patients had been managed with external fixation. Seven of these patients had a closed fracture, and eight had an open fracture. There were seven healing complications in this group, including two delayed unions, three nonunions, and two malunions. Sixteen patients had been managed with elastic stable intramedullary nailing. Eleven patients had a closed fracture, and five had an open fracture. The mean time to union for the intramedullary nailing group (seven weeks) was significantly shorter than that for the external fixation group (eighteen weeks) (p < 0.01). The functional outcomes for the intramedullary nailing group were significantly better than those for the external fixation group in the categories of pain, happiness, sports, and global function (the mean of the mean scores of the first four categories) (p < 0.01 for these comparisons). CONCLUSIONS: When surgical stabilization of tibial fractures in children is indicated, we believe that the preferred method of fixation is with elastic stable intramedullary nailing

Original studies at orthopaedic meetings are presented on the podium and in poster format. Publication of those studies in peer-reviewed journals is the standard of communicating scientific data to colleagues. Investigators of previous studies have reported publication rates, but never differentiated between the modes of presentation. We evaluated the annual meeting of the Orthopaedic Trauma Association from 1994-1998 and found that studies presented on the podium were 1.3 times more likely to be published than those presented in a poster format (67% versus 52%). The mean time to publication was similar, 21.6 months for poster presentations and 24.8 months for podium presentations. Podium presentations were more likely to be published in the Journal of Orthopaedic Trauma, Clinical Orthopaedics and Related Research, and the Journal of Bone and Joint Surgery (American and British editions). Our findings suggest different rates and distribution of publication between podium and poster presentations at an international trauma meeting. These findings should be considered when evaluating studies of interest at the Orthopaedic Trauma Association meeting

OBJECTIVES: To compare the biomechanical stability of internal fixation of extra-articular, dorsally unstable distal radius fractures fixed by 1 of 2 methods, either a standard dorsal nonlocked T-plate or a volar locked fixed-angle plate. DESIGN: Biomechanical cadaveric study. SETTING: Biomechanical testing laboratory. INTERVENTION: In 6 matched pairs of fresh-frozen cadaveric specimens, a simulated unstable extra-articular distal radius fracture was created. The fractures were stabilized with either a dorsal 3.5-mm stainless steel T-plate or a titanium locked volar fixed-angle plate. Specimens were axially loaded at 5 points (centrally, volarly, dorsally, radially, and ulnarly) and then cyclically loaded for 5000 cycles with an 80 N central load. Postcyclical loading, specimens were once again axially loaded at the 5 points. MAIN OUTCOME MEASURES: Initial fixation stiffness and stiffness after midaxial cyclical loading was compared at the 5 points. RESULTS: With the volar locked fixed-angle plate, fixation was significantly stiffer than with the dorsal nonlocked T-plate for ulnar and volar loading in single-cycle testing. After cyclic loading, the locked volar fixed-angle plate maintained more of its initial stiffness than the dorsal nonlocked T-plate. The dorsal 3.5-mm stainless steel T-plate's stiffness when dorsally loaded significantly decreased after cyclical loading. CONCLUSIONS: The volar locked fixed-angle plate maintained a greater percentage of its initial stiffness after cyclic loading compared to the dorsal nonlocked plate. Also, the volar locked plate was stiffer than the dorsal nonlocked plate for all loading configurations tested except when subjected to a dorsally applied eccentric load