Faculty Bibliography

BACKGROUND: The purpose of this study was to confirm the prevalence of medial ankle widening among patients with an isolated fibular fracture and to determine the functional outcome of nonoperative treatment despite a diagnosis of a supination-external rotation stage-IV injury based on stress radiography. METHODS: One hundred and one patients with evidence of an isolated fibular fracture and an intact mortise seen on a standard ankle trauma radiograph series were evaluated with stress radiographs. Clinical signs were recorded at the time of presentation. A positive stress test was defined as > or =4 mm of widening of the medial clear space. Patients with a negative stress test were treated nonoperatively, those with a positive stress test and clinical signs of medial injury were treated surgically, and those with a positive stress test and no signs of medial injury were treated according to the preference of the surgeon and patient. The patients were followed prospectively with radiographs and ankle outcome scores. RESULTS: Sixty-six (65%) of the 101 patients had a positive stress radiograph. Thirty-six of them had signs of medial injury, and thirty had no medial injury. With regard to predicting a positive stress radiograph, medial tenderness had a sensitivity of 56% and a specificity of 80%, swelling had a sensitivity of 55% and a specificity of 71%, and ecchymosis had a sensitivity of 26% and a specificity of 91%. Of the subset of patients without signs of medial injury, twenty were treated nonoperatively (group I) and ten were treated operatively (group II). Two of the twenty patients in group I had evidence of persistent widening of the medial clear space at the time of the latest follow-up (mean, 7.4 months); only one of those patients was symptomatic. The average American Orthopaedic Foot and Ankle Society (AOFAS) score was 94 points in group I and 93 points in group II. CONCLUSIONS: We found a high rate of positive stress radiographs for patients who presented with an isolated fibular fracture and an intact ankle mortise on the initial radiographs. Medial tenderness, swelling, and ecchymosis were not sensitive with regard to predicting widening of the medial clear space on stress radiographs. All of the patients with a positive stress radiograph and no clinical symptoms who were treated without surgery had a good or excellent clinical result

A tape blister, a skin excoriation that occurs under the taped portion of surgical bandages, can be a source of postoperative morbidity. Tape blisters are caused by the separation of the epidermis from the dermis at the dermal-epidermal junction. Tape resistant to stretching contributes to blister formation because of the concentration of forces at the ends of the tape. Although tape blisters are a pervasive clinical problem, their incidence after hip surgery has rarely been reported in the orthopedic literature. Therefore, we retrospectively reviewed a consecutive series of patients with hip fractures to determine the incidence of tape blisters at our institution. One hundred three patients were included in the study. Tape-related injuries occurred in 22 patients (21.4%). Patient age, patient sex, number of medical comorbidities, smoking history, nutritional status, and type of surgery were not statistically significantly associated with risk for developing tape blisters

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

The objective of this study was to determine the efficacy of postoperative single dose radiation therapy of 700 centigray on fracture/dislocations of the elbow in the prevention of heterotopic ossification. Eleven patients were reviewed for this study. Each patient sustained high-energy trauma to the extremity causing a fracture/dislocation of the elbow. After open reduction and internal fixation, a postoperative single dose of 700-centigray radiation therapy was administered to the patients within 72 hours of surgery. Primary outcome measurements were clinical physical examination of range of motion and radiographic analysis of heterotopic bone formation at 12 months follow-up. Three of eleven patients (27%) had radiographic evidence of heterotopic ossification formation. Ten of eleven patients (91%) however, were without functional limitations. All fractures healed without complications. There were no complications from the radiation therapy. A single dose of 700-centigray radiation therapy postoperatively within 72 hours may lessen the functional loss from heterotopic ossification formation without effecting healing at the fracture site

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

Background. More than 20 studies have investigated the relation between meat and dairy consumption and breast cancer risk with conflicting results. Our objective was evaluate the risk of assess whether non-dietary risk factors modify the relation. studies from North America and Western Europe with at least 200 intakes, and a validation study of dietary assessment instrument. diagnosed with invasive breast cancer during to 15 year of intakes of total meat, red me white meat, total dairy fluids, or total dairy solids and breast cancer risk. Categor analyses suggested a J-shaped association for egg consumption where, comp to women who did not eat eggs, breast cancer risk was slightly decreased am women who consumed <2 eggs per week but slightly increased among women who consumed >=1 egg per day. Conclusions. We produ and risk of breast cancer. An inconsistent relation between egg consumption risk of breast cancer merits further investigation