Fixation Of Acute Fractures Research Articles

Closed Reduction Followed by Percutaneous Fixation of Acute Femoral Neck Fractures in Young Adults: A Retrospective Cohort Study

OBJECTIVES: To evaluate the surgical outcomes of femoral neck fractures (FNF) in young adults treated with a closed reduction technique because it pertains to reduction quality, rates of union, and risk factors for complication. METHODS: Design: Retrospective cohort study with radiograph and electronic medical record review. Setting: Level 1 Swiss Trauma Center. Patient Selection Criteria: Between 2012 and 2021, young adults with isolated FNF (AO/OTA 31-B1) treated with percutaneous internal fixation were selected. Exclusion criteria were open reduction technique, age older than 65 years or younger than 16 years, pathologic fractures, and associated femoral head or shaft fractures. Outcome Measures and Comparisons: Primary outcome was quality of reduction, as assessed by 3 experienced trauma surgeons' evaluation of intraoperative and/or first postoperative radiographs using the overall impression, the Garden alignment index, and Lowell criteria. In addition, clinical outcomes, conversion to arthroplasty, and complications after closed reduction and fixation of femoral neck fractures were reviewed. RESULTS: A total of 54 patients with a median interquartile range age of 57.5 (48–60) years were included. Among them, 22 (41%) were women and 32 (59%) were men. The closed reduction technique demonstrated satisfactory reduction results in up to 87% of cases. Major complications occurred in 19%, with 17% requiring conversion to total hip arthroplasty. Unacceptable or borderline acceptable reduction quality correlated significantly with the need for later conversion (P = 0.03). CONCLUSIONS: The study supported the use of the closed reduction technique for acute FNF in patients younger than 65 years, achieving satisfactory reduction results in up to 87% of cases with comparable complication rates to treatment of young femoral neck fractures with open reduction. Furthermore, it underscored the significance of the surgeon's overall impression of reduction quality, alongside the established reduction criteria, the Garden alignment index, and Lowell criteria, in evaluating the quality of the reduction. In addition, risk of conversion to total hip arthroplasty was associated with worse closed reduction quality. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Arthroscopic suture anchor fixation results in similar clinical outcomes, less range of motion limitation, but poorer quality of reduction compared to open screw fixation for acute large anterior glenoid rim fractures

BackgroundThe purpose of the present study was to retrospectively compare the clinical and radiological outcomes of arthroscopic suture anchor fixation and open screw fixation for acute large anterior glenoid rim fractures. MethodsThis study enrolled patients with acute large anterior glenoid rim fractures treated with arthroscopic suture anchor fixation (group A) or open screw fixation (group O) from January 2013 to June 2020 with a minimum follow-up of＞2 years. The Subjective Shoulder Value (SSV), American Shoulder and Elbow Surgeons (ASES) score, Rowe score, Constant score, range of motion (ROM), recurrent instability rate, and complications were recorded as clinical results. The quality of the postoperative reduction, reconstructed glenoid sizes, rate of fracture healing, and progression of osteoarthritis (OA) were evaluated as radiological outcomes. ResultsThis retrospective study included 66 patients, including 37 in Group A and 29 in Group O with a mean follow-up of 46.9 (range, 24.3-94.2) months and a mean patient age of 46.8 (range, 21-69) years. No significant differences were found in the clinical outcomes between the two groups. A significant ROM limitation in all planes was found in both groups and group O showed more limitations in external rotation at the side (ERs) (18° vs. 10°, P = 0.002). The reduction quality was better in group O (P < 0.001). However, there was no significant difference between the two groups in terms of reconstructed glenoid size (101.6% ± 4.6% vs. 100.6% ± 7.1%, P = 0.460) and the rate of OA progression (26.9% vs. 20%, P = 0.525). ConclusionArthroscopic suture anchor fixation and open screw fixation achieved similar clinical outcomes, reconstructed glenoid sizes, and OA progression in patients with acute large anterior glenoid rim fractures. Arthroscopic suture fixation showed a poorer quality of reduction but less ERs limitations.

Four-screw compression plate fixation for diaphyseal humerus fractures.

While many humeral shaft fractures can be successfully treated with nonoperative management, compression plating techniques using at least three or four screws on either side of the fracture are the current gold standard. We hypothesized that a less rigid construct using compression with only two screws on either side of the fracture can provide adequate strength for uneventful fracture union. This is a retrospective review of all the patients who underwent open reduction and compression plate fixation for acute diaphyseal humerus fractures (ADHFs) at an academic Level-1 urban trauma center between 2018 and 2023. Patients treated with compression plating using only two screws and three or four plate-holes on either side of the fracture (Group 1) were matched one-to-one with patients treated using the conventional number of screws (three or more on either side of the fracture - Group 2). The incidence of nonunion/malunion, infection, and implant failure was compared among the two groups. There were eleven matched patients in both groups. The nonunion, infection complications, and hardware failure rates were 0% and 9.1% for the control group (Group 2) and four-screw group (Group 1) respectively. This difference was not statistically significant (p = 1.00). Although convention dictates the use of six or more bicortical screws (at least three bicortical screws on each side of the fracture), four-screw bicortical fixation may be a feasible option for ADHFs treated with large fragment compression plating techniques.

A qualitative study of clinicians' experience of a clinical trial for displaced distal radius fractures.

The aim of this study was to explore clinicians' experience of a paediatric randomized controlled trial (RCT) comparing surgical reduction with non-surgical casting for displaced distal radius fractures. Overall, 22 staff from 15 hospitals who participated in the RCT took part in an interview. Interviews were informed by phenomenology and analyzed using thematic analysis. Analysis of the findings identified the overarching theme of "overcoming obstacles", which described the challenge of alleviating staff concerns about the use of non-surgical casting and recruiting families where there was treatment uncertainty. In order to embed and recruit to the Children's Radius Acute Fracture Fixation Trial (CRAFFT), staff needed to fit the study within clinical practice, work together, negotiate treatment decisions, and support families. Recruiting families to this RCT was challenging because staff were uncertain about longer-term patient outcomes, and the difficulties were exacerbated by interdisciplinary tensions. Strong family and clinician beliefs, coupled with the complex nature of emergency departments and patient pathways that differed site-by-site, served as barriers to recruitment. Cementing a strong research culture, and exploring families' treatment preferences, helped to overcome recruitment obstacles.

Prediction of Short-Term Postoperative Complications Following Open Reduction Internal Fixation of Acute Ankle Fractures

Introduction/Purpose: Acute ankle fractures are a common injury and represent a significant financial burden to the healthcare system. Reimbursement following ankle fractures is complicated by bundled payments within the 90-day global period which do not account for unpredictable complications. Comorbidity indices, such as the American Society of Anesthesiologists (ASA) classification, are often correlated with complications; however, the positive predictive value of these metrics have not been investigated. As insurers continue to transition towards bundled reimbursements, greater attentiveness towards providing efficient care is paramount. The purpose of this investigation is to develop a machine learning (ML) model that is predictive of complications following operative management of acute ankle fractures. This study will also compare ML algorithms to legacy indices to assess the predictive value in predicting complications. Methods: The American College of Surgeons-National Surgical Quality Improvement Program database was queried via Current Procedural Terminology (CPT) from 2015-2018 for open reduction internal fixation (ORIF) cases for ankle fractures, including ORIF of the medial malleolus, posterior malleolus, lateral malleolus, bimalleolar, trimalleolar, syndesmosis. Training and validation sets were created by randomly assigning 80% and 20% of the data set. Included variables were age, body mass index (BMI), operative time, smoking status, comorbidities, diagnosis, and preoperative hematocrit and albumin. Complications included any adverse event, transfusion, surgical site infection, return to the operating room, deep vein thrombosis or pulmonary embolism, pneumonia, urinary tract infection, cerebrovascular accident, cardiac arrest, myocardial infarction. Each ML algorithm was compared with one another and to a baseline model using American Society of Anesthesiologists (ASA) classification. Model strength was evaluated by calculating the area under the curve (AUC) for receiver operating characteristic (ROC) of any adverse event. Results: We identified a total of 28,736 ORIF cases. Mean age and BMI were 32.2 ± 18.6 years, 30.8 ± 7.6 kg/m^2, respectively. The overall incidence of any medical complication was 3.4% (n=975) with surgical site infection (1.3%, n=386) and return to operating room (1.3%, n=367) being the most common. Percentage hematocrit, BMI, operative time, and age were of highest importance in outcome prediction. Logistic regression (AUC: 72%) and gradient boosting (AUC: 72%) ML algorithms outperformed ASA classification (AUC: 69%) for predicting any adverse event following ORIF of ankle fractures. Conclusion: Legacy comorbidity indices are simple metrics that can be easily constructed from patient demographic variables and past medical history. However, the predictive power is limited as they have shown a low positive predictive value for predicting complications. Machine learning algorithms can calculate patient-specific risk for postoperative complications which may adjust perioperative care and site of surgery. These models have the capability to optimize utilization of healthcare resources and minimize excessive expenditure by providing patient-specific care. Receiver Operating Curve-Area under the Curve Analysis for Adverse Events Following ORIF of Ankle Fractures

Intramedullary Screw Fixation for Midshaft Clavicle Fractures

Operative fixation for acute displaced midshaft clavicle fractures provides improved functional outcomes and patient satisfaction over nonoperative treatment. Although open reduction and plate fixation is most commonly used, intramedullary fixation produces similar patient outcomes with fewer symptomatic hardware or scar complications. The purpose of this Technical Note is to detail a straightforward and cost-efficient method of intramedullary clavicle fracture fixation using a headless cannulated screw.

Surgically reducing displaced distal radial fractures in children.

Displaced fractures of the distal radius in children are usually reduced under sedation or general anaesthesia to restore anatomical alignment before the limb is immobilized. However, there is growing evidence of the ability of the distal radius to remodel rapidly, raising doubts over the benefit to these children of restoring alignment. There is now clinical equipoise concerning whether or not young children with displaced distal radial fractures benefit from reduction, as they have the greatest ability to remodel. The Children's Radius Acute Fracture Fixation Trial (CRAFFT), funded by the National Institute for Health and Care Research, aims to definitively answer this question and determine how best to manage severely displaced distal radial fractures in children aged up to ten years.

Supraclavicular nerve sparing versus sacrifice during open reduction internal fixation of acute midshaft clavicle fracture

BackgroundThe branches of the supraclavicular nerve are often sacrificed during open reduction and internal fixation (ORIF) for clavicle fracture. No consensus exists on whether the supraclavicular nerve should be routinely identified and protected during ORIF.MethodsWe developed a simple method to make nerve sparing easier; Wide-Awake Local Anesthesia No Tourniquet (WALANT) solution is locally injected prior to the surgical incision being made. This retrospective study enrolled 340 patients and divided them into supraclavicular-nerve-sparing (n = 45) and supraclavicular-nerve-sacrifice (n = 295) groups. Surgical outcomes—including operative time, estimated blood loss, postoperative pain, union rate, time to union, functional score, paresthesia, complications, implant removal rate, and complication rate—were recorded.ResultsIncisional or anterior chest wall numbness and intraoperative blood loss were significantly less (p < 0.001) in the nerve-sparing group. The operative time was similar in the two groups. No significant differences were discovered in QuickDASH score, postoperative pain score, union rate, time to union, implant removal rate, complication rate, or revision rate.ConclusionsOur study demonstrated that the outcomes of supraclavicular nerve sparing during ORIF with WALANT can reduce postoperative incisional and anterior chest wall numbness and intraoperative blood loss without increasing the operative time or complication rate.

Exposed Intramedullary Fixation Produces Similar Outcomes to Buried Fixation for Acute Pediatric Monteggia Fractures.

Treatment of acute pediatric Monteggia fractures requires ulnar length stability to maintain reduction of the radiocapitellar joint. When operative care is indicated, intramedullary ulna fixation can be buried or left temporarily exposed through the skin while under a cast. The authors hypothesized that treatment with exposed fixation yields equivalent results to buried fixation for Monteggia fractures while avoiding secondary surgery for hardware removal. A retrospective review of children with acute Monteggia fractures at our Level 1 pediatric trauma center was performed. Patient charts and radiographs were evaluated for age, fracture type, fracture location, Bado classification, type of treatment, complications, cast duration, time to fracture union, time to hardware removal, and range of motion. Out of 59 acute Monteggia fractures surgically treated (average age 6y, range 2 to 14), 15 (25%) patients were fixed with buried intramedullary fixation and 44 (75%) with exposed intramedullary fixation under a cast. There were no significant differences between buried and exposed intramedullary fixation in cast time after surgery (39 vs. 37d; P =0.55), time to fracture union (37 vs. 35d; P =0.67), pronation/supination (137 vs. 134 degrees; P =0.68) or flexion/extension (115 vs. 114 degrees; P =0.81) range of motion. The exposed fixation had a return to OR of 4.5% (2 out of 44), and the buried fixation returned to the OR for removal on all patients. Exposed intramedullary fixation yielded equivalent clinical outcomes to buried devices in the treatment of acute pediatric Monteggia fractures while eliminating the need for a second surgery to remove hardware, reducing the associated risks and costs of surgery and anesthesia, but had a higher complication rate. Open Monteggia fractures or patterns with a known risk of delayed union may benefit from buried instead of exposed intramedullary fixation for earlier mobilization. III.

Assessment of diet quality after operative fixation of acute fractures

Assessment of diet quality after operative fixation of acute fractures

Management of gunshot-related forearm bone defect by sequential internal fixation and deferred bone grafting: experience from a tertiary hospital in Mogadishu

Gunshot-related forearm fractures are rare injuries, usually incurring bone defect. The aim of the study was to report clinical and radiological results for sequential internal fixation and bone grafting in acute civilian forearm gunshot fractures with bone defect. The procedure involves staged techniques consisting of bone debridement, soft-tissue closure and temporary intramedullary Kirschner wire fixation, followed by deferred bone grafting. To our knowledge, the present study is the first to investigate this surgical sequence in such injuries. Between June 2018 and September 2019, 6 civilian cases (5 male, 1 female) with a mean age of 26 years (range, 19–36 years) were operated on by sequential internal fixation and bone grafting for acute forearm gunshot fractures with segmental bone defect. Demographics, injury characteristics and surgical features were recorded. The Tang classification system was used to evaluate clinical and radiological results at final follow-up. Mean follow-up was 27 months (range: 21–32 months). Defect location was in the radius in 4 patients and in the ulna in 2, with a mean defect size of 3.75 cm (range, 2–8 cm). Union was achieved in 5 patients, at a mean 7 months (range, 4-10 months). Functional outcome was excellent in 4 patients, good in 1 and fair in 1. Sequential internal fixation and bone grafting seems a reliable option in the treatment of acute forearm gunshot fractures with bone defect. Level of evidenceLevel IV – Retrospective study.

Surgical management of slightly or non-displaced corporal scaphoid fractures by retrograde percutaneous screw fixation through the anterior trapezium horn: A single-center retrospective French study of 33 patients between January 2015 and January 2019

Percutaneous screw fixation has recently gained popularity as an alternative to conservative treatment to avoid prolonged immobilization. The placement of a screw in the central axis of the scaphoid has been shown to be biomechanically superior to its eccentricity. Still, it poses difficulties in performing percutaneous screw fixation via both palmar and dorsal approaches. We describe a palmar percutaneous screwing of corporal fractures of the scaphoid by a simple palmar transtrapezial approach allowing an optimal centering of the screw. We selected patients operated on by the same surgeon using the palmar transtrapezial approach between January 2015 and January 2019 based on the coding used for these fractures and the operative reports. In addition, pre- and postoperative data were collected from the patient's computer and paper records and by telephone contact with the patients. Thirty-three patients were included. Percutaneous screw fixation of the scaphoid was performed under locoregional anesthesia in the operating room with one arm in the supine position on the arm table. No hyper-extension of the wrist was performed. The Kirchner guidewire passed through the anterior horn of the trapezium and then into the trapezium-scaphoid joint. A screw replaced it after satisfactory centering in the axis of the scaphoid. Management took place on average within 12 days after the trauma. 75.8% were A2 fractures, according to Herbert's classification. The average operating time was 16.63minutes, and in 91% of the cases, the patient was hospitalized for one day. The variation of the scapholunate angle on the preoperative profile radiographs with the angle defined by the axis of the scaphoid screw and the lunate postoperatively was on average 2.94°. One patient presented nonunion, and four showed an undersized screw with a screw overhang requiring revision surgery. The transtrapezial approach to fixation of acute scaphoid fractures facilitates precise percutaneous screw placement in the central axis of the scaphoid. A study of long-term complications, including the degenerative impact on the scaphotrapezial joint, is needed to assess the safety of passage through the anterior horn of the trapezium.

Comparison of Infectious Complications after Surgical Fixation versus Epidural Analgesia for Acute Rib Fractures.

Background: Surgical stabilization of rib fractures (SSRF) is associated with decreased mortality and respiratory complications. Patients who are not offered SSRF are often treated with epidural analgesia (EA) to reduce pain and improve pulmonary mechanics. We sought to compare infectious complications in patients undergoing either SSRF or EA. We hypothesized that infectious complications are equivalent between the two treatment groups. Patients and Methods: We performed a retrospective cohort study of adult trauma patients with acute rib fractures within the Trauma Quality Improvement Program (TQIP) 2017 dataset and used International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes to identify patients who underwent SSRF or EA. We excluded patients who received both treatments in the same admission. Our primary outcome was the development of sepsis. Secondary outcomes were specific infections including ventilator-associated pneumonia (VAP), catheter-associated urinary tract infection (CAUTI), and central line-associated blood stream infections (CLABSI). Multiple logistic regression analyses were used to adjust for age, injury severity score (ISS), chest Abbreviated Injury Scale (AIS), flail chest, traumatic brain injury (TBI), and comorbidities. Results: We identified 2,252 and 1,299 patients who underwent SSRF and EA, respectively. Patients with SSRF were younger with higher ISS and longer length of stay (LOS). There was no difference in mortality, however, SSRF had higher rate of sepsis (1.6% vs. 0.5%; p = 0.001), VAP (5.1% vs. 0.9%; p < 0.001), CAUTI (1.7% vs. 0.5%; p = 0.001), and CLABSI (0.2% vs. 0%; p = 0.05). On multiple regression, SSRF was associated with higher odds of sepsis (odds ratio [OR], 2.63; 95% confidence interval [CI], 1.04-6.63), CAUTI (OR, 2.96; 95% CI, 1.11-7.88), and VAP (OR, 3.24; 95% CI, 1.73-6.06). Among those who developed sepsis, there was no significant difference in mortality or LOS between groups. Conclusions: Despite no difference in mortality, SSRF was associated with increased risk of septic complications in patients with rib fractures compared to epidural analgesia. Identifying, and addressing, risk factors of sepsis in this patient population is a critical performance improvement process to optimize outcomes without increased adverse events.

Protecting my injured child: a qualitative study of parents’ experience of caring for a child with a displaced distal radius fracture

BackgroundChildhood fractures can have a significant impact on the daily lives of families affecting children’s normal activities and parent’s work. Wrist fractures are the most common childhood fracture. The more serious wrist fractures, that can look visibly bent, are often treated with surgery to realign the bones; but this may not be necessary as bent bones straighten in growing children. The children’s radius acute fracture fixation trial (CRAFFT) is a multicentre randomised trial of surgery versus a cast without surgery for displaced wrist fractures. Little is known about how families experience these wrist fractures and how they manage treatment uncertainty. This study aimed to understand families’ experience of this injury and what it is like to be asked to include their child in a clinical trial.MethodsNineteen families (13 mothers, 7 fathers, 2 children) from across the UK participated in telephone interviews. Interviews were audio recorded, transcribed and analysed using reflexive thematic analysis.ResultsOur findings highlight parents’ desire to be a good parent through the overarching theme “protecting my injured child”. To protect their child after injury, parents endeavoured to make the right decisions about treatment and provide comfort to their child but they experienced ongoing worry about their child’s recovery. Our findings show that parents felt responsible for the decision about their child’s treatment and their child’s recovery. They also reveal the extent to which parents worried about the look of their child’s wrist and their need for reassurance that the wrist was healing.ConclusionOur findings show that protecting their child after injury can be challenging for parents who need support to make decisions about treatment and confidently facilitate their child’s recovery. They also highlight the importance of providing information about treatments, acknowledging parents’ concerns and their desire to do the right thing for their child, reassuring parents that their child’s wrist will heal and ensuring parents understand what to expect as their child recovers.

Comparison of conventional and transtrapezial palmar approaches for screw fixation of scaphoid waist fractures: a clinical study.

We investigated two palmar approaches for screw fixation of acute scaphoid waist fractures: the conventional percutaneous or transtrapezial approach. Thirty cases who underwent operation from 2013 to 2021 were reviewed (conventional group, 15; transtrapezial approach group, 15). Cross-sections were constructed along the long axis of the scaphoid on postoperative computed tomography to evaluate the screw position, relative to the centre point in the distal-third, midwaist and proximal-third of the bone. The screw could be inserted centrally in the proximal and distal regions using the transtrapezial approach. In the conventional approach, the screw was inserted radially in the distal region, but tended to be positioned centrally in the midwaist and proximal regions. As central placement of the screw in the proximal fragment offers a biomechanical advantage, both approaches can be options for some fracture patterns, while for others, the fracture pattern could influence which approach is better.Level of evidence: IV.

Fractures of the Distal Radial Metaphysis in Children: Which Ones Need Reduction?: Commentary on an article by Topi Laaksonen, MD, et al.: "Epidemiology, Treatment, and Treatment Quality of Overriding Distal Metaphyseal Radial Fractures in Children and Adolescents".

Commentary Overriding fractures of the distal radial metaphysis in children are common and are of interest to many orthopaedic surgeons. The large study by Laaksonen et al. is population-based and has important data regarding the epidemiology and outcomes of treatment of overriding distal radial fractures. Closed manipulation in the emergency department was associated with a 46% failure rate and a high utilization of opioid analgesics. Fractures treated with use of cast immobilization in an overriding position showed excellent functional outcomes and a low rate of secondary interventions. In the 1955 textbook “Fractures in Children,” Blount described the principles of fracture remodeling in children and advocated for nonoperative treatment of distal radial and ulnar fractures1. Since that time, techniques and technology have evolved, and the availability of fluoroscopy, percutaneous Kirschner wire fixation, and flexible intramedullary nailing have allowed the development of better techniques than were available when that book was written. These new techniques and technologies permit accurate reduction, stable fixation, and early mobilization. Blount understood the process of remodeling of pediatric fractures better than many of his contemporaries and perhaps better than many of the current generation of orthopaedic surgeons. Blount’s principles of fracture remodeling are as follows: 1. Remodeling occurs more quickly the closer the fracture is to the physis. 2. Remodeling occurs more quickly and extensively when residual displacement is in the plane of motion of the adjacent joint. 3. The speed of remodeling is related to the age at the time of the injury, with younger children experiencing faster remodeling1. These 3 principles are relevant to the treatment of distal radial fractures in growing children. Most fractures occur within 2 centimeters of the physis, as described in the study by Laaksonen et al. The most frequent direction of displacement is dorsal, and this is the primary plane of motion of the wrist joint1. Most fractures occur in active growing children1. Therefore, according to the teachings of Blount, these fractures should remodel quickly, and in younger children, they should remodel fully1. However, of the extensive references utilized by Laaksonen et al. to support their study, only Crawford et al. supported the use of immobilization in a below-the-elbow cast rather than reduction and fixation as the primary treatment2. Three randomized controlled trials examined the benefits of adding percutaneous Kirschner wire fixation after closed reduction versus cast immobilization, yet none of these studies addressed the central question of whether such fractures should be reduced3-5. Several of the referenced studies assessed the outcomes of reduction and Kirschner wire fixation compared with immobilization following loss of position of a previously reduced fracture. The evidence, although of low quality and inconclusive, suggested that most of these fractures do very well following simple alignment in a below-the-elbow cast without reduction and without fixation1,2. In the current era, when anatomic reduction and stable fixation of fractures is the prevailing philosophy for the majority of osseous injuries, it can be difficult for attending surgeons, residents, and parents to understand that nature may be capable of doing as good a job as technology. The educated parent of today, with “Dr. Google” in hand, will want to see their child’s radiographs and may be horrified by advice to accept a displaced fracture with obvious shortening1,2. A recently published book has a treasure trove of images to reassure the anxious parent and help convince doubting residents that surgery is not always better than nature6. This book is the 2021 update to the classic textbook by Blount and is an invaluable resource for counseling parents and teaching residents1,6. The current evidence for management is inconclusive, which is unsatisfactory given that this is a common fracture with substantial associated treatment costs2. The uncertainty regarding management has been acknowledged internationally in the British Society for Children’s Orthopaedic Surgery Research Priorities and in a survey of members of the Pediatric Orthopaedic Society of North America. Additionally, a multicenter randomized controlled trial, the Children’s Radius Acute Fracture Fixation Trial (CRAFFT), has been commenced in the United Kingdom to address the question of whether outcomes following closed reduction are better than those following simple immobilization. Given that there is equipoise regarding treatment and a lack of high-quality evidence, such studies are the only way to improve the evidence base. As a surgeon who has utilized Blount’s principles of remodeling for more than 40 years, I have had the opportunity to observe excellent outcomes from nonoperative treatment of this and other pediatric fractures. However, this is anecdote, not evidence. I look forward to the outcomes of the CRAFFT Trial. My hunch is that Blount was correct and that we do not need to reduce or internally fix these fractures in younger children1,2,7.

Posteromedial Approach to Fix Posterior Cruciate Ligament Tibial Avulsion: A Backup Fixation and Case Series

Tibial avulsion fractures of PCL are common; however, the choice between open reduction internal fixation (ORIF) and arthroscopic repair of acute fractures remains controversial. We assessed the efficacy and safety of managing PCL avulsion fractures with ORIF using the posteromedial approach.

653 DRAFFT Dodging? Fixation Methods for Distal Radial Fractures Since 2014 In A UK Trauma Unit

Abstract Introduction The 2014 randomised, controlled Distal Radius Acute Fracture Fixation Trial (DRAFFT) compared K-wires to internal fixation for management of dorsally displaced distal radius fractures. The authors found no clinical difference between the two fixation methods, concluding ‘The results of this trial will reverse the trend towards locking-plate fixation for this injury’. Our study aimed to measure local change in practice since 2014. Method From the DRAFFT CONSORT diagram, we calculated just 10.7% of eligible cases required locking plate fixation. 300 patients, 50 per year from 2014-19 meeting DRAFFT eligibility criteria undergoing fixation, were randomly selected from an electronic trauma database. Radiographs were reviewed to see whether patients received internal fixation or K-wires. Results Age and sex distributions of the study sample were not significantly different to the DRAFFT population (p &amp;lt; 0.05). Over 60% of recruited patients received internal fixation each year. No increasing trend in use of K-wires was detected (p = 0.27). No trend was observed in either fixation method adjusting for intra versus extra-articular fractures (p = 0.36). Conclusions Local practice remains unchanged in fixation of dorsally displaced distal radius fractures since 2014. Internal fixation remains the most prevalent surgery, and there has been no detectable increase in use of K-wires.

P23 Associate Principal Investigators in Trauma Trials

Oxford Trauma has designed a collection of randomised clinical trials to answer important clinical questions in trauma and meaningfully engage trainees and associate principal investigators (aPI’s) with research.These include: Children’s Radius Acute Fracture Fixation Trial (CRAFFT): • Weight-Bearing in Ankle Fractures (WAX): • Blood cEll Salvage and autoTransfusion (BEST): • Fractured Ankle Management Evaluation (FAME): • Surgery or Cast for Injuries of the EpicoNdyle in Children's Elbows (SCIENCE): • The HUmeral SHaft fracture trial (HUSH) Trainee engagement is promoted via: • Registration for the NIHR associate PI scheme with corresponding “how-to guide” for study set-up.Individually tailored points system for collaborative authorship.Automatic emailing of certificates for recruitment of participants (For ARCP evidence).A central database listing trial sites and contacts for aPI’s.https://www.ndorms.ox.ac.uk/Oxford-Trauma-and-Emergency-Care/trainee-involvementThis has led to the recruitment of sites and participants ahead of target, including sites aPI’s have set-up from scratch.We would love for you to join as an aPI or help us refine the model and share it with other collaborative groups!: Contact Christopher.Bretherton@ndorms.ox.ac.uk

Quotation errors related to the Distal Radius Acute Fracture Fixation Trial paper.

Quotation error is an inaccuracy in the assertions made by authors when referencing another's work. This study aimed to assess the quotation errors in articles referencing the Distal Radius Acute Fracture Fixation Trial (DRAFFT). A literature search was performed to identify all citations of DRAFFT from 2014 to 2020. The relevant publications were assessed by two reviewers using a validated framework of error classification. There were 83 articles containing references to DRAFFT. There was substantial agreement between the two reviewers (Kappa coefficient 0.66). We found 22/83 (28%) of articles contained an error, with one article containing two errors. There were 12 major errors, which were not substantiated by, were unrelated to or contradicted the findings of DRAFFT, and 11 minor errors, including numerical inaccuracies, oversimplification or generalization. This study highlights that a significant number of articles inaccurately quote DRAFFT. Authors and journals should consider checking the accuracy of key referenced statements.