Orthopaedic Trauma Surgeons Research Articles

Comparison Between Orthopaedic Trauma Versus Arthroplasty Fellowship Training on Outcomes of Total Hip Arthroplasty for Femoral Neck Fracture

BackgroundThis study aimed to identify differences in patient characteristics, perioperative management methods, and outcomes for total hip arthroplasty (THA) for femoral neck fracture (FNF) when performed by orthopaedic surgeons who have arthroplasty versus orthopaedic trauma training. MethodsThis study was a multicenter retrospective review of 636 patients who underwent THA for FNF between 2010 and 2019. There were 373 patients who underwent THA by an arthroplasty surgeon, and 263 who underwent THA by an orthopaedic trauma surgeon. Comorbidities, management methods, and outcomes were compared between patients operated on by orthopaedic surgeons who had arthroplasty versus trauma training. ResultsArthroplasty-trained surgeons had shorter operative times (102 versus 128 minutes, P < .0001) and utilized tranexamic acid more frequently than trauma-trained surgeons (48.8 versus 18.6%, P < .0001). Orthopaedic trauma surgeons more frequently utilized an anterior approach. Patients of arthroplasty-trained surgeons had lower rates of complications including pulmonary embolism (1.6 versus 6.5%, P = .0019) and myocardial infarction (1.6 versus 11.0%, P < .0001). Similarly, patients of arthroplasty-trained surgeons were discharged faster (5.3 versus 7.9 days, P < .0001) with greater ambulation capacity (92.2 versus 57.2 feet, P < .0001). Dislocation, periprosthetic joint infection, and revision were similar between both groups. When adjusted for covariates, there was no difference in 90-day, 1-year, or 2-year mortality. ConclusionA THA performed for FNF by arthroplasty surgeons was associated with lower in-hospital morbidities and improved functional statuses at discharge. However, mortalities and complications after discharge were similar between both specialties when adjusted for confounding variables. Optimization of protocols may further improve outcomes for THA for FNF.

Are Canadian orthopaedic surgeons and American orthopaedic surgeons on par? A Canadian practice survey of orthopaedic traumatologists.

The purpose of this study was to obtain information on Canadian orthopaedic trauma surgeon practices and salary demographics. It was hypothesized that most of the practicing surgeons recognize specific practice aspects (compensation, call schedule, operating room availability, and provided support staff) as key factors in employment opportunity evaluation. Cross-sectional survey study. Orthopaedic Trauma Association (OTA) practice surveys. All active Canadian members of the OTA were eligible to participate. A 50-question survey was sent through email to OTA members assessing physician, practice, and compensation metrics of Canadian orthopaedic traumatologists. Fifty-two of 113 Canadian OTA members participated giving a response rate of 46%. All surgeons worked in an academic practice, either for a university (83%) or community hospital (17%). Only 2% of surgeons have changed jobs in the last 5 years, and over 73% of surgeons maintain the same place of employment during their careers. Most had an available dedicated orthopaedic trauma operating room (73%). The majority indicated having residents (71%) and fellows (63%) as support staff. Many reported completing 300-500 cases per year (42%), which decreased during COVID-19 for 50% of surgeons. The most common reported compensation was between $400,000 and $600,000 US dollars (25%) with many working 4-6 call shifts a month (48%) and 51-70 hours a week (48%). This study demonstrated the varying practice and physician economic variables currently in Canada. The identification and continued surveillance of these employment variables will allow for transparency in job market evaluation by applicants. Level V.

Development and validation of the paediatric elbow trauma (PET) rules as a decision rule for radiography in traumatic elbow injuries: a study protocol

BackgroundTraumatic elbow injuries in children occur frequently and are among the most common traumatic injuries seen in the emergency department (ED) and in general practice. The use of a validated...

CLINICAL CHARACTERISTICS AND RESULT OF LOCAL FLAP RECONSTRUCTION FOR FINGERTIP INJURY IN ADULTS

Background: Fingertip injury at different levels is a common injury and management varies with variable outcomes. Local flap reconstruction techniques are the most commonly used method of treatment with satisfactory results in most. The current study aimed to analyze the clinical characteristics and results of different local flap reconstruction techniques in the treatment of fingertip injuries. Methods: This was a retrospective observational study of 31 fingertip injuries in 24 patients treated with one of the three local flap reconstruction techniques; V-Y advancement flap, thenar flap, and Moberg flap, performed by a single orthopedic surgeon in a tertiary care teaching hospital over 2 years period. The variables analyzed were demographic and injury characteristics, flap take-up function, and cosmesis of the finger and nail using descriptive statistics. Results: There were a total of 31 fingertip injuries at different levels and morphology with a mean age of 35.79 years (range 18-55). Household tools or machine-related injury was the most common mode of injury. A total of 23 (74%) fingertip amputations at a different level were treated with V-Y advancement local flap, 5 cases with thenar flap, and 3 cases of thumb tip amputation and laceration with Moberg flap. All the flaps survived well with preservation of sensation, function, and acceptable cosmesis. Conclusions: Local flap reconstruction techniques can give rise to consistently good results in the management of fingertip injury. They are technically simple, and reliable and should be practiced by all orthopedic trauma surgeons whenever it is indicated.

Road Traffic Accidents, Climbing Frames, or Trampolines: What Harms Children in the 2020s?

Background In the modern Western world, activities and the daily routine of children have changed over time. Detailed analyses of the mechanisms of injuries and current fracture patterns in children are rare. The aim of the study was to elicit and investigate the most dangerous leisure and sporting activities leading to fractures in children today. Materials and methods This is a retrospective study focusing on children that were treated in a level-one trauma center in Germany between 2015 and 2020. All children who were 14 years of age or younger and suffered a traumatic injury treated in our emergency department were included in this study. From the database, mechanisms of injury, type of injury, age, and gender were analyzed. Results The study included 12508 patients, including 7302 males and 5206 females. Among the 10 most common mechanisms of injury were collisions (8.6%), falls (7.7%), injuries while playing (6.1%) or while running or walking (5.9%), soccer (5.9%), bicycle accidents (3.8%), and trampoline falls (3.4%). Road traffic accidents involving passengers or pedestrians caused 3.3% of the injuries but were the most common cause of death. The most common mechanisms of injury causing a fracture were falls, playing soccer, and bicycle accidents. Sorting the mechanisms of injury by the percentage that caused a fracture, the most dangerous activities were falling from heights above 2 meters, skiing and snowboarding, climbing and bouldering, skateboarding, and horseback riding. In the five-year study period, four out of six children died due to road traffic accidents. Conclusion Injured children must be provided with the best quality of care 24/7 in orthopedic trauma departments and have to be kept as a focus in the training of orthopedic trauma surgeons. Road traffic accidents are still the main cause of death in children, but they are overall less common. Falls and sports activities are the most likely to cause a fracture.

Improving Cephalad Lag Screw Placement in the Femoral Head During Cephalomedullary Nailing Using a Novel Augmented Reality System.

To measure the effect of a novel augmented reality software designed to aid in lag screw placement into the femoral head for cephalomedullary nails. Retrospective cohort study. Single Level I trauma center. Between November 2017 and December 2020, 114 consecutive patients with a hip fracture that underwent repair with a cephalomedullary nail by one of 2 orthopaedic trauma surgeons were reviewed. Fracture classifications included OTA/AO 31-A1, 31-A2, 31-A3, and 31-B3. The first 57 patients underwent fracture repair without the software (control) and the subsequent 57 patients underwent repair with use of the augmented reality software (AR). Tip apex distance (TAD) and femoral head zone (AP: superior, center, inferior; Lateral: anterior, center, posterior) were measured using standardized techniques. The mean TAD was lower for the AR versus control cohort (10.7 ± 2.9 mm vs. 15.4 ± 3.8 mm; P < 0.001). TAD <10 mm for AR versus control: 25 (43.9%) versus 3 (5.3%), P < 0.001. TAD <15 mm for AR versus control: 50 (87.7%) versus 44 (77.2%), P < 0.001. On the AP view, center position was achieved in 50.9% versus 7.0% of cases for the AR versus control cohort, respectively. On the lateral view, center position was achieved in 68.4% versus 12.3% of cases for the AR versus control cohort, respectively. This study suggests that use of the novel augmented reality software for assistance in lag screw positioning within the femoral head improves overall TAD and ability to achieve the center-center position. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Вивчення особливостей структури хвороб системи кровообігу, травм і бойових поранень грудної клітки під час воєнного стану

The purpose of the work was to study the frequency of diseases of the cardiovascular system, the frequency and nature of received injuries and combat wounds of the chest in order to ensure the proper quality of the provision of highly qualified medical care of the cardiosurgical profile. Materials and methods. The study included military personnel who took part in combat operations and received injuries and combat wounds of the chest, as well as requiring surgical treatment for diseases of the cardiovascular system. The study was carried out on the basis of the State Institute “Amosov National Institute of Cardiovascular Surgery affiliated to National Academy of Medical Sciences of Ukraine”. Results and discussion. The article presents the results of the analysis of the primary accounting medical documentation, clinical data, research on the evacuation routes of servicemen with diseases of the cardiovascular system, injuries and combat chest wounds received during hostilities. According to the basics of medical care, all military personnel must be knowledgeable about cardiopulmonary resuscitation, bleeding control, immobilization, dressings, transportation of the wounded and evacuation, communication with other levels of medical care, and be able to fill out reports on accounting for combat wounds and injuries that will accompany soldiers during evacuation to medical facilities. After analyzing in more detail the mechanism of damage/injury to the chest according to the primary medical record documentation, as well as according to the medical card of the outpatient/inpatient patient, it was found that during the provision of specialized cardiosurgical care in 3 cases out of 7, there was a need for the involvement of specialists from other medical specialties. Having specified the clinical cases of combat injuries and wounds of the chest, it was established in which specialists there was a need for consultation and joint surgical intervention: a thoracic surgeon, an orthopedic trauma surgeon, a neurosurgeon, and others. The above determines the expediency of creating multidisciplinary medical teams, approving their work schedule/shifts during martial law. Conclusion. The study has begun on creating a clinical registry of diseases of the circulatory system, injuries and combat wounds of the chest in military personnel and civilians. The main types of injuries and combat wounds of the chest were established, nosological forms of diseases of the circulatory system were clarified. When analyzing the clinical forms of injuries and combat wounds of the chest, the feasibility of creating multidisciplinary medical teams to ensure the proper quality of medical care and increase its efficiency was substantiated

Suprapatellar Tibial Nailing: Future or Fad?

Over the last hundred years, there have been significant advancements in the way the Orthopaedic community treats tibial fractures. More recently, the focus of Orthopaedic trauma surgeons has been comparing the different techniques of insertion for tibial nails, specifically suprapatellar (SPTN) versus infrapatellar. The existing literature is convincing that there does not appear to be any clinically significant differences between suprapatellar and infrapatellar tibial nailing, with some apparent benefits of SPTN. Based on the current body of literature and our personal experience with SPTN, we believe the suprapatellar tibial nail will become the future for most tibial nailing procedures, regardless of fracture pattern. We have seen evidence of improved alignment in both proximal and distal fracture patterns, decreased radiation exposure and operative time, relaxation of the deforming forces, ease of imaging, and static positioning of the leg, which would be helpful for the unassisted surgeon, as well as no difference in anterior knee pain or articular damage within the knee between the two techniques.

Olecranon fractures : current treatment concepts.

Despite being one of the most common injuries around the elbow, the optimal treatment of olecranon fractures is far from established and stimulates debate among both general orthopaedic trauma surgeons and upper limb specialists. It is almost universally accepted that stable non-displaced fractures can be safely treated nonoperatively with minimal specialist input. Internal fixation is recommended for the vast majority of displaced fractures, with a range of techniques and implants to choose from. However, there is concern regarding the complication rates, largely related to symptomatic metalwork resulting in high rates of implant removal. As the number of elderly patients sustaining these injuries increases, we are becoming more aware of the issues associated with fixation in osteoporotic bone and the often fragile soft-tissue envelope in this group. Given this, there is evidence to support an increasing role for nonoperative management in this high-risk demographic group, even in those presenting with displaced and/or multifragmentary fracture patterns. This review summarizes the available literature to date, focusing predominantly on the management techniques and available implants for stable fractures of the olecranon. It also offers some insights into the potential avenues for future research, in the hope of addressing some of the pertinent questions that remain unanswered.Cite this article: Bone Joint J2023;105-B(2):112-123.

Complex Orthopaedic Trauma Is Shifting Away From Level I to Non-Level I Trauma Centers: An Analysis of the National Trauma Data Bank.

An increasing number of fellowship-trained orthopaedic trauma surgeons are working in non-Level I centers. This study aimed to examine trends of management of complex orthopaedic trauma in Level I centers versus non-Level I centers and its potential effect on patient outcomes. Data from the National Trauma Data Bank from 2008 to 2017 were analyzed. Non-Level I to Level I center ratios for complex fractures and complication rates, median hours to procedure for time-sensitive fractures, and uninsured/underinsured rates of Level I and non-Level I centers were recorded. Three hundred one thousand patients were included. A statistically significant downward trend was identified in the percent of all complex orthopaedic trauma at Level I centers and per-hospital likelihood of seeing a complex orthopaedic fracture in a Level I versus non-Level I hospital. Per-hospital complication rates were consistently lower in non-Level I hospitals after controlling for injury severity and payer mix. Time-sensitive fractures were treated earlier in non-Level I centers. This study demonstrates a reduction of complex trauma treatment in Level I centers that did not translate to adverse effects on patient outcomes. Policymakers should notice this trend to ensure the continued quality of orthopaedic trauma training and maintenance of expertise in complex fracture management.

Characterizing Single-star Negative Online Reviews of Orthopaedic Trauma Association Members.

The purpose of this study was to characterize factors that contribute to 1-star negative reviews regarding orthopaedic trauma surgeons. A search was done for Orthopaedic Trauma Association members on Yelp.com , Healthgrade.com , and Vitals.com in New York, Boston, San Francisco, Los Angeles, Dallas, Phoenix, Seattle, Baltimore, Denver, Houston, Philadelphia, and Washington, DC. All single-star reviews (out of a possible 5 stars) were included in this study. Reviews were categorized as either clinical or nonclinical and then further subcategorized. Categorical variables were analyzed using a chi-square test. The rate ratio (the ratio of the rate for nonsurgical divided by surgical reviews) was determined for each category. Two hundred eighty-eight single-star reviews were included in the study, comprising 655 total complaints. Of all complaints, 274 (41.8%) were clinically related and 381 (58.2%) were nonclinical. Of the 288 single-star reviews, 96 (33.3%) were from surgically treated patients and 192 (66.7%) were from nonsurgical patients. Most complaints were in reference to nonclinical aspects of care such as physician bedside manner (173 reviews, 60%), not enough time spent with provider (58 reviews, 20%), and wait time (42 complaints, 15%). The most common clinical complaints were for complication (61 reviews, 21%), disagree with decision/plan (49 reviews, 17%), and uncontrolled pain (45 reviews, 16%). Surgical patients had a significantly higher rate of clinical complaints than nonsurgical patients (1.57 vs. 0.64 clinical complaints per review, P < 0.001). Nonsurgical patients had a significantly higher rate of nonclinical complaints than surgical patients (1.43 vs. 1.10 nonclinical complaints per review, P < 0.001). Most 1-star reviews referenced a nonclinical aspect of care with a physician's bedside manner being the most common complaint. Surgical patients were markedly more likely to reference a clinical aspect of care, such as complications or misdiagnosis compared with nonsurgical patients, who more commonly referenced nonclinical aspects of care.

Ұршық ойығы сынықтарын емдеу: Әдеби шолу

Fractures of the acetabulum are among the most complex fractures involving the hip joint and pose a challenge for orthopedic trauma surgeons. The first known descriptions of surgical fixation of acetabular fractures were published in 1943. In 1964, R. Judet, J. Judet, and E. Letournel published a landmark article describing the classification system and surgical approaches for treating acetabular fractures. These teachings had a significant impact on clinical outcomes after surgical fixation of acetabular fractures. In 1980, Letournel demonstrated 80% good to excellent results, and in 2012, Matta demonstrated a 79% survival rate after surgical fixation of the acetabulum. Letournel finally proved that anatomical reduction of the fracture is the most influential factor predicting the clinical course. Numerous achievements have been made in pelvic and acetabular surgery. However, despite these accomplishments, surgeons are still striving to improve the outcomes of surgical treatment for acetabular fractures. Keywords: acetabulum, fracture, osteosynthesis, history.

Recognition of the pattern of complex fractures of the elbow using 3D-printed models.

This study aimed to answer the following questions: do 3D-printed models lead to a more accurate recognition of the pattern of complex fractures of the elbow?; do 3D-printed models lead to a more reliable recognition of the pattern of these injuries?; and do junior surgeons benefit more from 3D-printed models than senior surgeons? A total of 15 orthopaedic trauma surgeons (seven juniors, eight seniors) evaluated 20 complex elbow fractures for their overall pattern (i.e. varus posterior medial rotational injury, terrible triad injury, radial head fracture with posterolateral dislocation, anterior (trans-)olecranon fracture-dislocation, posterior (trans-)olecranon fracture-dislocation) and their specific characteristics. First, fractures were assessed based on radiographs and 2D and 3D CT scans; and in a subsequent round, one month later, with additional 3D-printed models. Diagnostic accuracy (acc) and inter-surgeon reliability (κ) were determined for each assessment. Accuracy significantly improved with 3D-printed models for the whole group on pattern recognition (acc2D/3D = 0.62 vs acc3Dprint= 0.69; Δacc = 0.07 (95% confidence interval (CI) 0.00 to 0.14); p = 0.025). A significant improvement was also seen in reliability for pattern recognition with the additional 3D-printed models (κ2D/3D = 0.41 (moderate) vs κ3Dprint = 0.59 (moderate); Δκ = 0.18 (95% CI 0.14 to 0.22); p ≤ 0.001). Accuracy was comparable between junior and senior surgeons with the 3D-printed model (accjunior = 0.70 vs accsenior = 0.68; Δacc = -0.02 (95% CI -0.17 to 0.13); p = 0.904). Reliability was also comparable between junior and senior surgeons without the 3D-printed model (κjunior = 0.39 (fair) vs κsenior = 0.43 (moderate); Δκ = 0.03 (95% CI -0.03 to 0.10); p = 0.318). However, junior surgeons showed greater improvement regarding reliability than seniors with 3D-printed models (κjunior = 0.65 (substantial) vs κsenior = 0.54 (moderate); Δκ = 0.11 (95% CI 0.04 to 0.18); p = 0.002). The use of 3D-printed models significantly improved the accuracy and reliability of recognizing the pattern of complex fractures of the elbow. However, the current long printing time and non-reusable materials could limit the usefulness of 3D-printed models in clinical practice. They could be suitable as a reusable tool for teaching residents.Cite this article: Bone Joint J2023;105-B(1):56-63.

Use of calcaneal plates in the treatment of posterior pelvic ring injuries and displaced iliac blade fractures- A case series

IntroductionThe operative fixation of pelvic ring injuries and associated acetabulum fractures presents a challenging scenario to most of the orthopaedic trauma surgeons. Current development of anatomically contoured reconstruction (ACR) plates gained popularity in fixing complex pelvic ring fractures. This study was done to assess the functional and radiological outcomes using of lateral wall stainless steel (LWSS) calcaneal plates in posterior pelvic ring injuries and displaced iliac blade fractures. Materials and methodsRetrospectively selected eight cases of pelvic ring injuries planned for fixing posterior pelvic instability and iliac blade fractures using LWSS plates. Mean follow-up was 18 months (Range 12–26 months). ResultsAverage time for radiological bony union achieved in 18 weeks (Range 13–22). Seven patients returned to their normal work. Average Majeed score was 60 (Range 50–68). Mean duration of surgery was 160 min (Range 120–200). ConclusionThis technique can be routinely used as supplementary fixation for posterior pelvic ring instability and iliac blade fractures. LWSS calcaneal plates showed no screw breakage or implant failure. Further this technique was cost effective in developing countries with limited resources.

Biological reconstruction of large bone defects : Masquelet technique and new procedures

Extensive diaphyseal and metaphyseal bone defects continue to pose amajor challenge for orthopedic trauma surgeons. Various treatment options have been described for the biological reconstruction of these defects. The most frequently used methods are bone segment transport, the Masquelet technique and 3D printed scaffolds. As far as the Masquelet technique is concerned, in the first stage spacers, such as polymethyl methacrylate (PMMA), calcium sulfate or polypropylene are inserted into the bone defects to induce a foreign body membrane. In the second stage the bone defect surrounded by the induced membrane is filled with autologous cancellous bone. The time interval between the first and second interventions is usually 4-8weeks whereby the induced membranes do not lose their bioactivity even with alatency period longer than 8weeks. Three-dimensional printed scaffolds are increasingly used but large clinical studies are lacking in order to show the exact role of this procedure in the reconstruction of bone defects.

Retrospective analysis of locked versus non-locked plating of distal fibula fractures

IntroductionUnstable distal fibular fractures have traditionally been treated with open reduction internal fixation using a 1/3 tubular non-locked plate (compression plating). Locked plating is a newer technique that has become more popular despite the lack of clinical data supporting improved outcomes. The cost of locked plating is almost four times that of compression plating. We compared rates of reoperation due to implant failure, infection, and symptomatic device between compression and locked plating in open reduction internal fixation of distal fibular fractures MethodsA retrospective study was performed at a level one trauma center over a ten-year period (2008-2017). Patients who were 18 and older and treated for unstable ankle fractures with locking or non-locking plate were included in this study. Patient charts were reviewed by orthopedic trauma surgeons to identify whether patients were treated with a 1/3 tubular non-locking or pre-contoured locked plate and to determine the cause of reoperation. ResultsIn total, 442 patients were identified with 203 in the non-locked 1/3 tubular plate group and 239 in the pre-contoured locked plate group. A total of 38 patients (8.6%) underwent device removal with a higher proportion of patients in the non-locked 1/3 tubular plate cohort (11.3% vs. 6.3%, p = 0.059). Statistically significant differences in reasons for reoperation were found for symptomatic implant (78.3% vs. 46.7%, p = 0.045) and infection (8.7% vs 53.3%., p < 0.01). Of patients who had device removal for symptomatic implant in the compression plating cohort, 13 (72.2%) had lateral positioning and 5 (27.8%) had posterior positioning (p < 0.01) whereas there was no statistical difference in plate positioning in the locked cohort. Of all medical comorbidities identified, only diabetes was associated with a higher rate of infection-related reoperations (83.3% vs. 15.6%, p < 0.01). ConclusionsBoth compression and locked plate techniques demonstrated low reoperation rates. Compression plating with 1/3 tubular plates placed laterally more often resulted in reoperation due to symptomatic implant but had fewer complications of infection. Given that the cost is significantly less, 1/3 tubular plating placed posteriorly may be preferred to decrease the risks of symptomatic implant and infection.

Periprosthetic acetabular fractures and defects : Trauma meets ortho

Periprosthetic acetabular fractures are considered to be asevere and challenging complication in total hip arthroplasty. To date, there are no internationally applicable standardized recommendations which can assist orthopedic surgeons and trauma surgeons in the treatment of patients. The aim of this article is to report on the current state of knowledge on periprosthetic acetabular fractures, to present the commonly used classification systems and to demonstrate appropriate treatment algorithms together with personal experiences. Aselective search of the existing literature was carried out and the commonly used classification systems and treatment options for periprosthetic acetabular fractures were compiled and are discussed in relation to the in-house cases. The comparison of the classification systems showed that frequently only fractures which have a purely traumatic origin are included among periprosthetic acetabular fractures. Insufficiency fractures within the framework of acetabular defects, which also belong to the group of acetabular fractures, are frequently included in revision arthroplasty. The management of defects with appropriate implants represents a challenge. By the combination of osteosynthesis and implant replacement, the selection of implants can often be de-escalated. Periprosthetic acetabular fractures represent a complex operation for both trauma surgeons and for specially trained orthopedic surgeons, which necessitate a high level of expertise. By the cooperation between trauma surgeons and orthopedic surgeons good treatment results can be achieved and recommendations for the selection of implants can be made.

INDIVIDUAL 3D PRINT PEEK MATRIX IS ​​A POSSIBLE TACTICAL SOLUTION IN THE TREATMENT OF LARGE DEFECTS OF THE DIAPHYSIS OF THE HUMERUS. DESCRIPTION OF TWO CLINICAL CASES

In the case of gunshot wounds to the limbs, 7.1% of wounded servicemen are diagnosed with primary defects of bone tissue, which in 79.3% of victims exceed 3 square centimeters. In the treatment of this category of patients, the use of 3D modeling becomes especially relevant. Polyetheretherketone (PEEK) is a polyaromatic semi-crystalline thermoplastic polymer with mechanical properties favorable for biomedical applications. PEEK-based materials are becoming an important group of biomaterials used for bone and cartilage replacement, as well as in a large number of diverse fields of medicine. The possibility of using these materials in the 3D printing process increases scientific interest in them. The PEEK matrix is ​​a 3D printed custom mesh that serves as a container for the plastic material. It is important to note that the chemical inertness of the PEEK surface does not guarantee good interfacial biocompatibility and requires surface modification before its use in vivo. The use of PEEK to replace bone defects, particularly after gunshot wounds to the extremities, requires further scientific research and clinical observations. The analysis of clinical cases presented in the article aims to expand the understanding of orthopedic trauma surgeons about the possibilities of using 3D print PEEK matrix technology and help in making tactical clinical decisions in complex cases where there are significant bone defects.

Computer-Generated Radiographic Measurements of Distal Radius Fractures: Does It Help With Decision Making?

Operative management of distal radius fractures (DRFs) has become increasingly common. Age, activity levels, and comorbid conditions are major factors influencing the treatment decision, although operative indications are still controversial. Radiographic parameters (RPs), such as radial inclination, dorsal tilt, and articular step-off, can provide objective support for effective decision making. However, manual measurement of RPs may be imprecise and subject to inconsistency. To address this problem, we developed custom software of an algorithm to automatically detect and compute 6 common RPs associated with DRF in anteroposterior and lateral radiographs. The aim in this study was to assess the effect of this software on radiographic interobserver variability among orthopedic surgeons. Our hypothesis was that precise and consistent measurement of RPs will improve radiographic interpretation variability among surgeons and, consequently, may aid in clinical decision making. Thirty-five radiograph series of DRFs were presented to 9 fellowship-trained hand and orthopedic trauma surgeons. Each case was presented with basic clinical information, together with plain anteroposterior and lateral radiographs. One of the 2 possible treatment options was selected: casting or open reduction with a locking plate. The survey was repeated 3 weeks later, this time with computer-generated RP measurements. Data were analyzed for interobserver and intraobserver variability for both surveys, and the interclass coefficient, kappa value, was calculated. The interobserver reliability (interclass coefficient value) improved from poor to moderate, 0.35 to 0.50, with the provided RP. The average intraobserver interclass coefficient was 0.68. When participants were assessed separately according to their subspecialties (trauma and hand), improved interobserver variability was found as well. Providing computed RPs to orthopedic surgeons may improve the consistency of the radiographic judgment and influence their clinical decision for the treatment of DRFs. Orthopedic surgeons' consistency in the radiographic judgment of DRFs slightly improved by providing automatically calculated radiographic measurements to them.

A retrospective assessment of the clinical efficacy of different internal fixation methods in the treatment of distal fibula fractures in the elderly.

An ankle fracture is a fracture of the distal tibia or fibula that forms the ankle joint, usually associated with ligament and soft tissue injury, and is a common type of lower limb fracture and one of the most common types of fracture in the elderly. Although ankle fractures are one of the most common injuries seen by orthopedic trauma surgeons, there is no uniform protocol for the diagnosis and treatment of ankle fractures in the elderly, and there are many controversial indications for surgery. The aim of this study is to assess the clinical efficacy of different internal fixation methods in the treatment of distal fibular fractures in the elderly, in an effort to improve the rational selection and application of clinical acts. A retrospective analysis was performed on 68 cases of patients who suffered an ankle fracture and were treated with different internal fixation methods according to the fracture types and individual differences in distal fibula fractures. The postoperative therapeutic effect assessment was performed in terms of clinical examination, imaging evaluation, and AOFAS ankle-hind foot function scoring. There was no unhealed bone, ankle instability and loose/fractured internal fixation. Fracture healing time was 2.7 to 4.0 months (average 3.2 months). AOFAS score was 88.3 ± 6.2, of which, 34 excellent cases, 30 good cases, and 4 fair cases. Ankle activity dorsiflexion 6º~18º, average 15º; plantar flexion 26º~47º, average 37º. A good clinical efficacy could be achieved from the most appropriate individualized internal fixation for distal fibula fractures of elderly patients.