Orthopaedic Traumatology Research Articles

Congenital Knee Dislocation: Help for Neonatologists and Pediatricians

Congenital knee dislocation is relatively rare pathology of the musculoskeletal system. Timely diagnosis and treatment onset allow us to achieve full range of motion in the knee joint. However, low awareness of physicians in these topics and, as a result, diagnostic errors lead to pseudo-correction and motor deficit in the knee joint. This article describes correct examination of a child with congenital knee dislocation directly in the delivery room, management after discharge, and subsequent patient's routing with the assistance of orthopedic traumatologist.

Demographics and Characteristics of Orthopaedic Surgery Residency Program Directors: A Cross-sectional Review.

To determine the objective characteristics of orthopaedic residency PDs by analyzing their demographic characteristics, academic backgrounds, institutional histories, research productivity, and professional leadership affiliations. Data for each PD were collected by searching publicly available curriculum vitae, LinkedIn, Healthgrades, Doximity, and/or institutional biographies and consolidated into a database. Research productivities were collected by searching PubMed and Scopus. Of the 210 PDs, 188 (89.5%) were male and 22 (10.5%) were female. One hundred seventy-four (82.9%) were non-Hispanic White, 14 (6.7%) Asian American and Pacific Islander, 12 (5.7%) Black or African American, 4 (1.9%) Hispanic or Latino, and 6 (2.9%) other/unknown. Twenty-four (11.4%) PDs had a military affiliation. Moreover, the most common subspecialties among orthopaedic PDs were orthopaedic traumatology (19.5%, n = 41), sports medicine (15.7%, n = 33), and hand surgery (11.9%, n = 25). The mean Scopus h-index, total number of publications at the time of data collection (June 2022), and total number of citations for all orthopaedic residency PDs were 10.5 ± 9.5, 33.9 ± 51.0, and 801.9 ± 1,536.4, respectively. Among all PDs, the mean tenure in the position was 8.9 ± 6.2 years to date, and the mean time from completion of residency to appointment as PD was 10.0 ± 6.2 years. Among orthopaedic surgery residency PDs, there is sparse female and minority representation. Overarchingly, orthopaedic PDs are White men in their early 50s. Moreover, 59.1% of PDs were appointed at an institution where they completed medical school, residency, or fellowship. orthopaedic traumatology (19.5%), sports medicine (15.7%), and hand surgery (11.9%) were the subspecialties most represented in current orthopaedic surgery PDs. This study outlines important demographic characteristics among orthopaedic surgery residency PDs. III.

Surgical Management of Recent Traumatic Epiphyseal Fractures-Detachments of the Distal Femur at Gabriel Touré University Hospital

Traumatic epiphyseal detachment fractures of the distal end of the femur are a rare lesion whose severity is linked to disabling sequelae such as limb length inequality or most often axial deviation. In this report, surgical treatment aims to reconstruct the anatomy of the distal femur, to avoid secondary displacements and to allow early mobilization of the knee. Surgery carried out mainly by the technique of plugging in or screwing, opened or better still closed, can be a source of complications including migration of pins, infections, knee stiffness, and growth disorders. The aim of this work was to describe their epidemiological, anatomo-clinical, therapeutic and evolutionary aspects in the Department of Orthopedics-Traumatology at the CHU Gabriel TOURE. It was a retrospective study over 30 months from July 2019 to December 2021. In fact, it concerned 42 patients with traumatic epiphyseal detachment of the distal femur occurring within 21 days or less, on a healthy knee with cartilage fertile treated surgically and followed in the department. However, the diagnosis of traumatic epiphyseal detachment of the distal femur was retained thanks to the clinical examination and supplemented by radiographic images of the knee from the front and from the side. The treatment was surgical. The functional results were evaluated according to the functional criteria of the Eastern Orthopedic Traumatology Society (SOTEST). Forty-two patients included 32 boys and 10 girls of average age of 12 years with extremes of 8 years and 16 years. The lesions were classified according to the Salter Harris classification. We noted 24% type I (n = 10), type II 71% (n = 30), type III 2% (n = 1), type IV 2% (n = 1). Union was achieved in all patients within an average of 6 weeks with extremes of 4 and 12 weeks. The functional result was considered good in 20% of cases and very good in 80%. Traumatic epiphyseal detachment fractures of the distal end of the femur are a rare lesion whose severity is linked to disabling sequelae such as limb length inequality or most often axial deviation. Surgical treatment aims to reconstruct the anatomy of the distal femur, to avoid secondary displacements and to allow early mobilization of the knee.

Risk Factors for Surgical Site Infections in Patients Operated at the University Clinic of Traumatology-Orthopedics and Restorative Surgery of the National Hospital and University Center Hubert Koutoukou Maga in Cotonou

Background: Operative site infections (ISO) are typically nosocomial. According to the WHO the incidence of ISO varies from 0.5% to 15% and exceeds 25% in developing countries. They result from the combined action of several factors and represent a concern for public health. To study the contributing factors of surgical site infections in patients operated at the University Clinic of Orthopedic Traumatology of CNHU-HKM of Cotonou. Method: This was an analytical cross-sectional study that involved 35 operated patients and ten nurses. Were included in our study: 1) All patients, without distinction of sex or age, having been operated on in the university clinic of orthopedic traumatology, during the survey period; 2) Patients hospitalized for post-operative care during the survey period; 3) The nursing staff on duty during our study period. The usual statistical measures were used according to the type of variables: means, standard deviations, percentages. Data analysis first involved calculating percentages for the qualitative variables and means followed by their standard deviations for the quantitative variables. Next, the Pearson Chi-square test was used to test the association between the dependent variable and the independent variables of interest. The significance level is set at p < 0.05. Results: The prevalence of surgical site infections was 28.58%. The main factors contributing to the occurrence of SSIs that were found were the patient’s level of education (p = 0.003) and the reuse of bandages used for dressing (p = 0.004). Other potential factors such as the economic status of the patient, the poor quality of technical dressings, and the preoperative stay were also highlighted. Conclusion: Surgical site infections remain a global concern. Risk factors were found on both the patient and nurse sides. It is urgent to address these various factors to minimize the occurrence of surgical site infections.

Professor Roman Romanovich Vreden (1867–1934) (on the 155&lt;sup&gt;th&lt;/sup&gt; anniversary of his birth)

An outstanding orthopedic traumatologist and military field surgeon, scientist and teacher, one of the founders of orthopedics in Russia, founder and long-term director of the St. Petersburg Orthopedic Institute (1906–1924), organizer of the first Department of Pediatric Surgery in Russia (1933) and creator of a large scientific school of orthopedic traumatologists, Professor Roman Romanovich Vreden was born on March 9 (21), 1867 in St. Petersburg in the family of a well-known otorhinolaryngologist, Professor Robert Robertovich Vreden. From childhood, Roman chose the profession of a doctor for himself, and after graduating with a gold medal from the First Classical Gymnasium in St. Petersburg in 1885, he entered the Imperial Military Medical Academy. After graduating from the academy in 1890, he passed the competition and left for further development of the specialty as an adjunct at the Department and Clinic of Hospital Surgery founded by N. I. Pirogov and led by Professor V. A. Ratimov. In 1893, R. R. Vreden successfully defended his dissertation for the degree of Doctor of Medicine on the topic: «On the etiology of cystitis», after which he was sent to Kiev, where from 1893 to 1896, he worked as a resident at the Kiev Military Hospital, headed the Surgical and Ear Departments there. In 1896, Roman Romanovich returned to the Military Medical Academy and received the position of senior assistant in the Hospital Surgical Clinic of V. A. Ratimov. In 1898, R. R. Vreden was awarded the academic title of Privatdozent. In 1902, in connection with the retirement due to illness of V. A. Ratimov, a competition was held to fill the position of the head of the Department of Hospital Surgery, but R. R. Vreden lost to S. P. Fedorov in it, after which he left the Department. In 1902–1904, he was a leading surgeon and director of the French Hospital in St. Petersburg and a surgical consultant at the Nikolaev Military Hospital. In 1903, R. R. Vreden was appointed an official for special assignments at the Main Military Medical Directorate. In February 1904, the Russo-Japanese War began and R. R. Vreden was sent to the Far East. In March 1905, Roman Romanovich returned to St. Petersburg, until 1906, served as head of the faculty surgical clinic of the Women’s Medical Institute. In July 1906, Roman Romanovich was appointed the first director of the first Russian Orthopedic Institute in St. Petersburg. R. R. Vreden can rightfully be considered the founder of operative orthopedics in our country. Such surgical interventions as arthrotomy, arthroplasty, arthrodesis, bone and joint resections, tendon and bone plasty, osteotomy, open reduction of dislocations and others were widely performed at the Institute. In 1911, Roman Romanovich was elected a professor at the Psychoneurological Institute and created the Department of Orthopedics on the basis of his Institute. In 1912, he organized training in orthopedics for doctors at the Clinical Institute of the Grand Duchess Elena Pavlovna, and in 1918, he created and headed the Department of Orthopedics at the First Petrograd Medical Institute. In 1925, the «Practical Guide to Orthopedics» was published, which summed up the 18-year activity of R. R. Vreden in this field of medicine. Roman Romanovich created one of the first and largest scientific schools of orthopedic surgeons in our country. Professor Roman Romanovich Vreden died in Leningrad on February 7, 1934 and was buried at the Smolensk Lutheran cemetery. In 1967, the Leningrad Research Institute of Traumatology and Orthopedics was named after R. R. Vreden.

A new classification of spondylodiscitis: possibility of validation and multidisciplinary expert consensus

Objective. To perform validation study of the E. Pola classification (2017) and to assess expert consensus on the diagnosis and treatment of infectious lesions of the spine in the national professional community.Material and Methods. A clinical and radiological database on 15 cases of infectious spondylitis, as well as the information about original article by Pola and a Russian translation of the classification and tactical tables from this article, were distributed to 408 orthopedic traumatologists, neurosurgeons and radiologists who have experience in treating patients with spinal pathology and whose data are available in the registers of the relevant professional associations of the Russian Federation. The coincidence/difference in the responses concerning the definition of lesion types and the choice of treatment tactics, as well as proposals for the use of classification were assessed.Results. Answers were obtained from 37 respondents from 11 regions of the Russian Federation. The general interobserver agreement index (Fleiss kappa) for all types of spondylodiscitis was 0.388 (95 % CI 0.374–0.402), including for lesion types: type A – 0.480 (95 % CI 0.460–0.499, type B – 0.300 (95 % CI 0.281–0.320), and type C – 0.399 (95 % CI 0.380–0.419). Agreement levels were higher among radiologists (type A – 0.486, type B – 0.484, and type C – 0.477), orthopedic traumatologists (type A – 0.474, type B – 0.380, and type C – 0.479), and specialists with clinical experience less than 10 years (type A – 0.550, type B – 0.318, and type C – 0.437). The pooled data for all 12 lesion subtypes showed general poor agreement (k = 0.247, CI 0.240–0.253), satisfactory level was found for B3.2 type (k = 0.561, CI 0.542–0.581), good agreement (k &gt; 0.61) was achieved between orthopedic traumatologists for type B3.2 and between radiologists for B3.1 and B3.2 lesion types. Respondents refused to use basic treatment options for type A in 15.1 %, type B in 7.5 % and type C in 3.2 % of answers, while indicating the need for interventions through anterior approach in 24.7 %, 43.0 % and 46.2 %, respectively. Limitations of the classification use depending on the localization and etiology of spondylitis were noted. Authors recommended taking into account the presence of systemic inflammatory response syndrome, mandatory CT scanning, clarification of spinal instability criteria, and the addition of anterior surgical interventions to the treatment algorithm.Conclusion. The Pola classification of spondylodiscitis is currently considered the most successful for tactical algorithms and implementation in broad clinical practice for spondylodiscitis. However, at the stages of its clinical application, there is an unsatisfactory interobserver expert consensus on the types of lesions, and there are limitations related to the etiology, localization and severity of the disease. A modified classification taking into account the identified limitations and including anterior procedures in the tactical options is advisable.

Risk of shortening in operatively treated proximal femur fractures with cephalomedullary nails with dynamically versus statically locked helical blades

IntroductionCephalomedullary nails (CMN) have proven to be effective for the fixation of unstable pertrochanteric hip fractures, but limited data exists regarding the degree of shortening that occurs with nailing systems that offer “dynamically” versus “statically” locked helical blades. This study aimed to determine the incidence, timing, and amount of postoperative fracture shortening in patients with pertrochanteric hip fractures treated with “dynamically” versus “statically” locked helical blades. MethodsA retrospective review was performed on patients requiring operative fixation of pertrochanteric fractures. Inclusion criteria were patients aged 55 or older, low energy mechanism of injury, primary surgical open reduction and internal fixation of the injury, surgery performed by a fellowship-trained orthopaedic traumatologist, and radiographic follow up until healing or failure (minimum of 3 months). Quantification of fracture shortening was determined using the lateral screw protuberance method. Fracture shortening measurements were calculated from immediate post-operative films and subsequent radiographs at each follow-up visit. Results222 patients met inclusion criteria (123 using Depuy Synthes Trochanteric Fixation Nail proximal femoral nailing system (TFN) with static locking; 65 TFN with dynamic locking; 23 using Depuy Synthes Trochanteric Fixation Nail-Advanced proximal nailing system (TFNA) with static locking; and 11 TFNA with dynamic locking). When comparing the final screw protuberance, the TFN dynamic (10.31 mm), TFNA static (9.52 mm), and TFNA dynamic (7.02 mm) groups were found to be significantly less compared to the TFN static cohort (11.67 mm; p < 0.001). The distribution of fracture shortening was found to be significant (p < 0.01). Interval measurements of fracture shortening by repeated measures of ANOVA within groups showed statistically significant increases in screw protuberance for the TFN static (p < 0.001), TFN dynamic (p < 0.001), and TFNA static (p < 0.01) cohorts within the first 60 days postoperatively. The TFNA with dynamic locking group was found to have statistically significant increases until the first 100 days post-operatively (p < 0.02). DiscussionThe incidence of fracture shortening remains high even with the use of cephalomedullary nails, regardless of dynamization status. Current pertrochanteric fixation constructs continue to favor fracture healing at the direct expense of fracture shortening.

Fracture-Dislocations of the Elbow: A Comparison of Monteggia and Terrible Triad Fracture Patterns.

Fracture-dislocations of the elbow are a spectrum of injuries that have varying outcomes and complications, such as limited range of motion and long-term pain. The Monteggia fracture-dislocation and terrible triad fracture-dislocation are 2 such injury patterns that occur secondary to different mechanisms. This study sought to compare complication profiles and patient outcomes associated with these 2 distinct injury patterns. A retrospective chart review of all adult patients treated by 1 of 3 orthopedic traumatologists at a major academic center for operative fixation for either a Monteggia fracture-dislocation or a terrible triad elbow fracture-dislocation over a 12-year period was performed. Data collected included demographics, surgical data, patient-reported pain and elbow stiffness, elbow range of motion, presence of elbow joint contracture, nerve injuries, healing complications, and need for reoperation. The review included 105 patients, 58 with Monteggia injury and 47 with terrible triad injury, who had complete follow-up and radiographic imaging available. At latest follow-up, the 2 groups had similar rates of pain, reoperation, and ultimate elbow range of motion in flexion, extension, pronation, and supination. Elbow contractures requiring operative release were more commonly associated with terrible triad injury, and the incidence of nonunion was significantly greater in Monteggia fractures. A Monteggia fracture-dislocation portends a higher risk of ulna nonunion, whereas terrible triad injury is associated with elbow contracture. Despite their unique complications, both patterns ultimately have high rates of reoperation as their unique complications are both indications for operative repair. Patients should be appropriately counseled on the complication profile of their unique injury pattern. [Orthopedics. 2023;46(3):158-163.].

“Turning The Tables”: A Technical Tip to Overcome Anatomic Constraints While Distal Locking During Femur Intramedullary Nailing

Introduction: Interlocking nailing for femoral shaft fractures is one of the most common surgeries by orthopedic traumatologists. With the advent of cephalon-medullary nailing, a center-center position of the head screw has become mandatory. With retroversion or reduced anteversion of neck, a center placement needs internal rotation of the nail. This makes distal locking problematic, as now making a perfect circle is difficult due to the physical constraints of C-arm rotation. Objective: To describe a novel technique to overcome the anatomic constraints and get a perfect circle for quick distal locking. Material and Methods: We used a novel technique in our routine femur nailing cases. Here, in cases with reduced anteversion of the neck, distal locking was tenuous due to difficulty in making a perfect circle. Thus, we have used a new technique called “Turning the table” where we externally rotate the table, which allows us to get a perfect circle for locking in almost a single exposure. Results: This is a useful technique in cases where getting a perfect circle is difficult due to anatomic constraints and variations and can help in getting a perfect circle with limited radiation exposure.

Volodymyr Oleksijovych Tankut

On March 23 of this year, one of the leading orthopedic traumatologists of Ukraine, a talented scientist-surgeon, Doctor of Medical Sciences, Professor Volodymyr Oleksiyovych Tankut, turned 75 years old.

Results of a Nationwide Practice Survey of Orthopaedic Traumatologists.

To describe the current practice setting, clinical metrics, and reimbursements for orthopaedic traumatologists in the United States. Nationwide survey of orthopaedic traumatologists. Orthopaedic traumatologists with an active clinical practice. Five-hundred three orthopaedic traumatologists responded to the survey request. A plurality of respondents practiced in an academic setting (48%), with a majority in practice 10 years or less (54%), and having achieved the untenured (89%) rank of assistant professor (37%). For those within private groups, 62% had achieved "partner" status, generally within 1-3 years (53%) of employment. Most surgeons (85%) reported access to a dedicated orthopaedic trauma room, providing nearly all surgeons (97%) with a first start case on weekdays, but only 55% with a first start on weekends. The greatest degree of ancillary support came from physician assistants (80%). Orthopaedic traumatologists most often reported working between 51 and 70 hours per week (66%), with 4-6 nights of call/month (43%), 1 clinic day/week (42%), and with the majority of clinical volume (>75%) related to managing traumatic injury. More than half (53%) of respondents received compensation for call. Annual case volumes and wRVU varied widely. Commonly, respondents had 100% of their salary guaranteed (48%), and most reported eligibility for additional revenue through production bonuses (70%). Three subgroup analyses by years in practice, practice setting, and physician sex provider further insight into clinical characteristics. The results of this nationwide survey provide insight into the current clinical status of orthopaedic traumatology. Providers may find this information useful in job searches and contract negotiations.

Unique indications for internal joint stabilizer for elbow instability.

Treatment of elbow instability remains challenging despite advancements in surgical techniques. The objective of this study was to evaluate obesity, advanced age or frailty, and altered cognitive function (because of mental handicap, stroke, dementia, or traumatic brain injury) as unique indications for the use of the internal joint stabilizer (IJS) to augment surgical treatment of elbow instability. This was a retrospective review of all patients 18 years and older with elbow instability who were managed with an IJS along with standard measures of care for their specific injury, such as fracture fixation and collateral ligament reconstruction. Patients were excluded if they did not have a minimum follow-up of 3 months. All patients were treated by a single shoulder and elbow fellowship-trained orthopedic traumatologist at an urban university-based level 1 trauma center. Twenty-two patients were included in the study. Five patients were 60 years of age or older. Nine patients had a body mass index of 30 or greater. Five patients had a history of 1 or more cerebral insults or cognitive impairment. The majority of patients (21/22; 95%) regained elbow stability after the index surgery. At last follow-up, 14 of 22 patients (63%) regained a functional arc of motion, defined as at least 100° arc of motion, and 77% of patients had at least 90° of motion. Complications requiring revision surgery included culture-negative recurrent elbow instability (n=1), deep infection (n=1), and IJS failure without recurrent instability (n=1). The IJS was removed in all 3 cases. Twelve patients underwent delayed IJS removal >2 months after the index surgery to grant additional time for bony and ligamentous healing and to permit secondary contracture release at the time of IJS removal. No complications were seen from delayed IJS removal. The IJS may be used to create elbow stability in complex patients, regardless of weight, frailty, cognitive function, neurologic insult, or other comorbidities. Unlike external fixation, the IJS does not require pin site care and is relatively light and low-profile. When augmenting surgical fixation for elbow instability, the IJS may be preferable for patients with complex comorbidities or social dynamics.

Diffusion-tensor magnetic resonance imaging of the growth plates: substantiation of the method and evaluation of its reproducibility

INTRODUCTION: In recent years there is an increasing interest in assessing the state of the physis among pediatric orthopedic traumatologists, due to the availability of surgical correction of conditions associated with impaired growth plate function. Application of these methods requires dynamic assessment of the state of the physis. The existing methods for assessing the functional state of the physis are few and imperfect. Magnetic resonance imaging (MRI), in particular diffusion tensor imaging (DTI), is promising for assessing the growth plates.OBJECTIVE: To assess the possibility of applying DTI technique to assess the state of the physis (growth plate).MATERIALS AND METHODS: The study was approved by the local ethical committee of the Institute of the Human Brain named after N.P. Bekhtereva of Russian Academy of Sciences, protocol No. 32, dated 21.12.2020. Informed consent was obtained from each legal representative. At the Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery of the Ministry of Health of the Russian Federation a standard magnetic resonance examination of the knee joints was performed, additionally diffusion tensor tomography was performed in 75 patients aged 4.1 to 14.3 years (41 males, 34 females), both deemed healthy and with a known physeal pathology. The studies were performed using a Philips Ingenia ElitionX machine with a magnetic field strength of 3 Tesla, DTI was performed in the coronal plane, TE=71.2 ms, TR=4000 ms, b-factor value 600 s/mm2, 15 diffusion directions were used, slice thickness was 3 mm without gaps, the matrix size was 1.25×1.25 mm. The resulting images were processed using the DSI Studio software, including tract construction, estimation of the total volume and average length of the tracts. The reproducibility of the technique was assessed.RESULTS: Higher volumes and mean tract lengths were found in healthy males at puberty compared to other groups. When assessing reproducibility, the standard deviations were about 10% of the final value.DISCUSSION: Images of growth plate tracts were obtained. In individuals of pubertal age that were deemed healthy, the tract volume values and the average length of the tracts were higher than in individuals of prepubertal age and those with pathological conditions affecting the state of the growth plates. The average tract length turned out to be more reproducible than the total tract volume parameter.CONCLUSION: With the help of DTI, it is possible to evaluate the arrangement of the structures in the growth plates.

A finite element analysis of the supportive effect of a new type of rotary support plate on lateral tibial plateau fractures

BackgroundTibial plateau fractures (TPFs) are a challenging type of fracture in orthopedic traumatology. We previously designed a plate (Patent Number: CN201520195596.5) for posterolateral TPF combined with posterior lateral collapse.. In this study, finite element analysis was used to compare the biomechanical characteristics of two internal fixation methods for posterolateral TPF. We investigated the support effect of the new steel plate on lateral TPFs combined with posterior TPFs.MethodsTwo models of complex TPF were established. Model A was fixed with the new type of plate, and model B was fixed without the plate. Three axial loads of 500, 1,000, and 1,500 N were applied using FEA on the two fracture models (A and B) to analyze the data.ResultsIn model A, the maximum displacement at 500, 1,000, and 1,500 N was 0.085797, 0.17043, and 0.25465 mm, respectively; the maximum stress of the bone block was 11.285, 20.648, and 29.227 MPa, respectively; and the maximum strain of the bone block was 0.0012474, 0.007435, and 0.0035769 mm, respectively. The maximum displacement of the internal fixation was 0.096932, 0.18682, and 0.27655 mm, respectively; the maximum stress was 69.54, 112.1, and 155.71 MPa, respectively; and the maximum strain was 0.00066228, 0.0010676, and 0.0014829 mm, respectively. In model B, the maximum displacement of fractures at 500, 1,000, and 1,500 N was 0.15675, 0.29868, and 0.44017 mm, respectively; the maximum stress of the bone block was 6.5519, 12.575, and 18.842 MPa, respectively; and the maximum strain of the bone block was 0.0032554, 0.0074357, and 0.012146 mm, respectively. The maximum displacement of the screw was 0.14177, 0.27109, and 0.39849 mm, respectively; the maximum stress was 48.916, 92.251, and 135.27 MPa, respectively; and the maximum strain was 0.00046608, 0.00087893, and 0.0012887 mm, respectively.ConclusionsThe fixation method using this type of plates and screws can replace other methods using two plates to fix complex TPF.

Routine Postoperative Computed Tomography Scans Following Posterior Pelvic Fixation of Pelvic Ring Fractures: A Survey of (OTA) Orthopaedic Traumatologists.

To assess practices related to ordering computed tomography (CT) scans routinely after posterior pelvic ring fixation and revision surgery rates. A 20-question cross-sectional survey. Fellowship-trained orthopaedic traumatologists. (1) Percentage of surgeons ordering a routing postoperative CT after posterior pelvic ring fixation, (2) Revision surgery rates based on routine CT scan results. Responses were received from 57 surgeons. Practices varied regarding postoperative CT scans, with 20 surgeons (35%, group A) routinely ordering them and 37 surgeons (65%, group B) not ordering them on all patients. Group A were younger and with less years of experience than those in Group B. Most group A surgeons report a revision surgery rate of <1% based on results of the postoperative CT. Group A report routine postoperative scans were obtained to assess reduction, instrumentation placement, and for educational purposes. Group B did not obtain routine postoperative CTs because of the following: unlikely to change postoperative treatment course, adequate reduction and instrumentation placement assessed intraoperatively and by postoperative radiographs, and increased radiation exposure and cost to patients. Group B did report obtaining postop CT scans on select patients, with postoperative neurological deficit being the most common indication. The routine use of postoperative CTs following posterior fixation of pelvic ring fractures is a controversial topic. Although we recognize the role for postoperative CT scans in select patients, our study questions the clinical utility of these scans in all patients and in conclusion do not recommend this protocol.

First national manual on pediatric traumatology and its author N.G. Dam’e

The article discusses the content of the first Russian manual on pediatric traumatology and the key points of the biography and work of its author, Nikolai G. Dame. The article introduction briefly outlines the creation history of the first Russian manual on traumatology for adult patients, which noted that pediatric traumatology developed within the framework of pediatric surgery. The first part of the work focused on its greatest interest to readers. It presents previously unpublished reviews of famous orthopedic traumatologists for the first (1950) and second (1960) editions, which perfectly reveal the books content. The second part of the article included the published autobiography written by N.G. Dame. Additionally, the work of N.G. Dame based on archival documents as a military field surgeon during the Great Patriotic War was presented in the same section. The final part included the role of N.G. Dame in creating an original school of pediatric trauma surgeons.&#x0D; The merit of N. G. Dame is the creation of a manual that outlines the basics of diagnosing and treating injuries in children of all types and localizations. He believed that a traumatologist should have the necessary knowledge and skills in emergency general surgery, neurotraumatology, and other surgical specialties. Thus, he anticipated the creation of injury surgery, of which the basic provisions were transferred from the practice of military field surgery.

Lateral femoral distraction is a safe and necessary adjunct for articulator visualization during the operative treatment of tibial plateau fractures

IntroductionRecent evidence suggests use of lateral femoral distractor (LFD) to aid in visualization during surgery for tibial plateau fractures (TPF) may result in an unacceptably high rate of iatrogenic peroneal nerve palsy. We sought to evaluate femoral distractor use for open reduction internal fixation (ORIF) of TPF and quantify the incidence of peroneal nerve palsy. MethodsWe retrospectively evaluated all patients undergoing ORIF of TPF between 2014 and 2019 by a single fellowship trained orthopaedic traumatologist at a single Level 1 trauma center. Inclusion criteria were use of a LFD during ORIF of TPF. Exclusion criteria were preoperative neurovascular injury in the operative extremity and distraction via pre-existing external fixator. Parameters included patient demographic variables, intraoperative techniques, postoperative outcomes, and fracture classification. Documented clinical exam was used to evaluate peroneal nerve status and injuries were classified as complete or incomplete. Incomplete injuries were classified as sensory or motor. ResultsOf 303 patients undergoing ORIF for a TPF, femoral distraction was used in 254 (83.8%) cases, with 201 utilizing applied intraoperative femoral distraction and 53 utilizing pre-existing knee-spanning external fixation for distraction. Three patients were excluded for preoperative sensory peroneal nerve palsy with 175 patients meeting inclusion criteria. The most common fracture type was lateral split depression (n = 130). Zero patients developed complete or incomplete peroneal nerve palsy. DiscussionOur study found no incidence of peroneal nerve palsy when using lateral femoral distraction. This study supports the utilization of lateral distraction for articular visualization and reduction during ORIF of TPF.

Triceps Surae Lengthening in Foot and Ankle Trauma: A Survey of OTA and AOFAS Members.

Background:The prevalence, indications, and preferred methods for gastrocnemius recession and tendo-Achilles lengthening—grouped as triceps surae lengthening (TSL) procedures—in foot and ankle trauma are supported by a scarcity of clinical evidence. We hypothesize that injury, practice environment, and training heritage are significantly associated with probability of performing adjunctive TSL in the operative management of foot and ankle trauma.Methods:A survey was distributed to members of the American Orthopaedic Foot & Ankle Society and the Orthopaedic Trauma Association. Participants rated how likely they would be to perform TSL at initial management, definitive fixation, and after weightbearing in the presence and absence of a positive Silfverskiöld test in 10 clinical scenarios of closed foot and ankle trauma.Results:A total of 258 surgeons with median 14 years’ experience responded. Eighty-five percent reported foot and ankle fellowship training, 24% reported traumatology fellowship training, 13% both, and 4% no fellowship. Ninety-nine percent reported performing TSL with a median 25 TSL procedures per year, 72% open gastrocnemius recession, and 17% percutaneous tendo-Achilles lengthening). Across all scenarios, we observed low overall 8% probability with fair agreement (κ = 0.246) of performing TSL (range, 1% at initial management of an unstable Weber B bimalleolar ankle fracture with negative contralateral Silfverskiöld test to 29% at definitive fixation of tongue-type calcaneus fracture with positive contralateral Silfverskiöld test). Silfverskiöld testing significantly influenced TSL probability at all time points. University of Washington training (β = 1.5, P = .007) but not trauma vs foot fellowship training, years in practice, academic practice, urban setting, or facility trauma designation were significantly associated with likelihood of performing TSL.Conclusion:Orthopaedic traumatology and foot and ankle surgeons report similar indications, methods, and low perceived propensity to use TSL in the management of foot and ankle trauma. We found that graduates of 1 fellowship training site were more likely to perform TSL in the setting of acute trauma potentially indicating the need for better scientific data to support this practice.Level of Evidence:Level V, therapeutic.

Clinical case of applying a safe loading range to a limb in a patient with a femoral neck fracture

Introduction. Currently, most orthopedic traumatologists consider surgical treatment as the method of choice for fractures of the femoral neck. However, despite the constant modernization of the available methods of osteosynthesis, the proportion of unsatisfactory outcomes of surgical intervention and the occurrence of early postoperative complications remains quite high (from 28 to 45%) [1]. One of the main directions for solving the problem of unsatisfactory outcomes of osteosynthesis is the improvement and strict control of measures taken in the postoperative period, including early activation of the patient. Despite the importance of the recovery period, there are still no unified standards for managing patients with hip fractures, and the available treatment protocols contain only a generalized plan for further therapeutic measures that do not take into account the individual characteristics of the patient. We have proposed a method for calculating the optimal load on the limb in the postoperative period. The purpose of this publication is to describe a clinical case of the effective application of the method for determining the optimal range of loads on a limb after surgical treatment of femoral neck fractures.Materials and methods: the study used materials from medical records and instrumental studies of the traumatology department of the TOGBUZ "City Clinical Hospital of Kotovsk", the results of dynamic observation for 12 months in a patient with a transcervical fracture of the femoral neck, for which the method we developed for determining the optimal range was applied. load on the limb after surgical treatment of injury.Results: 12 months after the operation, the patient who used the method for determining the safe load range in the recovery period achieved full functional and anatomical recovery of the operated limb. Full body weight bearing was allowed from the 6th month.Conclusion: the method for determining the safe range of load on the limb after a femoral neck fracture has been tested in practice and led to a positive result, which may indicate its effectiveness.

Estimating the Nosocomial Transmission Rate of COVID-19 in Orthopaedic Surgery Patients During the Peak of the Pandemic.

PurposeTo estimate the risk of hospital-acquired COVID-19 transmission in a population of orthopaedic trauma patients during the first wave of the pandemic.Patients and MethodsThis is a retrospective cohort study of 109 patients who underwent an emergent orthopedic procedure by a single orthopedic traumatologist between March 1, 2020 and May 15, 2020 during the first peak of the pandemic. After applying inclusion and exclusion criteria, a total of 82 patients (67 inpatients and 15 ambulatory) were identified for final analysis. The primary outcome measured was postoperative Coronavirus (COVID-19) status. Secondary outcome measures included length of stay and discharge disposition.ResultsThe mean age and length of stay in the hospital group was 59.5 years (± 21.7) and 4.3 days (± 4.6), respectively, versus 47.9 years (± 9.8) in the ambulatory group. 7.3% (6/82) of the inpatients subsequently tested or screened positive for COVID-19 at 2 weeks post-operatively, compared to 0/15 ambulatory patients (P=0.58). Of the 6 inpatients who tested positive, 4 (66.7%) were discharged to a rehabilitation center. Diabetes (P=0.05), hypertension (P=0.02), and congestive heart failure (P=0.005) were associated with transmission.ConclusionIn this analysis, there was a nosocomial transmission rate of 7% compared to zero in the ambulatory surgery center, however this was not found to be statistically significant. This data supports the use of precautions such as frequent screening, hand washing, and masks to reduce transmission when COVID-19 rates are high. There is a lower risk of nosocomial COVID-19 transmission for patients treated as an outpatient and elective surgical procedures may be safer in this setting.