Bicondylar Tibial Plateau Fractures: What Predicts Infection?

OBJECTIVES: The purpose of this study was to identify the patient, injury, and treatment factors associated with infection of bicondylar plateau fractures and to evaluate whether center variation exists. DESIGN: Retrospective review. SETTING: Eighteen academic trauma centers. PATIENTS/PARTICIPANTS: A total of 1,287 patients with 1,297 OTA type 41-C bicondylar tibia plateau fractures who underwent open reduction and internal fixation were included. Exclusion criteria were follow-up less than 120 days, insufficient documentation, and definitive treatment only with external fixation. INTERVENTION: Open reduction and internal fixation. MAIN OUTCOME MEASUREMENTS: Superficial and deep infection. RESULTS: One hundred one patients (7.8%) developed an infection. In multivariate regression analysis, diabetes (DM) (OR [odds ratio] 3.24; P ≤ 0.001), alcohol abuse (EtOH) (OR 1.8; P = 0.040), dual plating (OR 1.8; P ≤ 0.001), and temporary external fixation (OR 2.07; P = 0.013) were associated with infection. In a risk-adjusted model, we found center variation in infection rates (P = 0.030). DISCUSSION: In a large series of patients undergoing open reduction and internal fixation of bicondylar plateau fractures, the infection rate was 7.8%. Infection was associated with DM, EtOH, combined dual plating, and temporary external fixation. Center expertise may also play a role because one center had a statistically lower rate and two trended toward higher rates after adjusting for confounders. LEVEL OF EVIDENCE: Level IV-Therapeutic retrospective cohort study.

Outcomes of orthopaedic trauma surgery in COVID-19 positive patients.

OBJECTIVES: To investigate outcomes for operative orthopaedic trauma in patients who tested positive for coronavirus disease 2019 (COVID-19) during the height of the COVID-19 pandemic in New York. DESIGN: Retrospective case series. SETTING: Urban Level-1 academic trauma center. PATIENTS/PARTICIPANTS: Thirteen patients diagnosed with COVID-19 who underwent surgical management for orthopaedic trauma between January 21, 2020 and May 11, 2020. INTERVENTION: Does not apply to this study. MAIN OUTCOME MEASUREMENTS: Complications including death, coma lasting more than 24 hours, prolonged mechanical ventilation, unplanned intubation, blood transfusion, postoperative pneumonia, cerebrovascular event, thromboembolic event, myocardial infarction, urinary tract infection, acute renal failure, septic shock, return to the operating room, wound dehiscence, surgical site infection, graft/prosthesis/flap failure, and peripheral nerve injury. RESULTS: Two (18%) patients had symptoms of COVID-19 (cough, shortness of breath, fevers, chills, nausea/vomiting, diarrhea, abdominal cramps/pains) on admission. Average length of stay (standard deviation) was 6.6 (4.31) days. Average time to follow up was 29 (10.77) days. Three (27%) patients developed pneumonia postoperatively and 1 (9%) underwent unplanned intubation. One (9%) patient was intubated for greater than 48 hours. Two (18%) patients developed postoperative deep venous thromboembolism. Three (27%) patients developed acute renal failure postoperatively. Six (55%) patients underwent blood transfusion intraoperatively or postoperatively. Two (18%) patients died postoperatively. CONCLUSION: In this small series surgical management in Coronavirus-19 positive patients with skeletal injuries was successfully accomplished with patient anticoagulation, hematologic, and pulmonary status in mind. Therapeutic anticoagulation and patient hematologic status were optimized prior to the operating room to minimize development of venous thromboembolism and avoid blood transfusion. LEVEL OF EVIDENCE: Level IV prognostic.

Surgical Wound Complications After Percutaneous Posterior Pelvic Ring Fixation in Patients Who Undergo Pelvic Arterial Embolization.

OBJECTIVE: To report on the incidence of surgical wound complications after percutaneous posterior pelvic ring fixation in patients who have also undergone pelvic arterial embolization (PAE) and determine whether the risks outweigh the benefits. DESIGN: Retrospective cohort study. SETTING: Academic level 1 trauma center. PATIENTS: Two hundred one consecutive patients who underwent percutaneous posterior pelvic fixation at our institution were included in this study. Of these, 27 patients underwent pelvic arterial embolization. INTERVENTION: Percutaneous posterior pelvic fixation and pelvic arterial embolization. MAIN OUTCOME MEASUREMENTS: Charts were reviewed for posterior percutaneous surgical wound complications including infection, dehiscence, seroma, tissue necrosis, and return to OR for debridement in all patients. RESULTS: Of the 27 patients who received PAE, none developed posterior surgical wound complications. Of those who did not receive PAE, there was one posterior surgical wound complication documented. There were no cases of wound infection in either group. CONCLUSION: Pelvic arterial embolization can be a valuable intervention in treating hemodynamically unstable patients with pelvic ring injuries. Although even selective pelvic arterial embolization is not entirely benign, there seems to be minimal risk of wound complications when percutaneous posterior pelvic ring fixation is performed. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cerclage Cable Tensioning of Intraoperative Hip Arthroplasty Proximal Femoral Fractures: A Cadaveric Model.

Cerclage fixation following intraoperative fracture of the proximal femur during total hip arthroplasty (THA) carries a risk of compromising the femoral blood supply. Thus, we sought to determine the minimum cerclage cable tension required to restore the stability of a cementless femoral stem. Cementless femoral prostheses were implanted in seven proximal femoral cadaver specimens, and a periprosthetic fracture was simulated in the medial cortex. A single cerclage cable was placed just above the lesser trochanter and tensioned and tested at increasing intervals. The implant's torsional stability was determined in the intact bone, prior to fixation, and at each level of cable tension. We found that a single cerclage cable placed above the lesser trochanter can significantly improve, but not fully restore, torsional stability following intraoperative periprosthetic femur fracture during THA. The optimal position for a single cerclage cable appears to be above the lesser trochanter. (Journal of Surgical Orthopaedic Advances 29(4):209-211, 2020).

The Impact of Eccentric Diaphyseal Plate and Screw Placement on the Risk of Peri-Implant Fracture.

BACKGROUND: The objective of this study was to determine the impact of the type and orientation of peripheral screw placement in an eccentrically positioned locking plate on the structural integrity of the plate-diaphyseal bone interface. We hypothesized that central placement of the screw at the end of the plate in this setting is more important than screw type (locking versus nonlocking) to limiting the risk of subsequent fracture. METHODS: Twenty osteoporotic fourth-generation composite left humeri were divided into 4 groups and plated with stainless-steel 6-hole locking plates and 4.5-mm screws. Group 1 (control group) consisted of a centrally positioned plate with a centrally placed non-locking end screw at the sixth, most-proximal hole. Group 2 consisted of an eccentrically positioned plate with a non-locking proximal end screw placed through the center of the bone. Group 3 consisted of an eccentrically positioned plate with a locking proximal end screw placed perpendicular to the plate and eccentrically across the cortex. Group 4 consisted of an eccentrically positioned plate with a non-locking proximal end screw placed perpendicular to the plate and eccentrically across the cortex. Each group was tested with a single load to failure in torsion at a rate of 1°/second. RESULTS: The control group (Group 1) failed at significantly higher peak torque values (51.62 ± 7.35 Nm) than Group 2 (38.98 ± 6.78 Nm; p = 0.006), Group 3 (34.75 ± 1.81 Nm; p < 0.001), and Group 4 (31.55 ± 1.23 Nm; p < 0.001). Failure energy absorbed in Group 1 (2,591.49 ± 819.63 Nm/degree) was significantly higher than Group 3 (1,430.51 ± 449.99 Nm/degree; p = 0.04) and Group 4 (952.49 ± 123.52 Nm/degree; p = 0.004), but not significantly higher than Group 2 (1,847.73 ± 827.35 Nm/degree; p = 0.27). CONCLUSIONS: Eccentrically placed plating of humeral shaft fractures significantly increases the risk of peri-implant fracture compared with a centrally placed plate. Directing the proximal-end screw centrally in an eccentrically placed plate may help to mitigate this risk at the proximal end. CLINICAL RELEVANCE: When possible, care should be taken to place the plate centrally on the bone to avoid increased risk of peri-implant fracture at the proximal plate-bone interface.

Styryl-based compounds as potential in vivo imaging agents for beta-amyloid plaques.

A group of styryl-based neutral compounds has been synthesized in this study for potential use as in vivo imaging agents for beta-amyloid plaques. Of 56 candidates, 14 compounds were found to label beta-amyloid plaques well on Alzheimer's disease (AD) human brain sections in vitro. The binding affinity to beta-amyloid fibrils was then determined by measuring the change in fluorescence intensity. Interestingly, we found that a class of quinaldine-styryl scaffold compounds displays specific binding to beta-amyloid fibrils. A representative compound, STB-8, was used in ex vivo and in vivo imaging experiments on an AD transgenic mouse model and demonstrated excellent blood-brain barrier (BBB) permeability and specific staining of the AD beta-amyloid plaques.

RNA-selective, live cell imaging probes for studying nuclear structure and function.

The higher-order structural organization of the cell nucleus reflects the underlying genome-wide transcriptional activity and macromolecular transport processes. To study the microscopic organization of RNA distribution within the nucleus, a combinatorial library of fluorescent styryl molecules was synthesized and screened for an in vitro RNA response and live cell nuclear imaging. Four different cell lines (HeLa, A549, 3T3, and 3T3-L1) were analyzed in terms of higher-order nuclear organization. We identified RNA-selective dyes with better imaging properties relative to commercially available SYTORNASelect dye; the selected dyes were also cell permeant, photostable, and well tolerated by the cells. Our dyes also had very good counterstain compatibility with Hoechst and DAPI, which could help to image the DNA distribution in relation to RNA distribution in live cells and therefore reveal different patterns of RNA-DNA colocalization.