Outcomes of isolated medial tibial plateau fractures by fracture morphology.

PURPOSE: To identify a cohort of isolated medial tibial plateau fractures treated with surgical fixation and to categorize them by Moore and Wahlquist classifications in order to determine the rate of complications with each fracture morphology and the predictive value of each classification system. We hypothesized there would be high rates of neurovascular injury, compartment syndrome, and complications overall with a higher incidence of neurovascular injury in Moore type III rim avulsion fractures and Wahlquist type C fractures that enter the plateau lateral to the tibial spines. METHODS: Patients who presented to six Level I trauma centers between 2010 and 2021 who underwent surgical fixation for isolated medial tibial plateau fractures were retrospectively reviewed. Data including demographics, radiographs, complications, and functional outcomes were collected. RESULTS: One hundred and fifty isolated medial tibial plateau fractures were included. All patients were classified by the Wahlquist classification of medial tibial plateau fractures, and 139 patients were classifiable by the Moore classification of tibial plateau fracture-dislocations. Nine percent of fractures presented with neurovascular injury: 5 % with isolated vascular injury and 6 % with isolated nerve injury. There were no significant differences in neurovascular injury by fracture type (Wahlquist p = 0.16, Moore p = 0.33). Compartment syndrome developed in two patients (1.3 %). The average final range of motion was 0.8-122° with no difference by Wahlquist or Moore classifications (p = 0.11, p = 0.52). The overall complication rate was 32 % without differences by fracture morphology. The overall rate of return to the operating room (OR) was 25 %. CONCLUSIONS: Isolated medial tibial plateau fractures often represent fracture-dislocations of the knee and should receive a meticulous neurovascular exam on presentation with a high suspicion for neurovascular injury. No specific fracture pattern was found to be predictive of neurovascular injuries, complications, or final knee range of motion. Patients should be counseled pre-operatively regarding high rates of return to the OR after the index surgery.

Osteochondral Allografts in Knee Surgery: Narrative Review of Evidence to Date.

Knee articular cartilage defects can result in significant pain and loss of function in active patients. Osteochondral allograft (OCA) transplantation offers a single-stage solution to address large chondral and osteochondral defects by resurfacing focal cartilage defects with mature hyaline cartilage. To date, OCA transplantation of the knee has demonstrated excellent clinical outcomes and long-term survivorship. However, significant variability still exists among clinicians with regard to parameters for graft acceptance, surgical technique, and rehabilitation. Technologies to optimize graft viability during storage, improve osseous integration of the allograft, and shorten recovery timelines after surgery continue to evolve. The purpose of this review is to examine the latest evidence on treatment indications, graft storage and surgical technique, patient outcomes and survivorship, and rehabilitation after surgery.

The dual degree orthopedic surgeon: A survey of the trends, motivations, and perceived value of the master of business administration degree.

Orthopedic surgeons are obtaining Master of Business Administration (MBA) degrees at an increasing rate. This study aimed to identify the motivations, trends, and perceived value of the MBA degree for these dual degree surgeons. A total of 157 orthopedic surgeons with both MD and MBA degrees were surveyed with a 19-item questionnaire to identify surgeons' motivations for obtaining an MBA degree and the perceived value of the degree. A total of 66 responses (42%) were received. Most respondents (89.4%) viewed the MBA degree as either extremely valuable or valuable. Prior to obtaining an MBA, 71.9% of dual degree surgeons dedicated time to administrative duties outside of the clinic. This number increased to 98.4% after receiving an MBA (p < 0.001). With the growing number of surgeons pursuing MBA degrees, there is a decrease in the time spent in the clinical role suggesting that either the non-clinical burden is increasing, or surgeons choose to re-allocate their time. Despite the high direct costs of an MBA, a majority of orthopedic surgeons perceived the MBA degree as a valuable investment they would pursue again.

Platelet-Rich Plasma Is an Equal Alternative to Surgery in the Treatment of Type 1 Medial Epicondylitis.

BACKGROUND: Medial epicondylitis (ME) is characterized as an overuse injury resulting in pathological alterations of the common flexor tendon at the elbow. Platelet-rich plasma (PRP) has recently become of interest in the treatment of musculoskeletal conditions as an alternative to operative management. PURPOSE: To compare the outcomes of recalcitrant type 1 ME after treatment with either PRP or surgery. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: To compare the 2 methods of treatment, we performed a retrospective review of 33 patients diagnosed with type 1 ME from 2006 to 2016 with a minimum clinical follow-up of 1 year who had failed an initial nonoperative treatment program of injections, medication, topical creams, and/or physical therapy. Overall, 15 patients were treated with a series of 2 leukocyte-rich PRP injections, and 18 patients were treated with surgery. Outcome measures included time to pain-free status, time to full range of motion (ROM), the Mayo Elbow Performance Score (MEPS), and the Oxford Elbow Score (OES). Each patient had at least 1-year follow-up. They were then contacted by telephone to determine final scores at a minimum 2-year follow-up. Unsuccessful outcomes were determined by the Nirschl grading system and failure to reach pain-free status, achieve baseline ROM, or return to previous activity. RESULTS: The mean final follow-up was 3.9 years. A statistically significant improvement was noted in both time to full ROM (42.3 days for PRP vs 96.1 days for surgery; P < .01) and time to pain-free status (56.2 days for PRP vs 108.0 days for surgery; P < .01). Successful outcomes were observed in 80% of patients treated with PRP and 94% of those treated operatively (P = .37). No significant difference was found in return-to-activity rates, overall successful outcomes, MEPS scores, or OES scores. CONCLUSION: In this case series, the use of PRP showed clinically similar outcomes to those of surgery in recalcitrant type 1 ME. PRP can be considered as an alternative to surgery in the treatment of recurrent ME, with an earlier time to full ROM and time to pain-free status compared with surgery.

Occlusion Outside the Norm: A Unique Case of the Pulseless, Well-Perfused Hand Following Closed Humeral Shaft Fracture.

Transient arterial injury is a common complication encountered in the management of pediatric supracondylar humerus fractures, often presenting as a pulseless hand that appears well perfused, also known as the "pink, pulseless hand." Arterial injuries in pediatric humeral shaft fractures, on the other hand, are exceedingly rare, especially in closed fractures. The authors report a rare case of a humeral shaft fracture presenting as a pink, pulseless hand. Although this complication was initially managed according to supracondylar protocol, the patient's neurologic status deteriorated. This prompted vascular assessment with computed tomography angiography, revealing a complete occlusion of the brachial artery. At this more proximal level, there is significant risk for compromise of the collateral circulation. The patient was eventually treated successfully with open reduction of the fracture followed by brachial artery repair. Although watchful waiting may be appropriate in the management of this entity for supracondylar fractures, more aggressive management was indicated for this patient because of the occlusion occurring prior to the bifurcation of the brachial artery. The lack of collateral circulation makes improvement in this injury pattern unlikely. This report emphasizes that suspected vascular injury following humeral shaft fractures should be evaluated with computed tomography angiography. If an occlusion is identified, it should be treated aggressively with immediate open fracture reduction and evaluation by a vascular team for possible repair vs grafting. [Orthopedics. 2019; 42(2):e279-e281.].