Percutaneous Titanium Elastic Nail Stabilization for Pelvic and Acetabular Fractures: Surgical Technique and Case Series.

SUMMARY: The stabilization of fractures of the anterior pelvic ring and anterior column of the acetabulum with antegrade or retrograde intramedullary screws has been frequently described. However, these narrow and nonlinear bony corridors can be challenging and dangerous to accommodate with rigid linear implants. Titanium elastic nails (TEN) are ideal implants to navigate in the narrow, irregular medullary canal in this anatomical location. This study aims to describe this surgical technique and its preliminary results. From April 2018 to October 2023, patients who underwent acute TEN stabilization of their pelvic or acetabular fractures were identified from a review of medical records at a Level 1 trauma center. A focused review of their clinical documentation was performed to describe their demographics, injury patterns, the surgical techniques used in their treatment, and their clinical and radiographic outcomes. During the almost 6-year period, 19 patients were identified (age: 39 ± 22 years; 74% male). There were 3 acetabulum and 16 pelvic ring fractures stabilized. One of the 19 patients underwent bilateral TEN fixation of the superior pubic rami. Patients were followed-up through hospital outpatient clinics postoperatively (median follow-up 14 months, IQR: 8-24 months). No fractures were complicated by nonunion or secondary displacement of the reduction. A 14-year-old patient required hardware removal due to irritation, and a 19-month-old patient underwent planned hardware removal due to her age. No patients have undergone hip arthroplasty to date, and there were no instances of infection or neurovascular injury. These preliminary results are promising and suggest that larger scale assessment of the indications and feasibility of TEN stabilization in pelvic and acetabular surgery is warranted.

Microbiology of fracture related infections.

Fracture related infection remains a challenging complication that creates a heavy burden for orthopaedic trauma patients, their families, treating physicians and healthcare systems. Even current curative approaches (radical debridement, revision surgery and long-term antibiotics) often result in significant socioeconomic costs and the risk of life-long functional impairment to the patient. The prevalence of osteomyelitis due to trauma and surgical complications does not seem to be diminishing in our society and the emergence of antimicrobial resistance is a major health related concern with global relevance. Despite multi-drug resistant bacteria being on the rise universally, perioperative antibiotic prophylaxis in orthopaedic trauma care has only slightly changed in the last 25 years. Staphylococcus infections remain an increasing global concern, partially due to the resistance mechanisms developed by staphylococci to evade the host immune system and antibiotic treatment, and as such antibiotics are becoming increasingly ineffective. This paper will address fracture related infections in trauma patients, looking at the bacteriology of these infections, its clinical implications and evolving nature.

Medial Calcar Comminution and Intramedullary Nail Failure in Unstable Geriatric Trochanteric Hip Fractures.

Background and Objectives: An increasing global burden of geriatric hip fractures is anticipated. The appropriate treatment for fractures is of ongoing interest and becoming more relevant with an aging population and finite health resources. Trochanteric fractures constitute approximately half of all hip fractures with the medial calcar critical to fracture stability. In the management of unstable trochanteric fractures, it is assumed that intramedullary nails and longer implants will lead to less failure. However, the lack of power, inclusion of older generation femoral nails, and a variable definition of stability complicate interpretation of the literature. Materials and Methods: Between January 2012 and December 2017, a retrospective analysis of operatively treated geriatric trochanteric hip fracture patients were examined at a Level 1 Trauma Centre. The treatment was with a long and short version of one type of trochanteric nail. Unstable trochanteric fractures with medial calcar comminution were examined (AO31A2.3, 2.3 & 3.3). The length of the medial calcar loss, nail length, demographics, fracture morphology, and relevant technical factors were examined in univariate and multivariate analysis using competing risk regression analysis. The primary outcome was failure of fixation with post-operative death the competing event and powered to previously reported failure rates. Results: Unstable patterns with medial calcar comminution loss constituted 617 (56%) of operatively treated trochanteric fractures. Failure occurred in 16 (2.6%) at a median post-operative time of 111 days (40-413). In univariate and multivariate analysis, only younger age was a significant predictor of failure (years; SHR: 0.91, CI 95%: 0.86-0.96, p < 0.001). Nail length, medial calcar loss, varus reduction, and other technical factors did not influence nail failure. Conclusions: In a cohort of unstable geriatric trochanteric hip fractures with medial calcar insufficiency, only younger patient age was predictive of nail failure. Neither the length of the medial calcar fragment or nail was predictive of failure.

Suture and Splint Compared With K-Wire Fixation for Open Zone 1 Extensor Tendon Injuries.

Extensor tendon injuries are classified as per the zone of injury. Zone 1 injuries disrupt the lateral bands with resultant inability to extend the distal interphalangeal joint. Open Zone 1 injuries have many well-described treatment options. To date, none of these have been compared directly. Our aim was to compare the benefit of additional Kirschner-wire fixation with suture repair and splinting of open Zone 1 extensor tendon injuries. We performed a retrospective cohort analysis comparing 2 different surgical procedures, "Suture and Splint" versus "Suture, Splint, and Kirschner wire." The 2 outcomes measured were final range of movement and lag. We had a total of 50 patients. There was no difference in range of motion and the mean length of splint time between the 2 groups. There was increased incidence of lag associated with Kirschner-wire group.