Preinjury Narcotic Use Does Not Affect Treatment for Compartment Syndrome.

OBJECTIVES: To determine the association of preinjury opioid use on incidence of fasciotomy after lower extremity trauma. DESIGN: Retrospective case-control study. SETTING: Level 1 trauma center. PATIENTS/PARTICIPANTS: We identified 245 consecutive patients treated with fasciotomy for compartment syndrome of the lower extremity from 2011 to 2016. Of these, 115 were excluded for isolated vascular injury without fracture, age younger than 18 years, out-of-state residence, nontraumatic etiology, and/or incomplete opioid records. Three hundred ninety age- and sex-matched patients with tibial fractures not requiring fasciotomy were selected for comparison. INTERVENTION: Review of demographics, injury characteristics, and opioid prescriptions. MAIN OUTCOME MEASUREMENTS: Rate of preinjury narcotic use. RESULTS: There was no significant difference in chronic opioid use between patients requiring fasciotomy and those who did not (odds ratio = 0.80, 95% confidence interval: 0.43-1.50, P = 0.49). There was no significant difference in average morphine milligram equivalents (MME)/day (66.6 vs. 77.4, P = 0.68). There was no significant difference in active opioid use (odds ratio = 0.76, 95% confidence interval: 0.45-1.29, P = 0.30). There was no significant difference in average MME/day (69.3 vs. 75.6, P = 0.80) for active narcotic users. CONCLUSION: There were no differences in the rate or average MME/day of preinjury opioid use between patients with a tibia fracture treated with or without fasciotomy for compartment syndrome. These results indicate that pre-existing opioid use does not interfere with the accurate diagnosis of compartment syndrome in trauma patients. The diagnosis and treatment of compartment syndrome is not affected by preinjury narcotic use and potential associations with opiate-induced hyperalgesia. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Is there a gluteus medius tendon injury during reaming through a modified medial trochanteric portal? A cadaver study.

OBJECTIVES: The purpose of this cadaveric study was to evaluate whether there is any damage to the gluteus medius tendon when reaming through a modified medial trochanteric portal for antegrade intramedullary femoral nailing. METHODS: Ten cadaver hips were used in this study. A guidewire was placed in the modified medial trochanteric portal using the assistance of C-arm fluoroscopy and a 14-mm reamer was advanced over the wire. After the reaming was complete, each hip was dissected and the gluteus medius muscle and tendon were inspected to evaluate the amount of intrasubstance and medial tendon damage. RESULTS: Precise localization of the modified medial trochanteric portal was achieved in 9 of 10 cadaver hips. Of those nine hips, the use of the modified medial trochanteric portal did not result in any visible damage to the tendinous insertion of the gluteus medius or the medial aspect of the tendon in any of the specimens. CONCLUSIONS: There is no damage to the gluteus medius tendon with the use of the modified medial trochanteric portal. Although the clinical implications of this finding are not known with certainty, the use of the modified medial trochanteric entry portal for antegrade femoral nailing could possibly result in less postoperative morbidity because it does not damage the gluteus medius tendon as compared to the traditional more lateral trochanteric portal.

The link between texting and motor vehicle collision frequency in the orthopaedic trauma population.

BACKGROUND: This study will evaluate whether or not texting frequency while driving and/or texting frequency in general are associated with an increased risk of incurring a motor vehicle collision (MVC) resulting in orthopaedic trauma injuries. METHODS: All patients who presented to the Vanderbilt University Medical Center Orthopaedic Trauma Clinic were administered a questionnaire to determine background information, mean phone use, texting frequency, texting frequency while driving, and whether or not the injury was the result of an MVC in which the patient was driving. RESULTS: 237 questionnaires were collected. 60 were excluded due to incomplete date, leaving 57 questionnaires in the MVC group and 120 from patients with non-MVC injuries. Patients who sent more than 30 texts per week ("heavy texters") were 2.22 times more likely to be involved in an MVC than those who texted less frequently. 84% of respondents claimed to never text while driving. Dividing the sample into subsets on the basis of age (25 years of age or below considered "young adult," and above 25 years of age considered "adult"),young, heavy texters were 6.76 times more likely to be involved in an MVC than adult non-heavy texters (p = 0.000). Similarly, young adult, non-heavy texters were 6.65 (p = 0.005) times more likely to be involved in an MVC, and adult, heavy texters were 1.72 (p = 0.186) times more likely to be involved in an MVC. CONCLUSIONS: Patients injured in an MVC sent more text messages per week than non-MVC patients. Additionally, controlling for age demonstrated that young age and heavy general texting frequency combined had the highest increase in MVC risk, with the former being the variable of greatest effect.

Percutaneous fixation of the medial condyle in bicondylar tibial plateau fractures: novel use of the 3.5-mm medial distal tibia plate.

Internal fixation for fractures involving the medial tibial plateau is a controversial topic. Surgical options include buttress plating with antiglide plate, T-shaped proximal tibia plates, external fixation, and isolated screw fixation. Operative management is often complicated by soft-tissue concerns. In this article, we describe a percutaneous surgical technique in which a 3.5-mm medial distal tibia plate, originally designed for distal tibial shaft or pilon fractures, is used in osteosynthesis of the medial tibial plateau. Use of this implant reduces soft-tissue dissection and thereby decreases risk for soft-tissue infection or slough while preventing medial column collapse and varus deformity of the knee. Orthopedic surgeons should consider this novel hardware application as an option for osteosynthesis in certain bicondylar tibial plateau fractures.