Upper extremity injuries in the victims of intimate partner violence.

OBJECTIVES: To recognize most common patterns of upper extremity (UE) injuries in victims of Intimate Partner Violence (IPV). METHODS: Radiological review of 308 patients who reported physical IPV at our institution from January 2013 to June 2018, identified 55 patients with 88 unique UE injuries. Demographic data and injury patterns and associations were collected from the electronic medical records. RESULTS: The cohort included 49 females and 6 males (age 19-63, mean 38). At the time of injury, IPV was reported in 15/88 (17%) and IPV screening was documented for 22/88 (25%) injuries. There were 46 fractures, 8 dislocations or subluxations, and 34 isolated soft tissue injuries, most commonly involving the hand (56/88). Fractures most commonly involved the fingers (21/46, 46%) and the 5th digit (8/27, 30%). Medial UE fractures (5th digit, 4th digit) constituted 44% of hand and finger fractures (12/27) and 26% of all fractures (12/46). Comminuted and displaced fractures were rare (8/46, 17%). Head and face injuries were the most common concomitant injuries (9/22, 41%) and subsequent injuries (21/61, 35%). Of 12 patients with recurrent UE injuries, 6 had recurrent injuries of the same hand. Five of 6 non-acute fractures (83%) were of the hand. CONCLUSIONS: Hand and finger injuries are the most common UE injuries in patients with IPV, with finger being the most common site and medial hand the most common region of fracture. Repeated injuries involving the same site and a combination of medial hand and head or face injuries could indicate IPV. KEY POINTS: • Upper extremity injuries in victims of intimate partner violence are most commonly seen in the hand and fingers. • Fingers are the most common site of fracture and the medial hand is the most common region of fracture in the upper extremity in victims of intimate partner violence. • In intimate partner violence victims with upper extremity injuries, concomitant injuries and subsequent injuries are most commonly seen in the head and neck region.

Supracondylar Femur Fractures.

Supracondylar femur fractures are common fractures that represent a management challenge. Despite consistent fracture patterns and predictable challenges associated with reduction and stabilization, complications, including malunion, nonunion, and implant failure, can occur in patients who undergo treatment for the management of a supracondylar femur fracture. Although improvements in intramedullary nailing techniques, the emergence of biologically friendly surgical techniques, and the introduction of locked plating constructs have revolutionized orthopaedic fracture care, the surgical management of supracondylar femur fractures has improved minimally.

Isolated Buttress Plating of Posterior Wall Acetabular Fractures: Is it Sufficient?

BACKGROUND: Conventional fixation methods of posterior wall acetabular fractures feature the use of plating and lag screws. However, fixation of posterior wall fractures with buttress plating alone offers potential advantages by avoiding the hardware complications related to hardware placement through the wall fragment. The purpose of this study was to examine if buttress plating alone, without screw fixation through the wall would be a viable method of treating these fractures. Our hypothesis was that this technique would not result in loss of reduction. METHODS: Consecutive series of patients with isolated posterior wall acetabular fractures treated by two independent surgeons at two Level I Trauma centers without screw fixation across the fracture (Boston Medical Center/Harborview Medical Center). RESULTS: All 72 fractures treated without a screw through the posterior wall fragment maintained reduction at an average of 1.6 years post-operatively. For fractures fixed with buttress plating alone, 92 % were reduced within 2 mm of being anatomic compared to 94 % of fractures that had screws cross the fracture. CONCLUSION: The described buttress plating technique without screw fixation in the wall is an acceptable form of fixation for posterior wall acetabular fractures without the theoretical risk of intra-wall screw fixation.

Postoperative Complications of Hip Fractures Patients on Chronic Coumadin: A Comparison Based on Operative International Normalized Ratio.

In current clinical practice, orthopedic surgeons often delay the surgery intervention on geriatric hip fracture patients to optimize the international normalized ratio (INR), in order to decrease the risk of postoperative hematological complications. However, some evidence suggests that full reversal protocols may not be necessary, especially for patients with prior thromboembolic history. Our study aims to compare the surgical outcomes of patients with normal versus elevated INR values. We conducted a retrospective chart review on 217 patients who underwent surgeries on hip fractures at two academic trauma centers. We found that in our group (n = 124) of patients with an INR value of 1.5-3.0, there was only one reoperation for a hematoma, but there was a trend for more blood transfusions. There was no statistically significant difference in the odds of reoperation or overall complications. Nevertheless, there were significantly more events of postoperative anemia in this high INR patient group.

External fixation: how to make it work.

The external fixator has been in use for more than a century. Wutzer (1789-1863) used pins and an interconnecting rod-and-clamp system. Parkhill (1897) and Lambotte (1900) used devices that were unilateral with four pins and a bar-clamp system. By 1960, Vidal and Hoffmann had popularized the use of an external fixator to treat open fractures and infected pseudarthroses. The complications associated with the use of external fixation in the late 20th century were predominantly caused by a lack of understanding of the principles of application, the principles of fracture healing with external fixation, and old technology. Its use was reserved for the most severe injuries and for cases complicated by infection. Thus, pin problems, nonunions, and malunions were common. Better technology and understanding have since allowed for greater versatility and better outcomes. Simultaneous with developments in the Western world, Ilizarov developed the principles of external fixation with use of ring and wire fixation. It was not until the late 1980s and early 1990s, when more interaction and exchange between the West and East (Russia) became possible, and with the help of Italians who embraced the philosophy of external fixation, that the use of external fixation was proven to be successful. Several variations of external fixation have been developed, and its use is now widespread. However, in the United States, all but a minority of surgeons still have substantial apprehension about the use of external fixation.

Technical tips in fracture care: fractures of the hip.

Hip fracture is an increasingly common and clinically significant injury with substantial economic impact. Associated risk factors are age, gender, race, bone density, activity level, and medical disorders. Prevention efforts include treatment of osteoporosis and programs to reduce the risks of a fall. Nondisplaced or impacted fractures of the femoral neck can be treated with screw fixation. Displaced femoral neck fractures in younger, more active patients may be treated with reduction and fixation. In physiologically older patients, joint arthroplasty is indicated for displaced fractures. In patients with systemic arthritis or preexisting hip disease, total hip arthroplasty may be an appropriate treatment choice. Intertrochanteric fractures are treated with reduction and fixation using either a sliding hip screw and side plate or intramedullary nail with cephalic interlock. Key technical points for successful outcomes include proper patient positioning, using a correct starting point for the nail, achieving acceptable reduction before fixation, and the use of various reduction techniques and aids.

Factors associated with citation rates in the orthopedic literature.

INTRODUCTION: Investigators aim to publish their work in top journals in an effort to achieve the greatest possible impact. One measure of impact is the number of times a paper is cited after its publication in a journal. We conducted a review of the highest impact clinical orthopedic journal (Journal of Bone and Joint Surgery, American volume [J Bone Joint Surg Am]) to determine factors associated with subsequent citations within 3 years of publication. METHODS: We conducted citation counts for all original articles published in J Bone Joint Surg Am 2000 (12 issues). We used regression analysis to identify factors associated with citation counts. RESULTS: We identified 137 original articles in the J Bone Joint Surg Am. There were 749 subsequent citations within 3 years of publication of these articles. Study design was the only variable associated with subsequent citation rate. Meta-analyses, randomized trials and basic science papers received significantly more citations (mean 15.5, 9.3 and 7.6, respectively) than did observational studies (mean retrospective 5.3, prospective 4.2) and case reports (mean 1.5) (p = 0.01). These study designs were also significantly more likely to be cited in the general medical literature (p = 0.02). CONCLUSION: Our results suggest that basic science articles and clinical articles with greater methodological safeguards against bias (randomized controlled trials and meta-analyses) are cited more frequently than are clinical studies with less rigorous study designs (observational studies and case reports).