Prophylactic Radiotherapy for Prevention of Heterotopic Ossification After Periacetabular Fractures: A Review of Efficacy and Associated Conditions.

Prophylactic radiotherapy (XRT) is a commonly used treatment to decrease heterotopic ossification (HO) in patients with traumatic hip injuries. We conducted a retrospective review of patients at risk for HO who underwent XRT. Of the patients reviewed, 27.3% developed radiographic HO, 11.2% developed symptoms, and 2.0% required resection surgery. Patients were divided into primary (n = 71) and secondary prophylaxis (n = 27) cohorts. In the primary group, 25.0% developed radiographic HO, 5.6% developed symptoms, and 0 required surgery. In the secondary cohort, 33.3% of patients developed new radiographic HO, and 25.9% were symptomatic: four had a Brooker score of 3, and three had a score of 4 (p = 0.03), and 7.4% required surgical resection. (Journal of Surgical Orthopaedic Advances 31(2):113-118, 2022).

Anterior prosthetic knee dislocation with acute vascular injury: A case report.

Introduction: and Importance: Anterior dislocation of a prosthetic knee is rarely encountered. Acute vascular injury following anterior prosthetic dislocation has only been reported once in the literature with extremely poor outcomes. Case presentation: The authors report the case of a 70-year-old woman who presented with anterior prosthetic knee dislocation after a fall from slipping. After closed reduction, CT angiography found transection and active extravasation of the left popliteal artery. An emergent fasciotomy and popliteal bypass were performed with concurrent external fixation of the joint. Recovery was complicated by bacteremia requiring eventual explant of total knee arthroplasty (TKA). Clinical discussion: We report the only case of successful vascular repair after acute vascular injury from traumatic anterior prosthetic dislocation. External fixation of the knee allowed for better stabilization of the joint and preservation of the repaired vascular injury; however, it carries a risk for infection, as seen in this case. Conclusions: While there are no clear guidelines for management, we highlight the importance of rapid diagnosis with CT angiography and shared decision making with the vascular surgery team to repair the injury and stabilize the joint.

Watercraft propellers as a mechanism of orthopaedic injuries: injury patterns, management, and complications.

INTRODUCTION AND PURPOSE: Recreational watercraft use is popular across the United States, and there is a high rate of injury associated with the use and misuse of these vehicles. Watercraft propeller injuries represent a particularly devastating mechanism of injury. We aim to describe and analyze the range of orthopaedic injuries sustained from a watercraft propeller with a particular focus on the mechanism, injury pattern, management, and complications associated with these unique, high-energy injuries. MATERIALS AND METHODS: A retrospective review of 42 patients who sustained injuries from watercraft propeller that presented to a level 1 trauma center was performed. Data collected included patient demographics, mechanism of injury, surgical management, antibiotic use, and complications. RESULTS: Forty-two patients sustained 96 fractures. Ninety-one fractures (94.8%) were open and 5(5.2%) were closed. Twenty (20.8%) were of the upper extremity, 70(72.9%) were of the lower extremity, and 6(6.3%) were of the pelvic ring. The majority of open fractures were Gustilo-Anderson Type IIIA or greater (54, 59.3%). There were 9 total infections affecting 8 of 96 fracture sites (cumulative risk of 8.3%), and other complications included stiffness (3), heterotopic ossification (1), non-union (1), flap failure (1), DVT (2), PE (1), and systemic infection (1) for a total of 19 complications. CONCLUSIONS: Watercraft propellers often result in devastating injuries with high rates of morbidity. The high rate of open fractures and neurovascular injury, necessity for multiple surgeries, and extended length of hospital stay show the need for continued awareness about boat safety and the danger of propellers.

A growing problem: acetabular fractures in the elderly and the combined hip procedure.

Acetabular fractures in the elderly are most frequently the result of low-energy trauma and present unique management challenges to orthopedic surgeons. Evaluation and treatment should be performed in a multidisciplinary fashion with early involvement of internal medicine subspecialists and geriatricians. Distinct fracture patterns and pre-existing osteoarthritis and osteoporosis necessitate careful preoperative planning. The role of total hip arthroplasty should also be considered when surgical treatment is indicated. The outcomes of acetabular fractures in the elderly have improved, but complications remain higher and results less satisfactory than in younger individuals. The lack of randomized controlled trials has limited the ability to establish an evidence-based treatment algorithm.

Osteogenesis imperfecta and hyperplastic callus formation in a family: a report of three cases and a review of the literature.

Osteogenesis imperfecta is one of the most common groups of inherited disorders of connective tissue. Hyperplastic callus formation in patients with osteogenesis imperfecta after fracture or surgery is a rare occurrence that has often been misdiagnosed as osteosarcoma. Previous series reported that hyperplastic callus formation is more often present in osteogenesis imperfecta male patients, with white sclerae, and a negative family history of the disorder. This is the first time that this complication has been presented in three female siblings, with a positive family history of osteogenesis imperfecta type IV. An association between osteogenesis imperfecta type IV and hyperplastic callus formation is unclear. This association might, however, be a separate, specific subtype of osteogenesis imperfecta, with an unknown inheritance pattern.

Musculoskeletal trauma in four-wheeled all-terrain vehicles.

A longitudinal study of four-wheeled all-terrain vehicle-related musculoskeletal injuries requiring orthopedic surgery was performed. Avoidable risk factors such as alcohol intake, lack of helmets, inexperience, and excess speed were identified. This study also shows that the quantity, severity, cost, and frequency of preventable accidents while riding continue to be the same as prior to a Consent Decrees issued by the Consumer Products Safety Commission > 10 years ago.

Knee pain and leg-length discrepancy after retrograde femoral nailing.

We retrospectively studied postoperative knee function and leg-length discrepancy (LLD) in 31 patients with femoral diaphyseal fractures treated with retrograde intramedullary nailing (IMN) between October 1998 and April 2000. Mean follow-up was 25 months, mean knee range of motion was 126 degrees, mean Hospital for Special Surgery knee scores were 89.2 (pain) and 78.3 (function), and mean LLD was 1.19 cm. Despite the theoretically higher knee pain and LLD rates associated with retrograde IMN, we believe it may offer a viable treatment option when the antegrade nailing technique is restricted.