Disaster Management Response Guidelines for Departments of Orthopaedic Surgery.

Complacency and lack of preparation are major barriers to an effective disaster response. Leadership assignments and departmental organization for a response should be outlined in advance. Response rehearsal and after-action reviews allow for thoughtful change to a response plan. Hospital disaster alert notification systems should be standardized and should be understood. Communication systems used in a disaster should have redundancy. A department's response plan must be integrated into the overall hospital plan. Large casualty volumes require appropriate triage and resource allocation. Response provider emotional and health support is an important consideration.

Special topics.

Concerning the past decade of war, three special topics were examined at the Extremity War Injuries VII Symposium. These topics included the implementation of tourniquets and their effect on decreasing mortality and the possibility of transitioning the lessons gained to the civilian sector. In addition, the training of surgeons for war as well as residents in a wartime environment was reviewed.

Treatment of acetabular fractures in an older population.

OBJECTIVE: To identify factors predicting poor radiographic and functional outcome and delayed total hip arthroplasty in operatively managed acetabular fractures in patients 55 years of age and older. DESIGN: Retrospective chart and radiographic review of a prospectively maintained database. SETTING: Tertiary care hospital. PATIENTS: Ninety-three with a mean age of 67 years met all inclusion criteria and had follow up averaging 5 years. INTERVENTION: Open reduction and internal fixation and less commonly acute total hip arthroplasty for displaced acetabular fractures in an older cohort. MAIN OUTCOME MEASUREMENT: Three validated patient self-assessment measures were used: the Musculoskeletal Functional Assessment, the Short Musculoskeletal Functional Assessment, and the SF-36. RESULTS: The overall rate of hip replacement in our study was 30.95%. Poor fracture reduction (P < 0.02), development of avascular necrosis (P < 0.001), and previous contralateral hip arthroplasty (P = 0.02) were statistically associated with the need for secondary surgeries. Functional outcome scores in the current study compared favorably with functional outcome scores reported for acetabular fractures in younger populations and with age-matched "non-injured" norms published in recent literature. CONCLUSIONS: There was an acceptably low rate of major complications in 93 operatively managed fractures in this population. Nearly 70% of patients achieved functional outcomes similar to age- and injury-matched control subjects without the need for secondary surgeries. Thirty percent of patients required secondary total hip arthroplasty for posttraumatic arthritis. These patients achieved outcomes similar to patients in the other outcome groups and to injury- and age-matched norms.

Superior versus anteroinferior plating of the clavicle revisited: a mechanical study.

OBJECTIVES: This study was designed to compare bone-implant stiffness of two fixation techniques on a sawbone model of a clavicle fracture. METHODS: Twenty-four preosteotomized synthetic left clavicles (Sawbones Worldwide, Vashon, WA) were divided into four groups based on type of fixation: standard 3.5-mm pelvic reconstruction plate in the superior position; standard 3.5-mm pelvic reconstruction plate in an anteroinferior position; 3.5-mm locking pelvic reconstruction plate in a superior position; and a 3.5-mm locking pelvic reconstruction plate in an anteroinferior position. Three nondestructive cyclic mechanical tests were performed in random order: axial, torsion, and four-point bend. RESULTS: No significant difference was found in axial (P = 0.61) or torsional stiffness (internal rotation, P = 0.46 or external rotation, P = 0.49) among all groups. No significant difference occurred in bending rigidity (four-point bending test) with type of plate (P = 0.41), but when the plate was placed anteroinferiorly, bending rigidity was significantly higher (P < 0.001) than in the superior position. CONCLUSION: Placing the plate anteroinferiorly on the clavicle provides a more stable construct in terms of bending rigidity with no detriment in axial and torsional stiffness compared with placing the plate superiorly. We believe that anteroinferior plating is preferred as a result of the increase in bending rigidity together with other advantages, including avoidance of neurovascular compromise, the use of longer screws, and decreased hardware prominence.

Acetabular fractures in the elderly: treatment recommendations.

Acetabular fractures in the elderly population are marked by a high degree of variability in terms of patient and fracture characteristics. Successful outcomes depend on application of highly individualized management principles by experienced teams. Reviewed are indications and outcomes associated with various management options, including closed treatment, open reduction internal fixation, and acute or staged total hip arthroplasty. Proper initial management choices are critical, as early failures and subsequent salvage surgery can be accompanied by significant morbidity. Clinical results after ORIF closely follow the quality of articular reduction and the ability to maintain a congruent reduction of the hip joint. Fracture characteristics predictive of anatomic articular reduction should be treated with ORIF. Fracture characteristics predictive of early post-traumatic arthritis should be treated with simultaneous ORIF and THA. Presented is one referral institution's treatment algorithm and management approach.