Using the Equatorial Talar Line as a Radiographic Predictor of Sanders Type 3 and 4 Calcaneus Fractures and Lateral Wall Blowout.

OBJECTIVE: To assess the equatorial talar line (ETL) as a sensitive radiographic parameter to predict Sanders type III and IV fractures and the presence of lateral wall blowout. METHODS: Reliability of the ETL was assessed using the intraclass correlation coefficient (ICC) and receiver operating curve (ROC) to predict sensitivity. Using lateral ankle radiographs, raters determined whether the calcaneal tuberosity was "above" (predicting Sanders type I or II) or "below" (predicting Sanders type III or IV and lateral wall blowout). RESULTS: In determining the "above" or "below" location of the ETL, the calculated ICC was 1.0 for each session. As a predictor of Sanders fracture classification type, the calculated ICC was 0.93 for the first session and 0.89 for the second session for an overall ICC of 0.91. As a predictor of Sanders fracture type, ROC analysis yielded an overall sensitivity of 0.82. As a predictor of lateral wall blowout, ROC analysis yielded an overall sensitivity of 0.81. CONCLUSION: The ETL is a reproducible radiographic parameter that can be reliably used to crudely predict between Sanders type I or II (ETL is "above") and Sanders type III or IV (ETL is "below") calcaneus fractures as well as the presence of lateral wall blowout.

Physician Wellness in Orthopedic Surgery: Challenges and Solutions.

The growing epidemic of physician burnout suggests that a change is needed. Physician wellness is an ever-growing consideration, especially in orthopedic surgery, where the challenges to wellness are significant. This review provides many common sense wellness principles and solutions in four main components of wellness (physical, mental, emotional, and spiritual) interwoven with current research on the topic. Although directed to orthopedic surgeons, this guide can be applied to all physicians, because they are based on common human principles of wellness. Wellness is not created overnight, so wellness practices that increase the likelihood of experiencing wellness are encouraged.

Temporary External Fixation to Table as a Traction Reduction Aide in the Treatment of Unstable Pelvic Ring Injuries: A Technical Note.

Displaced pelvic ring injuries can be challenging to even the experienced orthopedic traumatologist. A temporary external fixation to table construct provides a quick, simple, and accessible means of external skeletal fixation to reliably obtain and maintain stable hemipelvis reduction on the operating room table. The contralateral hemipelvis can be stabilized to the table by use of Steinman pins safely inserted into the subtrochanteric and anterior column regions and later connected to external fixator bars attached to the table. With rigid stabilization, the displaced contralateral pelvic fragment(s) can be reduced in a more vector intentional manner with greater force than the traditional means of pelvic reduction can allow. The skeletal-table fixation technique is presented along with two cases, a combined pelvic-acetabular injury and an isolated pelvic ring injury.

Efficacy of skin preparation in eradicating organisms before total knee arthroplasty.

The solution of 2% chlorhexidine gluconate and 70% isopropyl alcohol (Chloraprep) is commonly used for antiseptic skin preparation before surgery. We conducted a study to evaluate the efficacy of this solution in eradicating organisms during skin preparation for total knee arthroplasty (TKA), to isolate the organism type, and to evaluate possible contributing factors leading to infection. Ninety-nine patients who were undergoing TKA were swabbed for cultures in the popliteal fossa before and after solution application. Swabs were collected, cultured, and read. Culture isolates grew in 20 (20%) of the 99 patients before solution application and in 5 (5%) of the 99 after application. Mean presolution body mass index (BMI) was 38 for patients with bacterial isolates and 34 for patients without isolates (P<.03). Mean postsolution BMI was 40 for patients with bacterial isolates and 35 for patients without isolates. BMI was a statistically significant factor in predicting presence of isolates after solution application. In addition, presence of bacteria in presolution cultures was predictive of isolation in postsolution cultures. Diabetic patients were 3.6 times more likely than nondiabetic patients to have a bacterial isolate. Other factors did not predict organism isolation. No patient developed a postoperative infection.