Favorable Outcome Twenty-Two Months after Delbet Type Ib Capital Femoral Transepiphyseal Fracture and Posterior Column Acetabular Fracture in a Fifteen-Year-Old Male.

Case: A fifteen-year-old male patient sustained a posteriorly dislocated right capital femoral Delbet type Ib epiphyseal fracture-separation and a right acetabular posterior column fracture after a low-energy trip and fall. The capital femoral epiphysis was closed reduced and fixed with cannulated screws on an urgent basis. He underwent acetabular osteosynthesis via a Kocher-Langenbeck approach two days thereafter. Twenty-two months after injury, he was weight-bearing on the right lower extremity without radiologic evidence of avascular necrosis or clinical evidence of pain or functional deficit. Conclusion: Fracture-separation of the capital femoral epiphysis comprises only 8% of skeletally immature femoral neck fractures in the Delbet and Colonna classification. Prognosis is worse with ipsilateral hip dislocation due to the risk of avascular necrosis from disruption of the medial femoral circumflex artery. Urgent referral to a trauma center and treatment by appropriate specialists enables good long-term results after this uncommon traumatic injury pattern.

Radiographic outcomes of cortical screw fixation as an alternative to Kirschner wire fixation for temporary lateral column stabilization in displaced Lisfranc joint fracture-dislocations: a retrospective cohort analysis.

BACKGROUND: Injuries of the tarsometatarsal joint complex ranging from purely ligamentous to multidirectionally unstable midfoot fracture-dislocations are anatomically fixed to minimize long-term sequelae including post-traumatic arthritis, pes planus deformity, and chronic pain. Lateral column disruption is commonly treated with temporary Kirschner wire (K-wire) fixation, maintaining alignment during healing and allowing resumption of physiologic motion after hardware removal. More unstable fracture patterns may require temporary cortical screw fixation to maintain adequate reduction. We evaluated the efficacy of temporary lateral column screw fixation compared to K-wire fixation for Lisfranc fracture-dislocation treatment. METHODS: This retrospective cohort study reviewed 45 patients over fourteen years who underwent Lisfranc fracture-dislocation fixation at a level-one trauma center. All patients underwent medial and middle column fixation; 31 underwent lateral column fixation. Twenty six patients remained after excluding those without electronic records or follow-up. The primary outcome was radiographic lateral column healing before and after hardware removal; secondary outcomes included pain, ambulation, and return to normal shoe wear. RESULTS: Twenty patients were male, with mean age 41 years. Thirteen patients underwent cortical screw fixation and twelve K-wire fixation. One had both implants. Twenty four patients underwent lateral column hardware removal; all had radiographic evidence of bony healing before hardware removal. Mean follow-up was 88.2 ± 114 weeks for all patients. The cortical screw cohort had significantly longer mean time to hardware removal (p = 0.002). The K-wire cohort had significantly more disuse osteopenia (p = 0.045) and postoperative pain (p = 0.019). CONCLUSIONS: Radiographic and clinical outcomes of unstable Lisfranc fracture-dislocation treatment support temporary lateral column screw fixation as an alternate technique. LEVEL OF CLINICAL EVIDENCE: 3 (retrospective cohort study).

Publication Rates of Abstracts Presented at Pediatric Orthopaedic Society of North America Meetings Between 2013 and 2016.

BACKGROUND: Academic conferences such as the annual Pediatric Orthopaedic Society of North America (POSNA) meeting provide opportunities to present up-to-date scientific work that can influence clinical decision making. This study reviewed 4 years of abstracts presented at POSNA to assess trends in poster and podium presentation publication rates and associated metrics and the impact of academic presentations on the pediatric orthopaedic literature. METHODS: All abstracts presented at POSNA annual meetings from 2013 to 2016 were analyzed for presentation type, subspeciality, level of evidence, study design, peer-reviewed publication within 4 years of presentation, 1-year publication rates, journal impact factors, number of authors, and citations of the final publication. χ2, analysis of variance, and t tests were conducted to measure independence of variables. Statistical significance was indicated at P<0.05. RESULTS: A total of 1135 abstracts were included with 676 published in peer-reviewed journals by August 2020 and 38 excluded because of publication before presentation. The number of accepted abstracts increased yearly. Total of 58.2% of POSNA abstracts were published and 42.5% had the same first author on the final manuscript. Average journal impact factor was 2.60±1.30 with a mean 14.3±16.0 citations. Podium presentations were significantly more likely to be published than poster presentations (63.1% vs. 51.2%, P<0.001) and in higher-impact factor journals. Level I evidence abstracts were published in journals with an average 1.663 higher impact factor than level V evidence abstracts, with no significant difference between overall publication rate and study type (P=0.69) or level of evidence (P=0.95) for podium presentations. The Journal of Pediatric Orthopaedics accepted the most abstracts, 38.4% overall, with 64.1% of acceptances resulting from podium presentations and no difference in time to publication based on subspecialty. CONCLUSIONS: The overall publication rate for POSNA abstracts has increased 8.7% from prior analysis. Podium presentations are more likely than poster presentations to be published, overall and in higher-impact journals, and are cited more frequently. LEVEL OF EVIDENCE: Level IV-descriptive retrospective epidemiological study.

Antibiotic Prophylaxis in Open Fractures: Evidence, Evolving Issues, and Recommendations.

Open fractures are often associated with high-energy trauma and have an increased risk of infection because of surrounding soft-tissue damage and the introduction of environmental contaminants that may communicate with the fracture site. The Gustilo-Anderson classification of open fractures has been used to guide prophylactic antibiotic therapy because different types of open fracture have been shown to have varying rates of surgical site infections with different combinations of pathogens. Prophylactic treatment with various classes of antibiotics, including penicillins and cephalosporins, aminoglycosides, and fluoroquinolones, has evolved over the past half century. More recently, broader spectrum agents including monobactams and glycopeptides have been used for additional coverage. Duration of antibiotic therapy remains variable between institutions, and antibiotic choice is not standardized. Coverage for nosocomial and multidrug-resistant organisms is an ongoing area of clinical research.