Prospective Randomized Comparison of Locked Plates Versus Nonlocked Plates for the Treatment of High-Energy Pilon Fractures.

OBJECTIVES: To compare the radiographic and functional outcome of patients with high-energy pilon fractures treated with locked versus nonlocked plates. DESIGN: Randomized prospective trial. SETTING: Academic level 1 trauma center. PATIENTS: Between December 2006 and December 2008, 60 consecutive patients with 62 AO/OTA type A, B, and C tibial pilon fractures were enrolled in the study. Thirty-two of the fractures were treated using locked plates and 29 were treated with nonlocked plates. Follow-up data were available for 33 of the 60 patients. INTERVENTION: Treatment with locked versus nonlocked plates. MAIN OUTCOME MEASURES: Short Musculoskeletal Function Assessment (SMFA) questionnaire and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale (AHS). Radiographic measurements on anteroposterior and lateral views for the quality of reduction and maintenance of alignment immediately postoperatively compared with the latest follow-up. RESULTS: There were no significant differences in the mechanism or injury pattern, average age of the patients, ratio of males to females, tourniquet time, operative time, interval to surgery, AHS, or SMFA scores. One of 15 fractures in the locked plate group lost reduction at the latest follow-up compared with 3 of 19 fractures in the nonlocked group. CONCLUSIONS: In this study, there seems to be no difference between the 2 constructs. Thus, one must question the routine use of locked plates in the treatment of high-energy pilon fractures. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Fix it or discard it? A retrospective analysis of functional outcomes after surgically treated patella fractures comparing ORIF with partial patellectomy.

OBJECTIVES: The goal of this study was to compare functional outcomes of patients with patella fractures treated with open reduction and internal fixation (ORIF) with those treated with partial patellectomy (PP). DESIGN: Retrospective cohort study. SETTING: Urban Level I Trauma Center. PATIENTS: Seventy-three patients with isolated displaced patella fractures underwent operative treatment between January 1, 2002, and December 31, 2009, at our institution. Of these, 52 (71%) patients with isolated patella fractures with minimum 1-year follow-up agreed to participate and were enrolled in the study. INTERVENTION: PP or ORIF. MAIN OUTCOME MEASUREMENTS: Patients completed outcome questionnaires and participated in a physical examination. Outcome instruments included the Knee Outcome Survey-Activities of Daily Living Scale, Short Form (SF)-36 Health Survey, and SF Musculoskeletal Function Assessment Survey. RESULTS: Twenty-six patients underwent PP and 26 underwent ORIF. There were no significant differences in any of the functional outcome instruments, including Knee Outcome Survey-Activities of Daily Living Scale (ORIF: 64.1 ± 11, PP: 62.1 ± 7.9, P = 0.76), SF-36 physical component score (ORIF: 40.8 ± 5.4, PP: 41.1 ± 5.2, P = 0.94), SF-36 mental component (ORIF: 47.7 ± 5.1, PP: 51.8 ± 4.9, P = 0.19), Short Musculoskeletal Function Assessment (SMFA) Function Index (ORIF: 28.6 ± 9.1, PP: 27.7 ± 6.7, P = 0.78), or SMFA Bother Index (ORIF: 26.0 ± 9.7, PP: 23.6 ± 8.8, P = 0.72). Complication rates did not differ significantly between the 2 groups. CONCLUSIONS: This study demonstrates that functional impairment persists after operative treatment of patella fractures. Both ORIF and PP demonstrated similar final range of motion, functional scores, and complication rates. Despite its purported benefits, in this study, ORIF did not result in superior outcomes compared with PP. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Transgluteal posterior column screw stabilization for fractures of the acetabulum: a technical trick.

The traditional exposure of high posterior column or transverse acetabular fractures can pose a challenge for lag screw stabilization. The authors describe an adjunctive percutaneous transgluteal lag screw technique for the internal fixation of the high posterior column. In the senior author's experience, this technique has been helpful to achieve the optimal trajectory for a stable perpendicular lag screw to maintain an anatomical reduction. In our experience, this technique has been used in conjunction with the standard Kocher-Langenbeck exposure and posterior column plating techniques.

The lateral decubitus approach for complex proximal femur fractures: anatomic reduction and locking plate neutralization: a technical trick.

SUMMARY: Unstable intertrochanteric or subtrochanteric fractures with significant proximal or distal extension or comminution are often a challenge for achieving stable fixation. In recent years, locked proximal femoral plates have been developed that aid fixation of these complex fractures often permitting the biological advantages of minimal contact or minimally invasive application. Although previously described with success using a standard lateral approach in the supine position, we describe a lateral decubitus position for the locked plating of proximal femur fractures. We have found that lateral positioning neutralizes the gravitational forces acting on the bone and soft tissues, facilitating reduction and exposure while continuing to be compatible with intraoperative image intensification. We present lateral positioning as a technical trick for anatomic and stable reduction of complex proximal femur fractures with proximal femoral locking plates and present a series of 10 cases that were treated with this combination of approach and internal fixation.

Pulsatile lavage irrigator tip, a rare radiolucent retained foreign body in the pelvis: a case report.

Retained foreign bodies after surgery have the potential to cause serious medical complications for patients and bring fourth serious medico-legal consequences for surgeons and hospitals. Standard operating room protocols have been adopted to reduce the occurrence of the most common retained foreign bodies. Despite these precautions, radiolucent objects and uncounted components/pieces of instruments are at risk to be retained in the surgical wound. We report the unusual case of a retained plastic pulsatile lavage irrigator tip in the surgical wound during acetabulum fracture fixation, which was subsequently identified on routine postoperative computed tomography. Revision surgery was required in order to remove the retained object, and the patient had no further complications.