A Single Proximal Interlocking Bolt May Be Sufficient for Retrograde Nailing of Extra-articular Femur Fractures.

OBJECTIVE: To evaluate whether a single proximal interlocking bolt was sufficient during the treatment of extra-articular femur fractures with retrograde medullary nailing. DESIGN: Retrospective comparative study. SETTING: Academic Level 1 trauma center. PATIENTS: The study included 136 patients with extra-articular femur fractures treated with retrograde medullary nailing who met inclusion and follow-up criteria. INTERVENTION: The intervention included surgical treatment for a femur fracture with retrograde medullary nailing, with comparisons made between those treated with a single proximal interlocking (1 IL) bolt and those treated with 2 proximal interlocking bolts (2 IL). MAIN OUTCOME MEASUREMENT: The main outcome measurements were as follows: (1) rate of nonunion and (2) rate of catastrophic implant failure. RESULTS: There was no difference in the rate of nonunion requiring surgical intervention between the 2 groups. There were no catastrophic failures in either group. CONCLUSIONS: A single proximal interlocking bolt may be sufficient when using retrograde nailing for the treatment of extra-articular femur fractures. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Impact on periosteal vasculature after dual plating of the distal femur: a cadaveric study.

Although dual plating of distal femur fractures has been described for injuries at risk of varus displacement, the vascular insult to the medial distal femur utilizing this technique is unknown. The aim of this study was to evaluate the perfusion of the medial distal femoral periosteal arteries after supplemental medial plating of the distal femur. METHODS: Fifteen human fresh-frozen cadaveric femora were thawed and randomized to lateral locked plating alone or with supplemental medial plate fixation. Conventional submuscular medial plating was performed using a 12-hole small fragment plate and multiple cortical screws. The superficial femoral artery was injected with latex dye. Specimens were dissected. The patency of the medial distal femoral periosteal vessels was evaluated. RESULTS: Four vessels were consistently observed traversing the distal medial femur: the transverse and descending (d-MMPA) branches of the medial metaphyseal periosteal artery, and the transverse and longitudinal branches of the descending geniculate artery. The anterior longitudinal arch (ALA) was present in 13 of 15 specimens and was fed by the d-MMPA. The median number of periosteal arteries occluded by the medial plate was 2 (6 out of 8 specimens). The d-MMPA was occluded in 6 of 8 medially plated femurs, resulting in a complete lack of perfusion of the ALA. CONCLUSIONS: Submuscular medial plating of the distal femur compressed the d-MMPA in the majority of specimens. This vessel gives rise to the ALA, which lacked perfusion in these specimens. This vascular insult could affect the healing of metaphyseal distal femur fractures treated with dual plating.

Use of an Intraoperative Limb Positioner for Adjustable Distraction in Acetabulum Fractures with Femoral Head Protrusion: A Case Report.

CASE: Anatomic reduction of acetabular fractures with femoral head protrusion requires lateralization of the medialized femoral head to facilitate reduction and definitive fixation. In this case of a 71-year-old man with an associated both column acetabular fracture with femoral head medialization after a fall from a 10 foot ladder, we present the successful use of a novel reduction technique involving a modified arthroscopic limb positioner to provide adjustable distraction and counteract the deforming force in this injury pattern. CONCLUSION: A limb positioner can provide appropriate on-table traction in pelvis and acetabular surgery to neutralize deforming forces and facilitate reduction and fixation.

Intramedullary Cage Fixation for Proximal Humerus Fractures Has Low Reoperation Rates at 1 Year: Results of a Multicenter Study.

OBJECTIVES: To determine reoperation rates after treatment of a proximal humerus fracture with cage fixation. DESIGN: Retrospective case series. SETTING: Eleven U.S. hospitals. PATIENTS: Fifty-two patients undergoing surgical treatment of proximal humerus fractures. INTERVENTION: Open reduction and internal fixation of a proximal humerus fracture with a proximal humerus cage. MAIN OUTCOME MEASUREMENTS: Reoperation rate at 1 year. RESULTS: At a minimum follow-up of 1 year, reoperations occurred in 4/52 patients (7.7%). Avascular necrosis (2/41) occurred in 4.9% of patients. CONCLUSION: Standard locked plating remains an imperfect solution for proximal humerus fractures. Proximal humerus cage fixation had low rates of revision surgery at 1 year. Proximal humerus cage fixation may offer reduced rates of complication and reoperation when compared with conventional locked plating for the management of proximal humerus fractures. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.