Use of 3D Navigation Versus Traditional Fluoroscopy for Posterior Pelvic Ring Fixation.

Unstable pelvic ring disruption is most commonly treated with closed reduction and percutaneous screw fixation. Traditional methods involve screw placement under fluoroscopic imaging, but with recent technologic advances, intraoperative 3D navigation can now be used to help with the insertion of sacroiliac screws. Various cadaver studies have shown that placement of sacroiliac screws under 3D navigation is more accurate than placement under traditional fluoroscopic guidance. This retrospective review of 134 patients evaluated the clinical use of 3D navigation vs traditional fluoroscopy for sacroiliac screw insertion at an urban level I trauma center. Analysis of surgical data showed a significantly longer imaging time with the conventional method compared with the more experimental 3D navigation (204.06 seconds vs 66.90 seconds, P<.01). Further, a significantly larger radiation dose to both the patient and the staff was seen with traditional fluoroscopy (80.1 mGy for each) compared with that of 3D navigation (39.0 mGy and 25.1 mGy, respectively). No statistically significant difference was seen for outcome or follow-up variables between the 2 extrapolated groups. These variables included length of hospital stay, infection, nerve injury, and hardware breakage. The authors advocate that 3D navigated sacroiliac screws are safe and effective for pelvic ring stabilization; this method may be especially applicable in certain difficult imaging situations, such as morbid obesity, bowel gas interference, and overlapping pelvic structures that make the sacral corridor difficult to discern with traditional 2D fluoroscopy. Safe placement of transiliac-transsacral screws (P<.01) occurred with 3D navigation, and there was a statistically significant increase in adequate screw placement in multiple sacral segments compared with single-level stabilization (P<.01). [Orthopedics. 2021;44(4):229-234.].

Safety of Early Weight Bearing Following Fixation of Bimalleolar Ankle Fractures.

Ankle fractures are common orthopedic injuries. Although operative indications and subsequent stabilization of these fractures have not significantly changed, postoperative protocols remain highly variable. Effects of early weight bearing (EWB) on fracture characteristics in operatively stabilized bimalleolar and bimalleolar equivalent ankle fractures remain poorly publicized. This study seeks to clarify postoperative fracture union rates, rates of hardware loosening or failure, and radiographic medial clear space changes when comparing EWB to late weight bearing (LWB) following open reduction and internal fixation (ORIF). A total of 95 patients with either bimalleolar (66%) or bimalleolar equivalent (34%) fractures who underwent ORIF were retrospectively reviewed. Weight bearing was allowed at three weeks in the EWB group and when signs of radiographic union were noted in the LWB group. Postoperatively, patients were evaluated at regular intervals for fracture union, signs of implant failure, and evidence of medial clear space widening radiographically. There were 38 patients (40%) in the EWB group and 57 patients (60%) comprising the LWB cohort. There were no significant demographic differences between groups. The EWB group on average began to weight bear at 3.1 + 1.4 weeks postoperatively, whereas the LWB group began at 7.2 + 2.1 weeks postoperatively (p<0.01). Union rate (p=0.51), time to union (p=0.23), and implant failure (p>0.1 at all time intervals) were not notably different between groups. No differences in medial clear space were detected at any postoperative interval between groups (p>0.1 at all time intervals). This study suggests that EWB at three weeks postoperatively does not increase markers of radiographic failure compared to six weeks of non-weight bearing (NWB), which has been regarded as the gold standard of treatment to allow for healing; this may represent an improvement to rehabilitation protocols after bimalleolar ankle ORIF of unstable ankle fractures.

Long-term Comparison of Retrograde and Antegrade Femoral Nailing.

Antegrade or retrograde nailing for femoral shaft fractures remains the gold standard, but long-term data on functional outcomes after intramedullary nailing are lacking. In a retrospective review of prospectively collected patient registry data, patients with an isolated femoral shaft fracture treated with antegrade or retrograde femoral nailing from 1997 to 2012 were interviewed and their medical records analyzed. Functional reported outcome data were obtained via the visual analog scale (VAS) for pain and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 5 to 17 years postoperatively. Antegrade and retrograde intramedullary nailing of diaphyseal femur shaft fractures demonstrated a mean WOMAC of 23.5%±23.6% (range, 0%-82.3%) and 29.7%±24.0% (range, 0%-88%), respectively (P=.23). The mean VAS scores of the antegrade vs retrograde intramedullary nailing groups were 2.5±2.6 (range, 0-8) and 3.4±2.8 (range, 0-10), respectively (P=.11). Location of pain differed between groups as well, with the antegrade group noting an increased rate of hip pain (25.6% vs 7.0%, P=.01), but a nonsignificant difference in the rate of thigh pain (27.9% vs 15.5%, P=.15) and knee pain (18.6% vs 26.7%, P=.49) as compared with the retrograde group. Diaphyseal femur fractures are successfully treated with either antegrade or retrograde intramedullary nails without significantly differing long-term functional outcomes, which correlates with other reported findings in the literature at short-term follow-up. [Orthopedics. 2020;43(4):e278-e282.].

Injury profile of mixed martial arts competitors.

OBJECTIVE: To provide an updated comprehensive profile of mixed martial arts (MMAs) injuries. DESIGN: Correlational and multivariate analyses were conducted on cross-sectional data to examine injuries sustained during 711 MMA bouts. One physician diagnosed any injuries occurring during the bouts. SETTING: Various sports venues in Kansas and Missouri holding MMA competitions. PARTICIPANTS: Male and female and amateur and professional MMA competitors contributing to 1422 fight participations (fight participations = 711 bouts × 2 fighters/bout). INDEPENDENT VARIABLES: State, level (amateur or professional), gender, number of rounds, and bout outcome (knockout/technical knockout [KO/TKO] vs other outcomes [eg, decision]). MAIN OUTCOME MEASURES: Injuries/fight participations, injury sustained (yes vs no), and fighter referred to emergency room (ER; yes vs no). RESULTS: The overall injury rate was 8.5% of fight participations (121 injuries/1422 fight participations) or 5.6% of rounds (121/2178 rounds). Injury rates were similar between men and women, but a greater percentage of the injuries caused an altered mental state in men. The risk of being injured was significantly greater for bouts held in Kansas, at the professional level, lasting more rounds, and ending in a KO/TKO. Fighters also were more likely to be referred to the ER if they participated in longer bouts ending in a KO/TKO. CONCLUSIONS: The observed injury rate was lower than previously reported suggesting recent regulatory changes have made MMA a safer sport. Increased clinical awareness and additional research should be extended to head-related injuries in MMAs especially those associated with KOs/TKOs.