Application of Negative Pressure Wound Therapy.

SUMMARY: The video depicts the materials and steps for applying negative pressure wound therapy. The clinical case involves a patient who had sustained a thigh Morel-Lavallee lesion that developed overlying skin necrosis and drainage that was treated with surgical debridement and the application of negative pressure wound therapy.

Acute Repair of Anterior Cruciate Ligament, Posterior Cruciate Ligament, Medial Collateral Ligament, and Posterior Lateral Corner After Knee Dislocation.

SUMMARY: This video depicts the materials and steps for the repair of a Schenck classification knee dislocation IV multiligamentous injury and peroneal nerve palsy. The patient had bilateral injuries after a car pinned him to a garage in his cabinet. The video demonstrates primary repair of the avulsions of the right knee with acute repair of anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, and posterior lateral corner in the patient.

Knee Dislocation With Acute Anterior Cruciate Ligament Reconstruction and Posterior Cruciate Ligament and Medial Collateral Ligament Repair.

SUMMARY: This video depicts the materials and steps for the repair of a Schenck classification KD III multiligamentous injury in a patient who had bilateral injuries after his car pinned him to a cabinet in his garage. The video demonstrates acute allograft reconstruction of anterior cruciate ligament and primary repair of the avulsions of posterior cruciate ligament and medial collateral ligament in the patient.

Tibia Antibiotic Intramedullary Nail.

SUMMARY: This video depicts the materials and steps for creating an antibiotic cement spacer in the form of an intramedullary nail and demonstrates how to insert the nail into a tibia. The indication for this patient was a history of a type 3B open tibia fracture 6 months before treated with an intramedullary nail that subsequently developed an infected nonunion.

Opiate Prescribing Practices After Common Isolated Lower Extremity Injuries.

OBJECTIVE: This retrospective study aimed at identifying opiate prescribing practices, the number of morphine milligram equivalents (MMEs) prescribed by orthopaedic and nonorthopaedic providers in patients with operatively treated isolated lower extremity fractures, and provide opiate prescribing recommendations. METHODS: Patients older than 18 years with isolated lower extremity (unicondylar, bicondylar, tibial shaft, pilon, and ankle) fractures between 2005 and 2016 were identified. Prescribing information was obtained from the State Controlled Substance Monitoring Database. Descriptive statistics were calculated for each injury and plotted for MME use. Mann-Whitney and Wilcoxon tests were used for data analysis. To aid in clinical relevance, MMEs were converted to number of pills of oxycodone 10 mg (OC 10 mg). RESULTS: Three hundred forty-one patients met our inclusion criteria. Mean age was 45 years; 56% (192/341) were men. Forty-seven percent (159/341) were prescribed opiates before their injury. Orthopaedic providers prescribed more opiates to patients with pilon fractures compared with unicondylar (P = 0.010), tibial shaft (P < 0.001), and ankle (P < 0.001) fractures. Bicondylar plateau fracture patients also received more opiates when compared with unicondylar (P = 0.001), tibial shaft (P < 0.001), and ankle (P < 0.001) fractures. Nonorthopaedic providers prescribed more opiates to patients with pilon fractures when compared with unicondylar (P = 0.006), bicondylar (P < 0.001), tibial shaft (P < 0.001), and ankle fractures (P = 0.006). Differences between orthopaedic and nonorthopaedic MMEs prescribed are significantly different for each injury type (<0.05). CONCLUSIONS: Patients with pilon or bicondylar tibial plateau fractures are currently being prescribed more opiates when compared with other isolated fractures. We have developed an opiate prescription guideline based on what is being prescribed by orthopaedic providers.