Ski and Snowboard - Related Orthopedic Injuries.

Participation in skiing and snowboarding continues to increase. Both sports are associated with unique equipment and movement patterns, placing athletes at risk for several characteristic injuries. Although the axial skeleton and extremities are at risk for injury in both sports, skiing and snowboarding are associated with distinctive injury patterns. This article summarizes the epidemiology, risk factors, and specific injuries associated with skiing and snowboarding to better educate orthopedic surgeons regarding diagnosis and treatment of athletes partaking in these sports.

Modern Results of Functional Bracing of Humeral Shaft Fractures: A Multicenter Retrospective Analysis.

OBJECTIVES: To evaluate the rate of, and reasons for, conversion of closed treatment of humeral shaft fractures using a fracture brace, to surgical intervention. DESIGN: Multicenter, retrospective analysis. SETTING: Nine Level 1 trauma centers across the United States. PATIENTS: A total of 1182 patients with a closed humeral shaft fracture initially managed nonoperatively with a functional brace from 2005 to 2015 were reviewed retrospectively from 9 institutions. INTERVENTION: Functional brace. MAIN OUTCOME MEASUREMENTS: Conversion to surgery. RESULTS: A total of 344 fractures (29%) ultimately underwent surgical intervention. Reasons for conversion included nonunion (60%), malalignment beyond acceptable parameters (24%), inability to tolerate functional bracing (12%), and persistent signs of radial nerve palsy requiring exploration (3.7%). Univariate comparisons showed that females and whites were significantly (P < 0.05) more likely to be converted to surgery. The multivariate logistic regression identified females as being 1.7 times more likely and alcoholics to be 1.4 times more likely to be converted to surgery (P < 0.05). Proximal shaft as well as comminuted, segmental, and butterfly fractures were also linked to a higher rate of conversion. CONCLUSIONS: This large multicenter study identified a 29% surgical conversion rate, with nonunion as the most common reason for surgical intervention after the failure of functional brace. These results are markedly different than previously reported. These results may be helpful in the future when counseling patients on the choice between functional bracing and surgical intervention in managing humeral shaft fractures. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Reduction of the posterior column in displaced acetabulum fractures through the anterior intrapelvic approach.

The anterior intrapelvic approach can be used for the reduction and fixation of displaced fractures of the acetabulum. Reduction techniques and options for placement of fixation deviate to some degree from those used with the traditional ilioinguinal approach secondary to the surgeon's perspective and available vectors. Here, we present several techniques for the application of reduction clamps, reduction techniques, and fixation options for the posterior column in displaced fractures of the acetabulum treated through the anterior intrapelvic approach.

Are quadrilateral surface buttress plates comparable to traditional forms of transverse acetabular fracture fixation?

BACKGROUND: Several construct options exist for transverse acetabular fracture fixation. Accepted techniques use a combination of column plates and lag screws. Quadrilateral surface buttress plates have been introduced as potential fixation options, but as a result of their novelty, biomechanical data regarding their stabilizing effects are nonexistent. Therefore, we aimed to determine if this fixation method confers similar stability to traditional forms of fixation. QUESTIONS/PURPOSES: We biomechanically compared two acetabular fixation plates with quadrilateral surface buttressing with traditional forms of fixation using lag screws and column plates. METHODS: Thirty-five synthetic hemipelves with a transverse transtectal acetabular fracture were allocated to one of five groups: anterior column plate+posterior column lag screw, posterior column plate+anterior column lag screw, anterior and posterior column lag screws only, infrapectineal plate+anterior column plate, and suprapectineal plate alone. Specimens were loaded for 1500 cycles up to 2.5x body weight and stiffness was calculated. Thereafter, constructs were destructively loaded and failure loads were recorded. RESULTS: After 1500 cycles, final stiffness was not different with the numbers available between the infrapectineal (568±43 N/mm) and suprapectineal groups (602±87 N/mm, p=0.988). Both quadrilateral plates were significantly stiffer than the posterior column buttress plate with supplemental lag screw fixation group (311±99 N/mm, p<0.006). No difference in stiffness was identified with the numbers available between the quadrilateral surface plating groups and the lag screw group (423±219 N/mm, p>0.223). The infrapectineal group failed at the highest loads (5.4±0.6 kN) and this was significant relative to the suprapectineal (4.4±0.3 kN; p=0.023), lag screw (2.9±0.8 kN; p<0.001), and anterior buttress plate with posterior column lag screw (4.0±0.6 kN; p=0.001) groups. CONCLUSIONS: Quadrilateral surface buttress plates spanning the posterior and anterior columns are biomechanically comparable and, in some cases, superior to traditional forms of fixation in this synthetic hemipelvis model. CLINICAL RELEVANCE: Quadrilateral surface buttress plates may present a viable alternative for the treatment of transtectal transverse acetabular fractures. Clinical studies are required to fully define the use of this new form of fixation for such fractures when accessed through the anterior intrapelvic approach.