Use of the Hybrid Operating Room for Pelvic and Acetabular Fracture Surgery.

The hybrid operating room (HOR) utilizes advanced imaging technology to improve intra-operative visualization and facilitate efficient care in procedures that are relatively image dependent. The robotic C-arm provides improved 2D image quality and is capable of large volume three-dimensional fluoroscopy (3DF) that can rapidly create multiplanar CT like images. Here we discuss on the technique, utility, potential benefits, pitfalls, and complications of using the hybrid suite with and without intra-arterial balloon occlusion for pelvic and acetabular fracture surgery. We also present a case series of patient who underwent pelvic fixation using the HOR. While not advocated for routine use in all pelvic and acetabular fractures; the hybrid suite can be an effective tool in the treatment of complex cases and may facilitate efficient care of the hemodynamically unstable patient. It should be considered when resuscitative stabilization, angioembolization, intra-arterial balloon occlusion, or life-threatening bleeding is anticipated. Additionally, use of the hybrid room allows access to 3D fluoroscopy, and the associated benefits, if a mobile 3D unit is otherwise unavailable. These benefits must be weighed against the cumbersome table, the potential pitfalls with patient size and positioning, and the increased cost to the hospital.

Outcomes and Cost Comparison Between Generic and Conventional Cephalomedullary Nails in the Treatment of Peritrochanteric Femur Fractures.

INTRODUCTION: Although generic orthopaedic implants have been available for several years, there has been slow adoption of this cost-saving option. We hypothesize equivalent outcomes between generic and conventional cephalomedullary nails (CMN) in the treatment of peritrochanteric femur fractures. METHODS: We evaluated 419 patients undergoing CMN for peritrochanteric femur fracture with a minimum 6-month follow-up. Demographic data, radiographic assessment, and clinical outcomes were compared. RESULTS: Ninety patients were treated with generic implants and 329 patients with conventional implants. The overall complication rate was 7.0%, with a revision surgery rate of 5.4%. No significant differences were seen in demographic variables or surgical factors. Although there was an increased incidence of postoperative infections with conventional nails (P = 0.045), no significant differences were seen in other complications. CONCLUSION: At our institution, generic nails cost approximately 38% less than their conventional counterparts. There seems to be no increased rate of implant-associated complications with the use of generic CMNs, although allowing for notable cost savings.

Selective screw placement in forearm compression plating: results of 75 consecutive fractures stabilized with 4 cortices of screw fixation on either side of the fracture.

OBJECTIVES: To (1) assess the effectiveness of an alternative plate and screw construct for all diaphyseal forearm fracture patterns and (2) test the hypothesis that as the working length (WL) to plate length (PL) ratio increases, so does the construct instability and therefore likelihood of failure. DESIGN: Retrospective. SETTING: Level 1 trauma center. PATIENTS/PARTICIPANTS: Sixty-three patients were operatively treated and 53 were available for follow-up, totaling 75 diaphyseal fractures (19 ulna, 12 radius, and 22 radius/ulna). Average follow-up was 14.6 months (8-26). MAIN OUTCOME MEASUREMENTS: Patients were followed postoperatively at 1 to 2 weeks, 6 weeks, 10 weeks, 4 months, and then at 3 month intervals. Radiographs were analyzed for changes in fracture alignment, loose or broken hardware, and fracture-healing characteristics. Fracture union was defined when a fracture was radiographically healed and clinically asymptomatic, and the patient was able to return to all activities without restrictions. RESULTS: No fractures showed radiographic evidence of changes in alignment after fixation. There were no refractures, no infections, and one nonunion. The overall union rate after the index procedure was 97.1% for the radius and 97.6% for the ulna. WL:PL ratio averaged 0.17 (range 0-0.57) and the most frequently used PL was 7 holes (n=43). Patients with closed fractures did have a significantly reduced time to union when compared to those with open fractures (P=0.002). Overall union rate averaged 9.8 weeks (range 6-32 weeks). CONCLUSIONS: Fixation with a standard length compression plate and four cortices of screw fixation on either side of the fracture seems to be a stable construct for diaphyseal forearm fractures and may result in union rates equivalent to those cited in the literature.

Contemporary management of subtrochanteric fractures.

Cephalomedullary interlocking nails that allow for trochanteric entry and minimally invasive fixation have revolutionized the contemporary management of subtrochanteric fractures with improved union rates and decreased incidence of fixation failure. The most successful alternative to intramedullary fixation remains the angled blade plate. Despite biomechanical superiority of contemporary intramedullary implants to previous intramedullary devices, the importance of achieving and maintaining satisfactory fracture reduction prior to and during hardware insertion cannot be overemphasized. In comminuted and more challenging fractures, additional techniques, such as limited open reduction with clamps and/or cables, can allow for canal restoration and more anatomic reductions prior to and/or during nail insertion.