Isolated posterior tibial plateau fractures are rare injuries that encompass a wide variety of fracture patterns. Based on the variation in fracture pattern, the surgical approach varies, with both anterior and posterior approaches described for surgical fixation. Postoperative protocol also varies among studies. The aim of this article is to summarize the outcomes related to posterior column tibial plateau fractures. The papers reviewed, primarily small retrospective case series, showed functional knee range of motion is preserved, a low incidence of wound complications, and patient outcome scores comparable to other reported lower extremity injury outcome scores.
The elderly (age 70þ) patient with orthopedic trauma is a rapidly growing subset of patients in the United States. Due to increased medical comorbidities and decreased physiological reserve, morbidity and mortality after trauma may significantly differ from those patients younger than 70 years old. A retrospective review was performed to investigate the effect of age on orthopedic trauma. A total of 870 records of patients with orthopedic trauma from 2006 to 2009 at our Level One trauma center were reviewed. A database was created to include demographics, type and number of comorbid conditions at presentation, injuries, intensive care unit (ICU) and hospital length of stay, and description of the fracture. Patients aged 70 years and older had an increased number of comorbidities per person (3.3214-P < .0001). Length of stay in patients aged 70 years and older was not significantly greater than that of the younger patients. They spent an average of 14.76 days in the hospital compared to 13.42 days for the combined younger patients (P ¼ .45), but they spent significantly (P < .0001) more of their stay in the ICU (52.74% vs 34.9% for the younger cohorts). The number of fractures per patient was lower (1.66) in the 70 and older age-group when compared to younger populations (P < .0001). The 70 and older group was more likely to have their injury due to a fall and less likely to have solid organ injuries. As the number of elderly patients increase, continued research in the management of elderly patients with trauma can lead to protocols and practice guidelines to improve outcomes.
Aims Use of the direct anterior approach (DAA) for total hip arthroplasty (THA) has increased in recent years due to proposed benefits, including a lower risk of dislocation and improved early functional recovery. This study investigates the dislocation rate in a non-selective, consecutive cohort undergoing THA via the DAA without any exclusion or bias in patient selection based on habitus, deformity, age, sex, or fixation method. Methods We retrospectively reviewed all patients undergoing THA via the DAA between 2011 and 2017 at our institution. Primary outcome was dislocation at minimum two-year follow-up. Patients were stratified by demographic details and risk factors for dislocation, and an in-depth analysis of dislocations was performed. Results A total of 2,831 hips in 2,205 patients were included. Mean age was 64.9 years (24 to 96), mean BMI was 29.2 kg/m2 (15.1 to 53.8), and 1,595 patients (56.3%) were female. There were 11 dislocations within one year (0.38%) and 13 total dislocations at terminal follow-up (0.46%). Five dislocations required revision. The dislocation rate for surgeons who had completed their learning curve was 0.15% compared to 1.14% in those who had not. The cumulative periprosthetic infection and fracture rates were 0.53% and 0.67%, respectively. Conclusion In a non-selective, consecutive cohort of patients undergoing THA via the DAA, the risk of dislocation is low, even among patients with risk factors for instability. Our data further suggest that the DAA can be safely used in all hip arthroplasty patients without an increased risk of wound complications, fracture, infection, or revision. The inclusion of seven surgeons increases the generalizability of these results. Cite this article: Bone Joint J 2021;103-B(7 Supple B):38–45.
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