Open-book pelvic fractures (OBPF) with concomitant intra-abdominal injuries carry a high morbidity and mortality; the significance of associated perineal open wound (OBPF-POW) has not been defined. We hypothesize that the presence of perineal open wounds increases morbidity, mortality, and concomitant use of hospital resources. Patients diagnosed with OBPF over a 5-year period at a Level I trauma center were identified by trauma registry review, and were retrospectively reviewed under an Institutional Review Board-approved protocol. Patients with OBPF without a perineal open wound were compared with those with OBPF-POW. Data collected included patient demographics, injury details, management, and outcomes. A total of 1,635 patients with blunt pelvic fractures were identified, of which 177 (10.8%) had OBPF. OBPF-POW (36/177) significantly increased the use of angioembolization, occurrence of sepsis, pelvic sepsis, ARDS, and multi-organ system failure. Patients with OBPF-POW had an increase of 13 days in length of hospitalization compared with the OBPF group ( P < 0.001), with cost of $120,647.30 and $62,952.72 respectively ( P < 0.001). Perineal open wounds complicate open-book pelvic fractures with significant increase in hospital resource utilization. Aggressive multidisciplinary evaluation and management is appropriate to detect and prevent complications.

Purpose:The goal of this study was to compare the cheese-wiring effects of three sutures with different coefficients of friction.Materials and Methods:Sixteen human cadaveric shoulders were dissected to expose the distal supraspinatus and infraspinatus muscle tendons. Three sutures were stitched through the tendons: #2 Orthocord™ suture (reference #223114, DePuy Mitek, Inc., Raynham, MA), #2 ETHIBOND* EXCEL Suture, and #2 FiberWire® suture (FiberWire®, Arthrex, Naples, FL). The sutures were pulled by cyclic axial forces from 10 to 70 N at 1 Hz for 1000 cycles through a MTS machine. The cut-through distance on the tendon was measured with a digital caliper.Results:The cut-through distance in the supraspinatus tendons (mean ± standard deviation, n = 12) were 2.9 ± 0.6 mm for #2 Orthocord™ suture, 3.2 ± 1.2 mm for #2 ETHIBOND* suture, and 4.2 ± 1.7 mm for #2 FiberWire® suture. The differences were statistically significant analyzing with analysis of variance (P = 0.047) and two-tailed Student's t-test, which showed significance between Orthocord™ and FiberWire® sutures (P = 0.026), but not significant between Orthocord™ and ETHIBOND* sutures (P = 0.607) or between ETHIBOND* and FiberWire® sutures (P = 0.103).Conclusion:The cheese-wiring effect is less in the Orthocord™ suture than in the FiberWire® suture in human cadaveric supraspinatus tendons.Clinical Relevance:Identification of sutures that cause high levels of tendon cheese-wiring after rotator cuff repair can lead to better suture selection.

Purpose To compare the likelihood of spiral fracture of the humerus using torsional load to failure after intraosseous biceps tenodesis at the position of the arthroscopic suprapectoral tenodesis versus the subpectoral meta-diaphyseal location. Methods Eight matched pairs of humeri were dissected. Unicortical tenodesis holes were drilled, either at the bottom of the bicipital groove (group 1) or just below the pectoralis major tendon insertion (subpectoral) in the humeral diaphysis (group 2). Tenodesis was performed in a 7-mm bone tunnel, with suture fixation distal to this site using 2 separate 2-mm holes, secured with No. 2 polyester suture. Each humerus was potted in plaster and mounted to a hydraulic torsional load frame, consistent with previously validated models for creating humeral spiral fractures. External rotation torque was applied to each humerus distally until fracture occurred. The paired t test was used to compare the 2 groups. Results Fracture occurred at the subpectoral cortical drill hole in all 8 specimens in group 2. In group 1, only 2 fractures occurred through the tenodesis hole, with spiral fracture resulting in the diaphysis of the humerus in 6 of 8 specimens. Average torque to failure measured 31.35 Nm in group 1 and 25.08 Nm in group 2; the difference was statistically significant ( P < .0001). Conclusions Subpectoral cortical drill holes for biceps tenodesis were shown to be a stress riser for humeral spiral fracture. Suprapectoral cortical drill holes were shown to be significantly less of a stress riser. The amount of torque required to fracture the humerus through the subpectoral drill holes was less than with the suprapectoral drill holes. Only 2 fractures occurred through the suprapectoral tenodesis holes, and significantly more torque was required to create these fractures. Clinical Relevance Clinically, the difference between suprapectoral and subpectoral tenodesis fracture potential should be considered when selecting a tenodesis location.

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femoral ligament (MQTFL) has been described in the treatment of patellar instability. The purpose of this study was to identify and describe the anatomic midpoint of the anterior attachment of the combined MPFL and MQTFL (termed the medial patellofemoral complex [MPFC]). Methods: Photographs of 31 cadaveric knee dissections were available for computer-assisted analysis. Using AutoCAD software, a bisecting line was created to identify the midpoint of the MPFC attachment. An anatomic reference point was identified at the intersection of the line along the medial border of the quadriceps tendon and the superior articular border of the patella (P1), and the distance to the midpoint was calculated on the basis of the patellar articular length (PAL). Results: Of the 31 cadaveric knee photographs, 25 had appropriate quality and landmarks for digital analysis. Of these 25 knees, 22 had MPFL and MQTFL fibers, 2 had MQTFL fibers only, and 1 had MPFL fibers only. The midpoint of the MPFC was 3.2 AE 5.9 mm (9.0% AE 16.4% PAL) proximal to P1. After exclusion of the 2 knees with MQTFL fibers only, the MPFC midpoint was 1.9 AE 3.1 mm (5.3% AE 8.6% PAL) proximal to P1. In all knees, the anatomic midpoint of the MPFC was at or proximal to the level of P1. Conclusion: In our anatomic study, the midpoint of the MPFC was found to be at or proximal to the junction of the medial border of the quadriceps tendon and superior pole of the patella. Given the risk of patellar fracture after traditional MPFL reconstruction, further consideration should be given to the analogous MQTFL reconstruction as a potentially safer and more anatomic alternative in the treatment of patellar instability.