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Although the overall infection rate after ACL reconstruction is relatively low, the significantly higher rate of infections with hamstring autografts compared with BPTB autografts should be a consideration when discussing graft choices for ACL reconstruction.

Purpose To quantify the long-term success of repeat injections for trigger fingers and to identify predictors of treatment outcomes. Methods This retrospective case series analyzed 292 repeat corticosteroid injections for trigger fingers administered by hand surgeons at a single tertiary center between January 2010 and January 2013. One hundred eighty-seven patients (64%) were female, 139 patients (48%) had multiple trigger fingers, and 63 patients (22%) were diabetic. The primary outcome, treatment failure, was defined as receiving a subsequent injection or surgical treatment. Patients without either documented failure or a return office visit in 2015–2016 were surveyed by telephone to determine if they had required subsequent treatment. Kaplan-Meier analyses with log-rank testing assessed the median time to treatment failure and the effect of demographic and disease-specific characteristics on injection success rate while predictors of injection outcome (success vs failure) were assessed with multivariable logistic regression. Results Second injections provided long-term treatment success in 39% (111/285) of trigger fingers with 86 receiving an additional injection and 108 ultimately undergoing surgical release. Thirty-nine percent (24/62) of third injections resulted in long-term success, with 22 receiving an additional injection, and 23 ultimately undergoing surgery. Median times-to-failure for second and third injections were 371 and 407 days respectively. Success curves did not differ significantly according to any patient or disease factor. Logistic regression identified that advancing patient age and injection for trigger thumb were associated with success of 2nd injections. Conclusion Thirty nine percent of second and third corticosteroid injections for trigger finger yield long-term relief. While most patients ultimately require surgical release, 50% of patients receiving repeat trigger injections realize one year or more of symptomatic relief. Repeat injections of trigger fingers should be considered in patients who prefer non-operative treatment. Level of Evidence IV, Therapeutic

Background: Delayed diagnoses of unstable thoracolumbar-spine (TL-spine) fractures can result in neurological deficits and avoidable pain, so it is important for clinicians to reach prompt diagnostic decisions. There are no validated decision aids for determining which trauma patients warrant TL-spine imaging.Objectives: Quantifying the diagnostic accuracy of the injury mechanism, physical examination, associated injuries, clinical decision aids, and imaging for evaluating blunt TL-spine trauma patients.Methods: A search strategy for studies including adult blunt TL-spine trauma using PubMed, Embase, Scopus, CENTRAL, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov was performed. Excluded studies lacked data to construct 2×2 tables, were duplicates, not primary research, did not focus on blunt trauma, examined associated injuries without any utility in identifying TL-spine injuries, only studied cervical-spine fractures, were non-English, had a pediatric setting, or were cadaver/autopsy reports. Risk of bias was assessed using the Quality Assessment Tool for Diagnostic Accuracy Studies. Diagnostic predictors were analyzed with a meta-analysis of sensitivity, specificity, and likelihood ratios. Results:In blunt trauma patients in the emergency department, the weighted pretest probability of a TL-spine fracture was 15%. The estimates for the detection of TL-spine fractures with plain

Emergency clinicians report that a variety of factors influence their parenteral pharmacotherapy in the management of patients with migraine headache. The comparison of hypothetical practice patterns with actual practice patterns reveals a range of institution-specific discordance. There is discordance between providers' responses to a fictitious scenario and their previously recorded practice patterns with regional variation.

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OBJECTIVES To compare the timing of soft-tissue (flap) coverage and occurrence of complications before and after the establishment of an integrated orthopedic trauma/microsurgical team. DESIGN Retrospective Cohort Study SETTING A single level 1 trauma center PATIENTS 28 subjects (13 pre- and 15 post-integration) with open tibia shaft fractures (OTA/AO 42A, 42B, 42C) treated with flap coverage between January 2009 and March 2015. INTERVENTION Flap coverage for open tibia shaft fractures treated before (“pre-integration”) and after (“post-integration”) implementation of an integrated orthopedic trauma/microsurgical team. MAIN OUTCOME MEASURE Time from index injury to flap coverage. RESULTS The unadjusted median time to coverage was 7 days (95% CI, 5.9–8.1) pre-integration, and 6 days (95% CI, 4.6–7.4) post-integration (p=0.48). For pre-integration, 9 (69%) of patients experienced complications, compared to 7 (47%) post-integration (p=0.23). CONCLUSIONS After formation of an integrated orthopedic trauma/microsurgery team, we observed a one-day decrease in median days to coverage from index injury. Complications overall were lowered in the post-integration group, though statistically insignificant. LEVEL OF EVIDENCE Therapeutic level III

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