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Dorsal distraction plating of complex distal radius fractures yields good radiographic results with minimal complications. In cases of complex distal radius fractures including dorsal marginal impaction where volar plating is not considered adequate, a dorsal distraction plate should be considered as an alternative to external fixation due to reduced risk for infection and better control of volar tilt.

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It is important to understand the mechanism of polymerization, mechanical properties, and environmental and temperature effects of polymethylmethacrylate.» The liquid component of bone cement comprises methylmethacrylate monomer, N,N-dimethyl-p-toluidine, hydroquinone, and possibly dye.» The powder component of bone cement contains benzoyl peroxide, beads of polymethylmethacrylate, possibly dye, zirconium dioxide or barium sulfate radiopacifier, and antibiotics. » Up to 2 g of powdered antibiotics added to a 40-g package probably does not compromise the integrity of the cement.» Preheating the implant or heating during polymerization is controversial but does not appear to strongly negatively affect the mechanical properties of the bone cement.

Background: There has been a trend towards flexible intramedullary nailing for unstable tibial shaft fractures in the pediatric population, traditionally, utilizing a 2-incision technique with passage of one nail medially and one nail laterally. Our study aims to compare a single incision approach for flexible nailing of unstable tibial shaft fractures in pediatric patients to the traditional 2-incision approach. Methods: Patients were selected for operative fixation if they had a length unstable tibial shaft fracture confirmed by fluoroscopy. Exclusion criteria included length stable tibial fractures that could undergo nonoperative treatment. Single incision technique utilized the medial incision only. Patients were monitored in the hospital for one postoperative day and followed up at 4 week, 8 week, and 12 week marks. Radiographic analysis was performed to evaluate for malunion or nonunion. Operative times, infection rates and complications were recorded and analyzed. Results: All patients achieved complete fracture healing at the 12-week follow up. There were no delayed unions, nonunions or malunions in either treatment group. Conclusions: Single medial incision for tibial flexible nails had equivalent outcomes with no difference in primary healing rate, malunion or nonunion rate when compared to the dual incision technique.

Radial neck fractures, unlike their radial head counterparts, have a low rate of nonunion. Our patient's only positive risk factor was age, but he developed a nonunion. At the 2-year follow-up after excision of the radial head, there was a lack of proximal migration of the radius during axial loading, demonstrating a positive outcome without the need for replacement of the radial head.

* The taper junction comprises a male trunnion and female bore at specific taper angles, which join together in an interference cold weld fit.* Studies have suggested that an impaction force of 4,000 N provides sufficient interference fit on modern taper designs.* Factors that may correlate with corrosion are mixed-alloy components, insufficient taper assembly force, a wet taper when assembling, lower flexural rigidity, and previous taper damage. Inconclusive factors are head length, head size, trunnion neck length, lateral offset, taper angle and design, contact area, and percent of taper contact.* A ceramic femoral head may reduce taper corrosion.* Researchers are investigating newer technologies and coatings to decrease taper corrosion.

One method of preventing surgical-site infection is lowering intraoperative environmental contamination. The authors sought to evaluate their hospital's operating room (OR) contamination rate and compare it with the remainder of the hospital. They tested environmental contamination in preoperative, intraoperative, and postoperative settings for a total joint arthroplasty patient. A total of 190 air settle plates composed of trypsin soy agar were placed in 19 settings within the hospital. Locations included the OR with light and heavy traffic, with and without masks, jackets, and shoe covers; the substerile room; OR hallways; the sterile equipment processing center; preoperative areas; post-anesthesia care units; orthopedic floors; the emergency department; OR locker rooms and restrooms; a resident's home; and controls. The trypsin soy agar plates were incubated at 36 °C for 48 hours. Colony counts were performed for each plate. Average colony-forming units (CFUs) were calculated in each setting. The highest CFUs were in the OR locker room, at 28 CFUs per plate per hour. Preoperative and post-anesthesia care unit holding areas were 7.4 CFUs and 9.6 CFUs, respectively. The main orthopedic surgical ward had 10.0 CFUs per plate per hour, whereas the VIP hospital ward had 17.0 CFUs per plate per hour. All OR environments had low CFUs. A live OR had slightly higher CFUs than settings without OR personnel. In comparison with the local community household, the OR locker room, restrooms, hospital orthopedic wards, emergency department, preoperative holding, post-anesthesia care unit, and OR hallway all had higher airborne contamination. On the basis of these results, the authors recommend environmental sampling as a simple, fast, inexpensive tool for monitoring airborne contamination. [ Orthopedics . 2021;44(3):e414–e416.]