In this worst-case model of an osteopenic, unstable, IT fracture, the IDS construct, likely owing to its larger surface area, noncylindrical profile, and fracture compression, provided significantly greater stability and resistance to femoral head rotation and varus collapse.
* Bicondylar tibial plateau fractures represent a broad category of complex, high-energy injuries associated with a high surgical complication rate.* Computed tomography and magnetic resonance imaging aid in diagnosis, classification, and surgical planning and should be considered during the initial evaluation or after provisional stabilization is performed as part of staged treatment.* No one classification system has superior descriptive traits or reliability. Simply classifying the fracture as unicondylar (partial articular) or bicondylar (complete articular) is the most reliable approach.* Malalignment, especially in the coronal plane, and instability predict poor outcomes and should direct surgical intervention. Articular displacement is less predictive.* Dual plating is the most stable type of fixation biomechanically but is associated with soft-tissue complications.* Single lateral locked plating is an alternative fixation type for bicondylar fractures without a large posteromedial coronal fracture line.* Hybrid external fixators are another means of fixation that avoid large exposures and associated soft-tissue disruption.* No one fixation strategy is superior in all cases. Patient and injury characteristics should be evaluated on a case-by-case basis to optimally direct the treatment of these complex injuries.
Intramedullary (IM) nailing is currently the most common method for treating patients with impending pathologic humeral fractures; however, this treatment is associated with known complications primarily owing to violation of the rotator cuff during insertion. A better option is needed. To determine if a humeral segmental replacement prosthesis would provide a stronger construct compared with an IM nail in this setting, we compared the mechanical properties of these two devices in a cadaver model simulating an impending pathologic fracture. In each of nine matched pairs of fresh human humeri one was randomly selected to undergo a 50% lateral middiaphyseal defect simulating an impending pathologic fracture and subsequent fixation with an IM nail and bone cement. The contralateral humerus underwent fixation using a humeral segmental defect prosthesis. We determined T-scores using DEXA. Each specimen subsequently was tested in torsion to failure. Peak torque and peak rotation at failure were greater for the prosthesis specimens whereas torsional stiffness was greater for the IM nail specimens. We found a linear relationship between peak torque and T-score for each device with the slopes of the lines suggesting the construct with the prosthesis can withstand greater forces than the IM nail and the differences between devices were greater in weaker bones.
To determine the association of preinjury opioid use on incidence of fasciotomy after lower extremity trauma.
Retrospective case–control study.
Level 1 trauma center.
We identified 245 consecutive patients treated with fasciotomy for compartment syndrome of the lower extremity from 2011 to 2016. Of these, 115 were excluded for isolated vascular injury without fracture, age younger than 18 years, out-of-state residence, nontraumatic etiology, and/or incomplete opioid records. Three hundred ninety age- and sex-matched patients with tibial fractures not requiring fasciotomy were selected for comparison.
Review of demographics, injury characteristics, and opioid prescriptions.
Main Outcome Measurements:
Rate of preinjury narcotic use.
There was no significant difference in chronic opioid use between patients requiring fasciotomy and those who did not (odds ratio = 0.80, 95% confidence interval: 0.43–1.50, P = 0.49). There was no significant difference in average morphine milligram equivalents (MME)/day (66.6 vs. 77.4, P = 0.68). There was no significant difference in active opioid use (odds ratio = 0.76, 95% confidence interval: 0.45–1.29, P = 0.30). There was no significant difference in average MME/day (69.3 vs. 75.6, P = 0.80) for active narcotic users.
There were no differences in the rate or average MME/day of preinjury opioid use between patients with a tibia fracture treated with or without fasciotomy for compartment syndrome. These results indicate that pre-existing opioid use does not interfere with the accurate diagnosis of compartment syndrome in trauma patients. The diagnosis and treatment of compartment syndrome is not affected by preinjury narcotic use and potential associations with opiate-induced hyperalgesia.
Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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