Patients who underwent distal radius fracture (open reduction and internal fixation [ORIF]) at a Level 1 trauma center deemed "overlapping" (greater than 30 minutes overlap) were compared against consecutive cases. Unplanned return to surgery within 1 year was the primary outcome. Sixty-two patients were included in the overlapping group and 37 in the consecutive group. There was no difference in unplanned return to surgery 1 year following procedure with three cases (5%) in the overlapping group and one case (3%) in the consecutive group. There was a significant difference (p = 0.02) in procedure time between the overlapping group (151 + 54 minutes) and nonoverlapping group (126 + 35 minutes). There was no difference in infection, readmission, nonunion, malunion, deep infection, or superficial infection between groups. Based on a post-hoc power analysis with p < 0.05 and power at 80%, 2,691 patients would be needed to determine if there is truly no difference between groups. (Journal of Surgical Orthopaedic Advances 31(2):127-130, 2022).
Management of patients with non-unions or stress fractures of the tibia or distal femur with debilitating ipsilateral knee arthritis can be difficult to manage. In these examples of care, we present three illustrations of using long stemmed modular total knee components to successfully manage both tibial and femoral non-unions and stress fractures as well as ipsilateral arthritis with resultant deformity. The average improvement in our knee outcome scores for these three patients via pre-operative Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR) and one-year post-operative KOOS, JR is 44.37. After treatment with a long stemmed modular total knee prosthesis all three examples of care went on to union and the arthritic deformity was corrected. (Journal of Surgical Orthopaedic Advances 31(3):166-168, 2022).
We aimed to determine whether addition of an in vivo ectopic induced membrane (EM) to the Masquelet Technique enhanced angiogenesis and bone formation in a segmental defect. After generating and stabilizing a diaphyseal femur defect, 10 rats received a polymethylmethacrylate (PMMA) spacer within the defect (control); 10 received another PMMA spacer implanted subcutaneously (EM). We removed the spacers and added autograft; the excised EM was added to their autograft (EM group). Post-mortem x-rays assessed bone formation and bridging. Osteogenesis in the proximal defect was significantly more uniform (p < 0.01), and there was greater amount of bone remodeling distally in the EM group (p < 0.05). There was no difference in bone formation (p = 0.19) but greater degrees of bridging in the EM group (2.20 vs. 1.20, p = 0.09). The EM resulted in more homogeneous proximal osteogenesis and increased bone remodeling distally. These findings could lead to more consistent and predictable bone healing. (Journal of Surgical Orthopaedic Advances 31(3):161-165, 2022).
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