Lerchehoyle5341

Statistical analyses included descriptive statistics and univariate analyses. Data for the full cohort of 183 patients were analyzed (91 prenatal, 92 postnatal). There were no differences in rates of scoliosis, kyphosis, hip abnormality, clubfoot or tibial torsion between patients treated with prenatal or postnatal repair. The rate of LLD was lower in the prenatal repair group at 12 and 30 months (7 vs. 16% at 30 months, P = 0.047). The rates of patients requiring casting or bracing were significantly lower in patients treated with prenatal repair at 12 and 30 months (78 vs. 90% at 30 months, P = 0.036). Patients treated with prenatal myelomeningocele repair may develop milder forms of orthopaedic conditions and may not require extensive orthopaedic management.Our study aimed to compare the clinical and radiographic outcomes of transitional distal tibia fractures treated with K-wire fixation versus screw fixation after open reduction. A retrospective study was performed on all displaced transitional distal tibia fractures that underwent operative fixation. Following open reduction, surgical fixation was performed using either percutaneously inserted 2.0 mm K-wires, or 4.0 mm partially-threaded cannulated cancellous screws. Clinical and radiographic outcomes between the two groups were assessed using the modified Weber score. Other outcome measures assessed were surgical time, casting duration, follow-up duration and duration before return-to-sports. We recruited 49 patients with transitional distal tibia fractures requiring open reduction and surgical fixation. There were 18 patients in the K-wiring group (KWG), and 31 patients in the screw fixation group (SFG). All patients in both groups had excellent clinical and radiographic outcome based on the modified Weber's scoring, full radiological healing, and no residual displacement upon final follow up. The KWG had significantly shorter surgical time (41.0 min versus 75.1 min, P less then 0.0001) and shorter follow-up duration needed before discharge (5.4 months versus 8.7 months, P = 0.024). However, they required a longer post-operative casting duration (7.3 weeks versus 5.3 weeks, P = 0.006). No significant difference was found for the duration before return to sports between both groups. Complications were few in this study group. Selleckchem Anacardic Acid Superficial pin site infection was noted in one patient in the KWG, and valgus deformity of the ankle was noted in one patient in the SFG. In our study, surgical treatment of transitional distal tibia fractures demonstrated equally excellent outcomes when treated by open reduction with either K-wire or cannulated screw fixation. Level of evidence III.

To determine the incidence of iatrogenic peroneal nerve palsy after application of an intraoperative lateral distractor during open reduction and internal fixation of tibial plateau fractures.

Retrospective review.

Single academic Level I trauma center.

One hundred forty-seven patients met criteria and were included in the study.

Patients with unicondylar and bicondylar tibial plateau fractures underwent open reduction and internal fixation and received application of an intraoperative lateral distractor to aid in visualization and reduction of the impacted lateral plateau.

Incidence of iatrogenic peroneal nerve palsy.

There was a 2.0% incidence of iatrogenic peroneal nerve symptoms (3 of 147 patients), most of which were incomplete sensory deficits. There was no association with staged external fixation, regional anesthesia, or tourniquet use.

Use of an intraoperative lateral distractor is safe and has a low incidence of iatrogenic peroneal nerve palsy if applied carefully.

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

To compare the complication profile of femoral neck (FN) and intertrochanteric (IT) femur fractures in young patients.

Retrospective Database Review SETTING Large, national private insurer claims database with longitudinal follow-up PATIENTS Individuals undergoing surgical fixation of IT or FN fractures from 2010-2017 were identified. Patients were included if they were 18-50 years of age and had 1-year postoperative follow-up. Those with comorbid conditions of chronic kidney disease (CKD), congestive heart failure (CHF), diabetes, or coronary artery disease (CAD) were excluded from the primary analysis.

Complication data, including a diagnosis of nonunion, malunion, avascular necrosis (AVN) or need for revision surgery at 1-year follow-up were compared. Additionally, medical complication data at 90-days post-operatively was evaluated.

In total, 808 patients were identified 392 (48.5%) patients with IT femur fractures and 416 (51.5%) patients with FN fractures. On multivariate analysis, FN fractures hof evidence.

Intra-articular screw cut-out is a common complication after proximal humerus fracture (PHF) fixation using a locking plate. This study investigates novel technical factors associated with mechanical failures and complications in PHF fixation.

A retrospective radiological study.

Level 1 trauma center.

Clinical and radiological data from consecutive PHF patients treated between January 2007 and December 2013 were reviewed.

Open reduction and internal fixation with the Synthes Philos locking plate.

Postoperative radiographs were assessed for quality of initial reduction, humeral head offset, screw length, number and position, restoration of medial calcar support or the presence of calcar screws, and intra-articular screw perforations. Using SliceOMatic software, we validated a method to accurately identify screws of 45 mm or longer on AP radiographs. Follow-up radiographs were reviewed for complications.

Among 110 patients included [mean age 60 years, 78 women (71%), follow-up 2.5 years] and the following factors were associated with a worse outcome. (1) Screws >45 mm in proximal rows [Odds Ratio (OR) = 5.3 for screw cut-out); (2) lateral translation of the humeral diaphysis over 6 mm (OR = 2.7 for loss of reduction); (3) lack in medial support by bone contact (OR = 4.9 for screw cut-out); (4) varus reduction increased the risk of complications (OR = 4.3).

The importance of reduction and calcar support in PHF fixation is critical. This study highlights some technical factors to which the surgeon must pay attention avoid varus reduction, maximize medial support, avoid screws longer than 45 mm in the proximal rows, and restore the humeral offset within 6 mm or less.

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

To compare the deep infection rates following immediate versus staged open reduction internal fixation (ORIF) for pilon fractures.

Retrospective cohort study.

Three Academic Level One Trauma Centers.

401 patients with closed OTA/AO type 43C distal tibia fractures treated with ORIF. 66% were male, mean age was 45.6. Median (Interquartile Range) follow-up was 1.7 (1.0-3.7) years.

Acute, primary (<24 hours) versus delayed, staged ORIF (>24 hours).

Deep infection or wound complication as defined by return to OR for surgical irrigation and debridement.

Patients were grouped by time from presentation to surgery acute ORIF (n=99) and delayed ORIF (n=302). Acute ORIF was more frequent in patients with OTA/AO type 43C1 fractures, low-energy mechanisms (i.e. fall from standing), younger and female patients. Patients who demonstrated severe swelling (242, 80%), swelling and fracture blisters (26, 9%), swelling and ecchymosis precluding planned surgical approach (4, 1%), polytrauma requiring resuscitaplafond fractures. If early definitive fixation is considered, extreme care should be taken to carefully evaluate the soft tissue envelope and assess for other risk factors (such as age, male gender, smokers, diabetics, and those with higher energy fracture patterns) that may predispose the patient to a post-operative soft tissue infection. Our study has shown that the judicious use of early definitive fixation in closed pilon fractures, in the appropriate patient, and with careful evaluation of the soft tissue envelope, is likely safe and does not appear to increase the risk of wound complications and deep infection in the hands of experienced fracture surgeons.

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Paradoxically, overweight and obesity are associated with lower odds of complications and death after hip fracture surgery. Our objective was to determine whether this "obesity paradox" extends to patients with "super-obesity." In this study, we compared rates of complications and death among super-obese patients with those of patients in other body mass index (BMI) categories.

Using the National Surgical Quality Improvement Program database, we identified >100,000 hip fracture surgeries performed from 2012-2018. Patients were categorized as underweight (BMI <18.5), normal weight (BMI 18.5-24.9), overweight (BMI 25-29.9), obese (BMI 30-39.9), morbidly obese (BMI 40-49.9), or super-obese (BMI ≥50). We analyzed patient characteristics, surgical characteristics, and 30-day outcomes. Using multivariate regression with normal-weight patients as the referent, we determined odds of major complications, minor complications, and death within 30 days by BMI category.

Of 440 super-obese patients, 20% had major complications, 33% had minor complications, and 5.2% died within 30 days after surgery. When comparing patients in other BMI categories with normal-weight patients, super-obese patients had the highest odds of major complications (odds ratio [OR] 1.6, 95% confidence interval [CI], 1.2-2.0) but did not have significantly different odds of death (OR 0.91, 95% CI, 0.59-1.4) or minor complications (OR 1.2, 95% CI, 0.94-1.4).

Super-obese patients had significantly higher odds of major complications within 30 days after hip fracture surgery compared with all other patients. This "obesity paradox" did not apply to super-obese patients.

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

To identify if timing to surgery was related to major 30-day morbidity and mortality rates in periprosthetic hip and knee fractures (OTA/AO 3 [IV.3, V.3], OTA/AO 4 [V4]).

Retrospective database review.

Hospitals participating in the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database.

Patients in the NSQIP database with periprosthetic hip or knee fractures between 2007-2015 INTERVENTION Surgical management of periprosthetic hip and knee fractures including revision or open reduction internal fixation.

Major 30-day morbidity and mortality following operative treatment of periprosthetic hip or knee fractures.

A total of 1265 patients, mean age 72, including 883 periprosthetic hip and 382 periprosthetic fractures about the knee were reviewed. Delay in surgery greater than 72 hours is a risk factor for increased 30-day morbidity in periprosthetic hip and knee fractures (RR = 2.90 (95% CI = 1.74 - 4.71); p-value = <0.001) and risk factor for increased 30-day mortality (RR = 8.