Hwangcrouch2893

Assigning PEWS to patients being admitted to our hospital from the PED was associated with a reduced number of emergency response calls in the period immediately after admission.External fixation is often used for temporary stabilization of the tibia in several clinical scenarios. Conventional placement of external fixation pins may impede instrumentation with intramedullary nailing, thus requiring pin removal, loss of reduction, and increased operative time during definite fixation. In this article, we describe a strategic pin placement routinely used at our institution in which we create a medially based inverted triangular construct that allows for pins to remain in place during definitive fixation.

This study highlights demographics and orthopaedic injuries of electric scooter-related trauma that presented to our institution over a 27-month period.

Retrospective review.

Urban Level 1 trauma center.

Patients presenting to the emergency department, trauma bay, or outpatient clinic after electric scooter injury were identified from November 2017 through January 2020 using ICD-10 diagnosis codes.

Patient charts were reviewed for demographics, injury characteristics, imaging, treatment, perioperative data, and Injury Severity Scores.

Four hundred eighty-five patients presented during the study period. Of these, 44% had orthopaedic injuries, including 30% with pelvis or extremity fractures. There were 21 (10%) polytraumatized patients in the orthopaedic cohort. The age ranged from 16 to 79 years (average 36 years), with 58% men, and 18% were visitors from out of town. Of 49 patients requiring orthopaedic surgery, 8 underwent surgery on an urgent basis. The average Injury Severity Score for orthopaedic patients was 8.4 with a median of 5.0 for nonoperative injuries versus a significantly higher median of 16.0 for operative injuries. Twenty-nine percent of patients were intoxicated and only 2% wore a helmet.

Electric scooter injuries are increasing, and many patients sustain high-energy injuries. As electric scooter use continues to increase, the prevalence of orthopaedic injuries is also likely to rise. Further studies are needed to fully understand the impact scooter-related injuries have on individual patients and the health care system.

Prognostic Level IV. See find more for Authors for a complete description of levels of evidence.

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

To compare displacement between the cuneiforms and metatarsals for a typical Lisfranc screw and a transmetatarsal base screw under biomechanical loading.

Eight pairs of cadaveric feet (16 total) were evaluated. The Lisfranc ligamentous structures were transected in all specimens. All feet were repaired with screws traversing the first and second tarsometatarsal joints. A Lisfranc screw was placed from the first cuneiform to the second metatarsal in 8 specimens. A transmetatarsal base screw from the first metatarsal to the second metatarsal was placed in the remaining 8 corresponding feet. The repairs were randomized by side. Markers were placed on the dorsum of the midfoot for optical tracking. The feet were mounted into a load frame and loaded on the plantar forefoot to 100, 400, 800, and 1100 N. Displacement was measured and recorded using 3D camera tracking.

Displacement between the first cuneiform and second metatarsal base was found to be significantly less (P = 0.02) with the transmetatarsal screw than the Lisfranc screw. There were no significant differences between displacements at any other articulations.

This study demonstrates biomechanical superiority using a modified transmetatarsal base screw compared with the highly used Lisfranc screw for fixation of ligamentous Lisfranc injuries.

This study demonstrates biomechanical superiority using a modified transmetatarsal base screw compared with the highly used Lisfranc screw for fixation of ligamentous Lisfranc injuries.

To assess the outcome of the sinus tarsi approach and C-Nail fixation of displaced intra-articular calcaneal fractures (DIACFs).

Prospective study.

University Trauma Department.

Sixty-four patients (mean age 44.3 years, 48 men and 16 women) with 75 DIACFs were treated between October 1, 2016 and December 31, 2018.

In all cases, the posterior facet was reduced through the sinus tarsi approach and fixed with one or 2 screws. After reducing all fragments to the articular block, the final fixation was performed percutaneously with C-Nail, locked with 6 screws.

Patients were assessed for restoration of the Böhler angle, complications, and overall fracture reduction. #link# To assess the functional outcome, we used the Mean American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Score and Maryland Foot Score after 12 months.

The Böhler angle improved from -0.5 degrees preoperatively to 28.6 degrees postoperatively. The articular step-off was reduced from 5.4 mm preoperatively to 0.6 mm postoperatively. The postoperative radiologic calcaneal score was 2.9, on average. Superficial wound edge necrosis was seen in 3 patients (4%) and superficial infection was observed in one (1.3%). After a 1-year follow-up, we recorded a mean American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Score of 90.2 and a mean Maryland Foot Score of 91.2.

After obtaining an anatomic reduction of the articular surface of the posterior facet with lag screws, the C-Nail represented a viable alternative to plate stabilization in the treatment of DIACFs, combining primary stability with low soft tissue complications.

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 determine the usefulness of a validated trauma triage score to stratify short-term outcomes including hospital length of stay (LOS), in-hospital complications, discharge location, and rate of readmission after an ankle fracture.

Retrospective cohort.

Level 1 trauma center.

Four hundred fifteen patients, age ≥55 with 431 ankle fractures.

Closed or open reduction.

Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA).

Of the 415 patients, 38% were male, 72% were white, and the mean age was 66 years. The mean LOS was 4.4 days, and this increased from 2.6 days in the minimal-risk group to 11.8 days in the high-risk group (P < 0.001). Similarly, 74% of minimal-risk patients were discharged home versus 13% of high-risk patients (P < 0.001). There were 19 readmissions (4.6%) within 30 days, ranging from 1.5% to 10% depending on the risk cohort (P = 0.006). Seventy-three patients (18%) experienced an in-hospital complication. On multiple linear regression, moderate- and high-risk STTGMA stratification was predictive of a longer hospital LOS, and moderate-risk STTGMA stratification was predictive of subsequent readmission after injury.