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The use of ultrasound in evaluating orthopaedic trauma patients.

Musculoskeletal ultrasound is a low-cost, noninvasive method of evaluating orthopaedic trauma patients. It is particularly useful for patients with metallic hardware, which may degrade computed tomography or magnetic resonance images. Ultrasound has been used to evaluate fracture union and nonunion, infection, ligamentous injury, nerve compression, and mechanical impingement caused by hardware. Real-time dynamic examination allows identification of pathology and provides direct correlation between symptoms and the observed pathology.

The use of locked plating in skeletally immature patients.

The philosophy and techniques for the management of fractures in the pediatric patient have changed over the past several decades. The immature skeleton has unique properties, and injuries in children have different characteristics, management options, and complications than do similar injuries in adults. The basic surgical techniques used in the management of pediatric fractures include closed reduction and casting, closed or open reduction with internal fixation, and external fixation. The concept of bridging plate osteosynthesis has evolved based on scientific insight into bone biology and the importance of blood supply to bone. The use of locked plating is gaining favor in the treatment of certain fractures in adults. However, the role for this technique in the skeletally immature patient has not been described.

Surgical treatment of nonarticular distal tibia fractures.

Distal tibia metaphyseal fractures can be difficult to manage. Treatment selection is influenced by the proximity of the fracture to the plafond, fracture displacement, comminution, and injury to the soft-tissue envelope. Nonsurgical management is possible for stable fractures with minimal shortening. Indications for intramedullary nailing have expanded to include distal metaphyseal tibia fractures. Intramedullary nailing allows atraumatic, closed stabilization while preserving the vascularity of the fracture site and integrity of the soft-tissue envelope. Intramedullary canal anatomy at this level prevents intimate contact between the nail and endosteum, however, and concerns have been raised regarding the biomechanical stability of fixation and risk of malunion. Plate fixation is effective in stabilizing distal tibia fractures. Conventional techniques involve extensive dissection and periosteal stripping, which increase the risk of soft-tissue complications. Percutaneous plating techniques use indirect reduction methods and allow stabilization of distal tibia fractures while preserving vascularity of the soft-tissue envelope. External fixation is effective in the setting of contaminated wounds or extensive soft-tissue injury. Careful preoperative planning with consideration for fracture pattern and soft-tissue condition helps guide implant selection and minimize postoperative complications.

Investigators Compare Outcomes of ORIF Versus THA for Femoral Neck Fractures

A study comparing outcomes with open reduction and internal fixation (ORIF) versus total hip arthroplasty (THA) for femoral neck fractures in patients younger than age 65 years found that THA was a cost-effective option for healthy patients older than 54 years. THA was also a cost-effective option for patients with mild comorbidity older than 47 years and for patients with multiple comorbidities older than 44 years.

Posterior Wall Acetabular Fractures: Diagnosis, Treatment, and Results

Fractures of the posterior wall of the acetabulum are the most common type of acetabular fracture, accounting for approximately 25% of all acetabular fractures. The simple appearance of the posterior wall fracture on plain radiographs underestimates its potential complexity. Rather than having one simple fracture fragment, most posterior wall fractures are comminuted or have areas where the articular surface along the margin of the primary fracture line is impacted into the underlying cancellous bone. In general, posterior wall fractures are amenable to nonsurgical treatment if the remaining, intact part of the acetabulum is large enough to maintain hip joint stability and congruity; however, this situation is often difficult to determine. Clinical outcome has been shown to be directly related to the accuracy of reduction, but accurate repositioning of all of the small posterior wall fragments is frequently a challenging task. This article reviews the etiology, clinical presentation, and the technique and results of open reduction and internal fixation of posterior wall fractures of the acetabulum.