Jennifer M. Bauer

One-year mortality after acetabular fractures in elderly patients presenting to a level-1 trauma center.

Objectives: To evaluate the 1-year mortality of elderly patients after isolated acetabular fractures treated both operatively and nonoperatively, and compared with nonisolated fractures. Design: Retrospective review. Setting: Single level 1 trauma center. Patients/Participants: All consecutive patients who were 60 years of age and older were treated for acetabular fractures over a 12-year period (n = 176). Intervention: Operative and nonoperative management. Main Outcome Measurements: 1-year mortality. Methods: Exclusion criteria for the isolated group included associated injuries to other body systems (Abbreviated Injury Score >2), long bone fractures, and concurrent sacral fractures. Mortality data were obtained from the Social Security Death Index. Results: The isolated group (n = 86) had an average age of 71.1 ± 7.1 years with 64.0% fractures treated operatively. Mortality rates for the isolated group at 30 days, 3 months, 6 months, and 1 year were 2.3%, 5.8%, 8.1%, and 8.1%, respectively. No significant differences in mortality rates were seen between operative and nonoperative patients across all time points for the isolated group (P = 0.093–0.346). Mortality rates were lower at all time points for the isolated group than for the nonisolated group (n = 90; P = 0.0002–0.02). However, the 1-year postdischarge mortality rates for patients who were discharged from the hospital were similar for the nonisolated and isolated groups (6.8% vs. 7.1%; P = 0.76). Conclusions: The mortality rates for elderly patients with isolated acetabular fractures were found to be significantly lower than those for acetabular fractures with concurrent injuries. Age was identified as the only significant variable differing between patients treated operatively versus nonoperatively, as opposed to medical comorbidities in the isolated acetabular fracture group. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Analysis of retrograde femoral intramedullary nail placement through traumatic knee arthrotomies.

Objectives: To analyze the rate of postoperative infection after retrograde femoral nail placement in the setting of traumatic knee arthrotomy (KA). Design: Retrospective. Setting: Level-I trauma center. Patients: A review of all adult femur fractures (N = 1748) treated with an intramedullary nail over a 10-year period identified 34 retrograde nails with traumatic KA as the study group and 23 antegrade nails with traumatic KA as a control group. The retrograde femoral traumatic KA group was also compared with a 4:1 matched control group of 136 patients with retrograde femoral nails without traumatic KA. Intervention: Retrograde femoral nail placement with traumatic KA. Main Outcome Measurements: Occurrence of postoperative infection. Results: The traumatic KA groups treated with retrograde and antegrade femoral nails were similar across all recorded patient variables. No infections occurred in the retrograde traumatic KA group versus 1 infection (4.3%) in the antegrade traumatic KA group (P = 0.404). Four nonunions (11.8%) occurred in the retrograde traumatic KA group versus 1 nonunion (4.3%) in the antegrade traumatic KA group (P = 0.638). The matched control group of retrograde nails did not significantly differ when compared with the retrograde traumatic KA group for infection or nonunion (P = 1.000 and 0.261). Conclusions: This is the first study to investigate retrograde nail placement through traumatic KA with comparison to control groups, with no differences found in infection rates. Furthermore, no infections (knee or fracture) occurred in those patients who were treated using a retrograde femoral nail with traumatic KA. This study documents the relative safety associated with retrograde femoral nailing in the setting of a concurrent traumatic KA with surgical debridement. Level of Evidence: Therapeutic level III. See Instructions for Authors for a complete description of levels of evidence.

Treatment of Hip Dislocations and Associated Injuries: Current State of Care.

Hip dislocations, most often caused by motor vehicle accidents or similar high-energy trauma, traverse a large subset of distinct injury patterns. Understanding these patterns and their associated injuries allows surgeons to provide optimal care for these patients both in the early and late postinjury periods. Nonoperative care requires surgeons to understand the indications. Surgical care requires the surgeon to understand the benefits and limitations of several surgical approaches. This article presents the current understanding of hip dislocation treatment, focusing on anatomy, injury classifications, nonoperative and operative management, and postinjury care.

Bicondylar Tibial Plateau Fracture with Compartment Syndrome

A 34-year-old man sustained a closed right tibial plateau fracture as the passenger in a golf cart rollover accident. He was transferred from an outside hospital and evaluated in the emergency room 6 h after injury. At the time, his leg compartments were but compressible, with normal distal sensation and pulses, and no pain with passive stretch.

Length-Preserving Intramedullary Femoral Fixation for Traumatic Leg Amputation

Case: We present the case of a twenty-one-year-old woman with a traumatic left leg amputation, substantial proximal skin degloving, and an ipsilateral femoral fracture treated with revision amputation distal to the fracture site and retrograde femoral nailing through the amputation site. Conclusion: A short retrograde femoral nail is a surgical option to fix a femoral shaft fracture proximal to a traumatic amputation in order to preserve limb length for effective prosthetic fit and ambulation.CASE We present the case of a twenty-one-year-old woman with a traumatic left leg amputation, substantial proximal skin degloving, and an ipsilateral femoral fracture treated with revision amputation distal to the fracture site and retrograde femoral nailing through the amputation site. CONCLUSION A short retrograde femoral nail is a surgical option to fix a femoral shaft fracture proximal to a traumatic amputation in order to preserve limb length for effective prosthetic fit and ambulation.