Kamran S. Hamid

Salvage of Severe Foot and Ankle Trauma With a 3D Printed Scaffold

Treatment of segmental tibial bone loss in the setting of highenergy trauma remains a clinical challenge despite advances in modern orthopaedic traumatology. In the acute setting, options to span large bony defects are limited by devitalized soft tissue and contamination in the case of open injuries. Delayed reconstruction of these injuries has been described through a variety of methods including autograft bone transport utilizing an external fixator, massive cancellous bone grafting with and without tissue transfer, vascularized fibular transfer, osteomyocutaneous flaps, and 2-stage reconstructions including the Masquelet technique. In cases of large segmental defects, bone transport utilizing an external fixator has traditionally been selected over other techniques because of surgeon familiarity and the desire to employ the patient’s intrinsic healing biology. While bone transport has historically proven beneficial, it is not a panacea and has its own complications, including nonunion, stress or refracture at the docking site, pin tract infection, extended period of non-weightbearing, and prolonged external fixator placement. From a patient perspective, this represents a long-term investment that will be a severe hindrance to daily function, and thus compliance can be a limiting factor despite a technically proficient procedure. From a societal perspective, the lost days of work productivity and investment in the patient’s recuperation are significant. In fact, Paley et al reported that 1 cm of regenerated bone takes 1 month to consolidate and distal (docking) consolidation is obtained after 6 months of stable contact between the distal and transported fragments, leaving some authors to recommend maintenance of the external fixator for 1 year until significant hypertrophy is demonstrated. Additive manufacturing—commonly referred to as “3D printing”—is the process of creating a predefined object via precise deposition of materials in a layer-by-layer fashion. 3D printing can create a myriad of structures with a variety of materials, including metals, plastics, and even living cells. The customizability of 3D printing with regard to shape and biocompatible materials make it an attractive potential alternative for the treatment of segmental bone loss in the foot and ankle. This report describes successful limb salvage through the use of a patient-specific custom 3D printed titanium scaffold to replace intra-articular distal tibia segmental bone loss with concomitant comminuted talus fracture and multiple additional foot fractures.

Doing Well by Doing Good Assessing the Cost Savings of an Intervention to Reduce Central Line–Associated Bloodstream Infections in a Hawaii Hospital

A complete understanding of the financial impact of patient safety interventions must consider the economic incentives of both payers and providers within the current fee-for-service payment model. This study evaluated the impact of a central line–associated bloodstream infection (CLABSI) initiative on costs, reimbursements, and margins for 1 Hawaii hospital and its payers. Intensive care unit patients (January 2009-December 2011) who developed a CLABSI were compared to matched controls. Mean hospital cost, reimbursement, and margin was

Radiographic and CT Assessment of Reduction of Calcaneus Fractures Using a Limited Sinus Tarsi Incision

222 692 versus

Clinical Presentation and Management of Hallux Rigidus.

80 144 (P = .01),

Using Wearable Video Technology to Build a Point-of-View Surgical Education Library

259 433 versus

An Orthopedic-Hospitalist Comanaged Hip Fracture Service Reduces Inpatient Length of Stay:

72 543 (P < .01), and

Ratio of Range of Motion of the Ankle and Surrounding Joints After Total Ankle Replacement: A Radiographic Cohort Study.

54 906 versus

Operative Wound Complications Following Total Ankle Arthroplasty

6506 (P < .01), respectively. Although hospitals and payers reduce costs by preventing CLABSIs, hospitals also would decrease their margins, which creates a perverse incentive to have more line infections. An optimal reimbursement system must reward hospitals and payers for preventing harm rather than treating illness. This study highlights the critical role that health care payers have as patient safety advocates, financial sponsors, and facilitators.

Determining the Cost-Savings Threshold and Alignment Accuracy of Patient-Specific Instrumentation in Total Ankle Replacements

Background: The lateral extensile incision for fixation of displaced intra-articular calcaneus fractures allows for fracture reduction but has been associated with high rates of soft tissue complications. This has prompted a search for less invasive methods of fracture fixation. The purpose of the present study was to determine the adequacy of reduction and rate of complications associated with operative fixation of calcaneal fractures using a limited sinus tarsi approach. Methods: A limited sinus tarsi incision with plate fixation was utilized for treatment of 39 displaced intra-articular calcaneal fractures in 35 consecutive patients as part of a single surgeon series. Imaging assessment of previously described fracture displacement measures was undertaken in preoperative and postoperative radiographs and CT. A retrospective chart review was conducted to identify postoperative complications. Results: Mean preoperative Bohler angle measurement was 7.7 (range, –26.0 to 30.0) degrees and the mean final postoperative standing Bohler angle was 25.5 (range, 12.3 to 37.7) degrees. Postoperative CT demonstrated that subtalar articular reduction was within 2 mm of anatomic in 91% of patients. There were 2 instances of superficial wound dehiscence (5.1%) and 1 deep infection (2.6%) that required debridement and complete hardware removal. Visual analog score (VAS) for pain averaged 3 of 10 in the 32 available patients at 1-year follow-up. Eight of these patients (25%) reported no pain (0/10) at final follow-up. Conclusion: Operative fixation of displaced intra-articular calcaneal fractures utilizing the limited sinus tarsi approach resulted in acceptable fracture reduction and a low rate of complications. Level of Evidence: Level IV, retrospective case series.

Predictors of Time to Union After Operative Fixation of Closed Ankle Fractures.

Hallux rigidus is the most commonly occurring arthritic condition of the foot and is marked by pain, limited motion in the sagittal plane of the first metatarsophalangeal joint and varying degrees of functional impairment. In conjunction with clinical findings, radiographic grading helps guide therapeutic choices. Nonsurgical management with anti-inflammatory medications, corticosteroid injections, or shoewear and activity modifications can be successful in appropriately selected patients. Patients with more severe disease or refractory to conservative management may benefit from surgical intervention. Operative options range from joint-preserving procedures (eg, cheilectomy with or without associated osteotomies) to joint-altering procedures (eg, arthroplasty or arthrodesis).