Laurence B. Kempton

Fractures of the tibial plateau involve similar energies as the tibial pilon but greater articular surface involvement.

Patients with tibial pilon fractures have a higher incidence of post‐traumatic osteoarthritis than those with fractures of the tibial plateau. This may indicate that pilon fractures present a greater mechanical insult to the joint than do plateau fractures. We tested the hypothesis that fracture energy and articular fracture edge length, two independent indicators of severity, are higher in pilon than plateau fractures. We also evaluated whether clinical fracture classification systems accurately reflect severity. Seventy‐five tibial plateau fractures and 52 tibial pilon fractures from a multi‐institutional study were selected to span the spectrum of severity. Fracture severity measures were calculated using objective CT‐based image analysis methods. The ranges of fracture energies measured for tibial plateau and pilon fractures were 3.2–33.2 Joules (J) and 3.6–32.2 J, respectively, and articular fracture edge lengths were 68.0–493.0 mm and 56.1–288.6 mm, respectively. There were no differences in the fracture energies between the two fracture types, but plateau fractures had greater articular fracture edge lengths (p < 0.001). The clinical fracture classifications generally reflected severity, but there was substantial overlap of fracture severity measures between different classes. Similar fracture energies with different degrees of articular surface involvement suggest a possible explanation for dissimilar rates of post‐traumatic osteoarthritis for fractures of the tibial plateau compared to the tibial pilon. The substantial overlap of severity measures between different fracture classes may well have confounded prior clinical studies relying on fracture classification as a surrogate for severity.

Increased Cost of Negative Pressure Dressings Is Not Justified for Split-Thickness Skin Grafting of Low-Risk Wounds.

Objectives: (1) To determine whether negative pressure dressings (NPDs) are superior to conventional compressive dressings (CDs) for split-thickness skin grafts (STSGs) placed on healthy, low-risk wounds, (2) To determine the cost difference of NPDs versus that of CDs. Design: Retrospective. Setting: Level I Trauma Center. Patients/Participants: One hundred ninety-five traumatic wounds treated with STSG. Main Outcome Measurements: Patients were assigned outcomes based on postoperative documentation: completely healed, incompletely healed (small areas of graft necrosis), failed, or lost to follow-up. The costs associated with each dressing type were documented. Results: Thirty five of 195 STSGs were lost to follow-up, leaving n = 120 STSG–NPD, n = 40 STSG–CD. Of the remaining 120 STSGs treated with NPD, 91 completely healed, 23 incompletely healed, and 6 failed. Of the 40 STSGs treated with a CD, 37 completely healed, 1 incompletely healed, and 2 failed. Patients treated with CDs had a higher likelihood of healing relative to those treated with the NPD (P = 0.018). Analyzing the outcomes as failed versus “not failed” revealed no significant difference between the groups (P = 1.00). There were more smokers in the CD group (P = 0.022). In this series, the mean cost associated with NPD compared with that of CD was

Wide Variation of Surgical Cost in the Treatment of Periarticular Lower Extremity Injuries Between 6 Fellowship-trained Trauma Surgeons

2370 more per patient. Conclusions: There is a high rate of successful healing of STSGs for traumatic extremity wounds regardless of the dressing used. The increased cost of NPDs is not justified in wounds that are at a low risk of developing STSG failure. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Fracture Healing and Imaging Evaluation

Objectives: We hypothesized that negligible surgical material cost variation exists between traumatolgists for treatment of bimalleolar ankle and bicondylar tibial plateau fractures. Design: Retrospective medical record review. Setting: Academic level 1 Trauma Center; 2-year period. Patients/Participants: Current Procedure Terminology codes for open treatment of bimalleolar ankle and bicondylar tibial plateau fractures identified patients. Patients who had operative treatment of other injuries under the same anesthetic session were excluded. Only definitive treatment procedures were analyzed. Intervention: We analyzed the intraoperative material costs of these procedures and compared them between surgeons. This analysis was done with a newly developed proprietary program designed for inventory and cost analysis. Main Outcome Measurements: Mean and median total case material costs were compared using one-way analysis of variance. Individual items that significantly increased costs were identified. Results: We identified 88 bimalleolar ankle and 46 bicondylar tibial plateau fractures treated by 6 surgeons. The mean intraoperative material cost per bimalleolar ankle fracture was

Objective Metric of Energy Absorbed in Tibial Plateau Fractures Corresponds Well to Clinician Assessment of Fracture Severity.

1099. The least expensive surgeons mean case cost was

Timing of Treatment in the Multiply Injured Patient

613, which was significantly less than the most expensive surgeons

Intramedullary Nailing of Periarticular Fractures

2243 (P = 0.009). The median cost range was

Response to Letter to the Editor: Costs and Radiographic Outcomes of Rotational Ankle Fractures Treated by Orthopaedic Surgeons With or Without Trauma Fellowship Training

598–

Costs and Radiographic Outcomes of Rotational Ankle Fractures Treated by Orthopaedic Surgeons With or Without Trauma Fellowship Training

784. The top quartile of cases resulted in 57% of overall material cost for ankle fractures. The mean intraoperative material cost per bicondylar tibial plateau fracture was

Locking Plate Fixation in a Series of Bicondylar Tibial Plateau Fractures Raises Treatment Costs Without Clinical Benefit

3219 (range