Mark R. Adams

Distal radius fractures.

Distal radius fractures are a common injury, particularly in the elderly population. Severity of these fractures is directly related to the bone mineral density of the patient, and clinical results are dependent on this parameter as well. In terms of treatment, several options exist. Nonoperative management consists of closed treatment with casting. Operative treatment options include intrafocal pinning, nonbridging and bridging external fixation, arthroscopic-assisted external fixation, and various methods of open reduction internal fixation. When operative intervention is indicated, considerations include the characteristics of the fracture and the experience of the surgeon with the treatment modalities.

Inadvertent Reduction of Symphyseal Diastasis During Computed Tomography.

Objective: To determine the quantifiable difference in pubic symphysis diastasis when comparing computed tomography (CT) and pelvic radiographs in individuals with anterior pelvic ring injuries. Design: Retrospective chart and radiographic review. Setting: Level 1 trauma center. Patients/Participants: Between 2002 and 2013, all individuals requiring internal fixation of the anterior pelvic ring were reviewed. Of the 163 patients, 72 met the inclusion criteria. Patients with a symphysis dislocation were included if the pelvic radiograph and CT were performed without a pelvic binder, and imaging was adequate for required measurements. Intervention: Symphyseal diastasis was measured on the initial pelvic radiograph, the CT scout, and axial views. Main Outcome Measurements: Comparison of measured symphyseal diastasis on CT and pelvic radiographs. Results: Seventy-two patients met the inclusion criteria. Ninety-seven percent (70/72) had a reduction of their symphysis diastasis in the CT with an average reduction of 6.6 mm (Range, −2.6 to 35.5 mm). The average diastasis on radiograph was 26.3 mm compared with 19.7 mm on CT scout (P < 0.001). Fourteen patients (19.2%) had a reduction from greater than 25 mm to less than 25 mm—a traditional cutoff for operative intervention. Conclusions: The anteroposterior pelvis radiograph remains an important part of the workup for trauma patients. Reliance on CT alone may underestimate the true degree of pelvic displacement. Failure to obtain pelvic radiographs in the acute setting limits the information in which the medical team can base both immediate and definitive decisions about pelvic ring injuries. Level of Evidence: Diagnostic level III. See Instructions for Authors for a complete description of levels of evidence.

Is S3 a Viable Osseous Fixation Pathway

Objectives: To report the incidence of patients with a third sacral segment (S3) osseous fixation pathway (OFP) that could accommodate a transiliac-transsacral screw. Design: Retrospective case series. Setting: Regional Level 1 Trauma Center. Patients/Participants: A total of 250 patients without pelvic trauma from January 2017 to February 2017 were included. Intervention: The axial and sagittal reconstruction images of each patients computed abdomen and pelvis tomography (CT) scans were reviewed. Main Outcome Measurements: Each CT was evaluated for the presence of sacral dysmorphism and whether an S3 OFP that could accommodate an intraosseous transiliac-transsacral screw exists. Results: There were 130 of the 250 patients (52%) with sacral dysmorphism. Overall, 38 of the 250 patients (15.2%) had an S3 OFP that could accommodate a 7.0-mm transiliac-transsacral style screw. When narrowed to patients who had an S3 OFP, 38 of 153 patients (24.8%) could accommodate a 7.0-mm transiliac-transsacral screw. Specific to the 38 patients with an adequate S3 OFP, 34 of 38 patients (89.5%) were noted to have sacral dysmorphism. Conclusions: Our study demonstrates that 15.2% of patients have an S3 OFP large enough to accommodate an intraosseous implant. Patients who have sacral dysmorphism are more likely to have an adequate S3 OFP. Additional studies are needed to quantify the S3 OFP, understand the bone quality of the S3 segment and accompanying biomechanical implications, and investigate the anatomical concerns associated with S3 screw placement. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Low Incidence of Neurovascular Complications After Placement of Proximal Tibial Traction Pins

Skeletal tibial traction is a temporizing measure used preoperatively for femoral fractures to improve the length and alignment of the limb and provide pain relief. The goal of this study was to identify possible neurovascular morbidity associated with the use of bedside skeletal tibial traction to treat femur fractures. All femoral fractures treated with proximal tibial traction during a 10-year period at an urban level I trauma center were retrospectively reviewed. The medical record was reviewed to determine whether a pin-related complication had occurred. Records also were reviewed to identify ipsilateral multi-ligamentous knee injuries that were not diagnosed until after the application of traction. In total, 303 proximal tibial traction pins were placed. A total of 7 (2.3%; 95% confidence interval, 0.60%-4.0%) pin-related neurologic complications and zero vascular complications were noted. All complications involved motor and/or sensory deficits in the distribution of the peroneal nerve. Of the 7 complications, 6 resolved fully after surgery and removal of the pin. After traction placement, 6 (2.0%) ipsilateral multiligamentous knee injuries were diagnosed. None of these patients had a neurovascular complication. This study suggests that bedside placement of proximal tibial traction for femoral fractures is associated with a low incidence of neurovascular complications and that traction can be safely placed at the bedside by residents. A thorough neurovascular examination should be performed before insertion, and care should be taken to identify the proper starting point and reduce soft tissue trauma during pin placement. [Orthopedics. 2017; 40(6):e1004-e1008.].