Susan P. Harding

Percutaneous Column Fixation and Total Hip Arthroplasty for the Treatment of Acute Acetabular Fracture in the Elderly

We used our database of primary total hip arthroplasties to identify those patients who had acetabular fractures fixed with percutaneous screws under the same anesthesia as for the arthroplasty procedure. There were 19 patients with the average follow-up of 22 months. Fourteen patients sustained the fracture secondary to a low-energy trauma, while the remaining patients were involved in a high-energy trauma accident. The mean survival time was calculated to be 2.5 ± 0.6 years for the low-energy group and 4 ± 1.4 years for the high-energy group. We believe that this unique treatment of acetabular fractures has a role in carefully selected patients and provides the necessary reduction and immediate stability of the fracture needed to ensure adequate fit for the acetabular cup in the subsequent THA.

Incidence of Orthopedic Surgery Intervention in a Level I Urban Trauma Center With Motorcycle Trauma

BACKGROUND This study summarizes orthopedic injuries sustained in motorcycle collisions in patients presenting to a Level I trauma center. METHODS We performed a retrospective review of orthopedic injuries in motorcycle trauma victims brought into the emergency department. Of 2,634 presenting cases, 151 were identified as involving motorcycle collisions. Variables included age, gender, mechanism of injury, type and location of injury, concomitant injuries, length of hospitalization, number of orthopedic procedures during primary admission, and subsequent readmission. RESULTS A total of 71.5% of patients required orthopedic consultation. Average age was 35.0 years, with men injured at a ratio of 8:1. The most common mechanism of injury was motorcycle versus automobile (n=48). A total of 206 fractures in 108 patients were discovered. The most common site of fracture involved the lower extremities. Open reduction with internal fixation was performed on 110 fractures (69 patients) during primary admission. Fifty-seven patients (52.8%) sustained open fractures requiring emergent orthopedic intervention. Fifty-three patients had various concomitant complications. Two patients died during initial hospitalization. Average hospitalization for patients without orthopedic consultation was 11.9 days versus 13.8 days with orthopedic consultation. The average number of orthopedic procedures performed on patients was 1.6. CONCLUSIONS Motorcycle collisions frequently involve patients in their working prime, thus placing substantial burden on the individual and society. Although these patients must continue to receive Level I trauma care, strengthened prevention and improved education efforts are warranted.

Pelvic Fractures in Professional Cyclists: A Report of 3 Cases

Background: Professional riders demonstrate increased risk factors for such injuries including both extensive time on the bike in addition to a possible underlying osteopenia secondary to the nonimpact nature of the sport. Hypothesis: Nonoperative management of stable, nondisplaced pelvic fractures in professional cyclists offers excellent results. Study Design: Case series. Methods: Three cases of professional cyclists with pelvic fractures were reviewed. Results: All 3 cyclists were able to return to professional competition and remain symptom free. Conclusion: Accurate early diagnosis of pelvic fractures, with the aid of computed tomography, is crucial. Early non-weightbearing with a progression to weightbearing as tolerated and early return to stationary training are appropriate. Accurate diagnosis and careful nonoperative management of stable, nondisplaced pelvic fractures in professional cyclists offers excellent results. Clinical Relevance: Accurate diagnosis of pelvic fractures in high-demand athletes with few complaints and no obvious findings on plain film radiographs. Control of weightbearing and competitive status to prevent injury progression. Gauged return to competition at professional level.

Cessation of teriparatide in order to heal a humeral fracture: a case report.

Teriparatide (Forteo; Eli Lilly, Indianapolis, IN, USA) is a recombinant protein consisting of a biologically active portion of the parathyroid hormone (PTH) molecule. Acting on bone and renal G-protein receptors, the net effect of the medication is to increase cortical and cancellous bone mass. Given in a continuous fashion, Teriparatide can favor bone reabsorption; however, if pulsed by daily dosing, it can favor bone formation. PTH has been proven to increase cortical thickness without increasing porosity in osteoporotic patients. Teriparatide has also been shown to decrease vertebral fracture risk in postmenopausal women with osteoporosis. The drug is currently U.S. Food and Drug Administration-approved to treat patients with severe osteoporosis at high risk for future fracture. Teriparatide’s ability to increase bone mass and decrease fracture risk has led to the investigation of PTH peptide 1-34 as an adjunct to assist in fracture healing. The current literature has focused on teriparatide use as an adjunct to heal acute fractures and fracture nonunions. All of these studies have demonstrated that teriparatide has a positive outcome on fracture healing, but no studies have proven an outright negative outcome with its use. We present a case report of a proximal humeral nonunion with successful healing after termination of teriparatide therapy initially begun for fracture prevention.

Placing Femoral Intramedullary Nails in Severely Bowed Femurs

The authors describe a novel technique of anterograde femoral intramedullary nail fixation for hip fracture using the starting guide pin as a blocking screw. This cost-effective technique uses fluoroscopic radiography to ensure the guidewire is within the posterior aspect of the femur on a lateral view, thereby minimizing the risk of anterior cortical femoral fractures.