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1. Accelerated surgery versus standard care in hip fracture (HIP ATTACK-1) : a kidney substudy of a randomized clinical trial

Author

Flavia K. Borges, P.J. Devereaux, Meaghan Cuerden, Jessica M. Sontrop, Mohit Bhandari, Ernesto Guerra-Farfán, Ameen Patel, Alben Sigamani, Masood Umer, John Neary, Maria Tiboni, Vikas Tandon, Mmampapatla Thomas Ramokgopa, Parag Sancheti, Abdel-Rahman Lawendy, Mariano Balaguer-Castro, Richard Jenkinson, Paweł Ślęczka, Aamer Nabi Nur, Gavin C.A. Wood, Robert J. Feibel, John Stephen McMahon, Bruce M. Biccard, Alessandro Ortalda, Wojciech Szczeklik, Chew Yin Wang, Jordi Tomás-Hernández, Jessica Vincent, Valerie Harvey, Shirley Pettit, Kumar Balasubramanian, Gerard Slobogean, Amit X. Garg, Laurent Veevaete, Bernard le Polain de Waroux, Patricia Lavand'homme, Olivier Cornu, Karim Tribak, Jean C. Yombi, Nassim Touil, Jigme T. Bhutia, Carol Clinckaert, Dirk De Clippeleir, Maike Reu, Leslie P. Gauthier, Victoria RA. Avram, Mitchell Winemaker, Daniel M. Tushinski, Justin de Beer, Andrew Worster, Diane L. Simpson, Kim A. Alvarado, Krysten K. Gregus, Kelly H. Lawrence, Darryl P. Leong, Philip G. Joseph, Patrick Magloire, Benjamin Deheshi, Stuart Bisland, Thomas J. Wood, David AJ. Wilson, Sandra N. Ofori, Jessica Spence, Emmanuelle Duceppe, Maria E. Tiboni, John D. Neary, Anthony Adili, David D. Cowan, Vickas Khanna, Amna Zaki, Janet C. Farrell, Anne Marie MacDonald, David Conen, Steven CW. Wong, Arsha Karbassi, Douglas S. Wright, Harsha Shanthanna, Javier Ganame, Andrew Cheung, Ryan Coughlin, Moin Khan, Spencer Wikkerink, Faraaz A. Quraishi, Waleed Kishta, Emil Schemitsch, Timothy Carey, Mark D. Macleod, David W. Sanders, Edward Vasarhelyi, Debra Bartley, George K. Dresser, Christina Tieszer, Richard J. Jenkinson, Steven Shadowitz, Jacques S. Lee, Stephen Choi, Hans J. Kreder, Markku Nousiainen, Monica R. Kunz, Ravianne Tuazon, Mopina Shrikumar, Bheeshma Ravi, David Wasserstein, David J.G. Stephen, Diane Nam, Patrick D.G. Henry, Gavin CA. Wood, Stephen M. Mann, Melanie T. Jaeger, Marco LA. Sivilotti, Christopher A. Smith, Christopher C. Frank, Heather Grant, Leone Ploeg, Jeff D. Yach, Mark M. Harrison, Aaron R. Campbell, Ryan T. Bicknell, Davide D. Bardana, Katie McIlquham, Catherine Gallant, Samantha Halman, Venkatesh Thiruganasambandamoorth, Sara Ruggiero, William J. Hadden, Brian PJ. Chen, Stephanie A. Coupal, Stephen J. McMahon, Lisa M. McLean, Hemant R. Shirali, Syed Y. Haider, Crystal A. Smith, Evan Watts, David J. Santone, Kevin Koo, Allan J. Yee, Ademilola N. Oyenubi, Aaron Nauth, Emil H. Schemitsch, Timothy R. Daniels, Sarah E. Ward, Jeremy A. Hall, Henry Ahn, Daniel B. Whelan, Amit Atrey, Amir Khoshbin, David Puskas, Kurt Droll, Claude Cullinan, Jubin Payendeh, Tina Lefrancois, Lise Mozzon, Travis Marion, Michael J. Jacka, James Greene, Matthew Menon, Robert Stiegelmahr, Derek Dillane, Marleen Irwin, Lauren Beaupre, Chad P. Coles, Kelly Trask, Shelley MacDonald, J.A.I. Trenholm, William Oxner, C.G. Richardson, Niloofar Dehghan, Mehdi Sadoughi, Achal Sharma, Neil J. White, Loretta Olivieri, Stephen B. Hunt, Thomas R. Turgeon, Eric R. Bohm, Sarah Tran, Stephen M. Giilck, Tom Hupel, Pierre Guy, Peter J. O'Brien, Andrew W. Duncan, Gordon A. Crawford, Junlin Zhou, Yanrui Zhao, Yang Liu, Lei Shan, Anshi Wu, Juan M. Muñoz, Philippe Chaudier, Marion Douplat, Michel Henri Fessy, Vincent Piriou, Lucie Louboutin, Jean Stephane David, Arnaud Friggeri, Anthony Viste, Charles Hervé Vacheron, Frankie Ka Li Leung, Christian Xinshuo Fang, Dennis King Hang Yee, Parag K. Sancheti, Chetan V. Pradhan, Atul A. Patil, Chetan P. Puram, Madhav P. Borate, Kiran B. Kudrimoti, Bharati A. Adhye, Himanshu V. Dongre, Bobby John, Valsamma Abraham, Ritesh A. Pandey, Arti Rajkumar, Preetha E. George, Manesh Stephen, Nitheesh Chandran, Mohammed Ashraf, A.M. Georgekutty, Ahamad S. Sulthan, S. Adinarayanan, Deep Sharma, Satish P. Barnawal, Srinivasan Swaminathan, Prasanna U. Bidkar, Sandeep K. Mishra, Jagdish Menon, M. Niranjan, Z.K. Varghese, Santosh A. Hiremath, N.C. Madhusudhan, Abhijit Jawali, Kingsly R. Gnanadurai, Carolin E. George, Tatarao Maddipati, K.P. Mary, Vijay Sharma, Kamran Farooque, Rajesh Malhotra, Samarth Mittal, Chavi Sawhney, Babita Gupta, Purva Mathur, Shivanand Gamangati, Vijaylaxmi Tripathy, Prem H. Menon, Mandeep S. Dhillon, Devendra K. Chouhan, Sharanu Patil, Ravi Narayan, Purushotham Lal, Prashanth N. Bilchod, Surya U. Singh, Uttam V. Gattu, Ravi P. Dashputra, Prashant V. Rahate, Maurizio Turiel, Riccardo Accetta, Paolo Perazzo, Daniele Stella, Marika Bonadies, Chiara Colombo, Giuseppe De Blasio, Stefania Fozzato, Fabio Pino, Ilaria Morelli, Francesco De Donato, Eleonora Colnaghi, Vincenzo Salini, Giacomo Placella, Giuseppe Giardina, Gaetano Lombardi, Anna Marcato, Luca Guzzetti, Ilaria Rivetti, Massimiliano Greco, H.M. Khor, Hou Yee Lai, C.S. Kumar, K.H. Chee, P.S. Loh, Kit Mun Tan, Simmrat Singh, Li Lian Foo, Komella Prakasam, Sook Hui Chaw, Meng-Li Lee, Joanne HL. Ngim, Huck Wee Boon, Im Im Chin, Ydo V. Kleinlugtenbelt, Ellie BM. Landman, Elvira R. Flikweert, Herbert W. Roerdink, Roy BG. Brokelman, Hannie F. Elskamp-Meijerman, Bas Staffhorst, Jan-Hein MG. Cobben, Dilshad Begum, Anila Anjum, Pervaiz M. Hashmi, Tashfeen Ahmed, Haroon U. Rashid, Mujahid J. Khattak, Rizwan H. Rashid, Riaz H. Lakdawala, Shahryar Noordin, Naveed M. Juman, Robyna I. Khan, Muhammad M. Riaz, Syedah S. Bokhari, Ayesha Almas, Hussain Wahab, Arif Ali, Hammad N. Khan, Eraj K. Khan, Kholood A. Janjua, Sajjad H. Orakzai, Abdus S. Khan, Khawaja J. Mustafa, Mian A. Sohail, Muhammad Umar, Siddra A. Khan, Muhammad Ashraf, Muhammad K. Khan, Muhammad Shiraz, Ahmad Furgan, Piotr Dąbek, Adam Kumoń, Wojciech Satora, Wojciech Ambroży, Mariusz Święch, Jacek Rycombel, Adrian Grzelak, Ilona Nowak-Kózka, Jaroslaw Gucwa, Waldemar Machala, Mmampapatla T. Ramokgopa, Gregory B. Firth, Mwalimu Karera, Maria Fourtounas, Virsen Singh, Anna Biscardi, Muhammad N. Iqbal, Ryan J. Campbell, Matimba L. Maluleke, Carien Moller, Lerato Nhlapo, Sithombo Maqungo, Margot Flint, Marcin B. Nejthardt, Sean Chetty, Stephen Venter, Ernesto Guerra-Farfan, Jordi Tomas-Hernandez, Yaiza Garcia-Sanchez, Miriam Garrido Clua, Vicente Molero-Garcia, Jordi Teixidor-Serra, Maria del Mar Villar-Casares, Jordi Selga Marsa, Juan A. Porcel-Vazquez, Jose-Vicente Andres- Peiro, Jaume Mestre-Torres, Patricia Guilabert, M Luisa Paños Gozalo, Luis Abarca, Nuria Martin, Gemma Usua, Pilar Lalueza-Broto, Judith Sanchez-Raya, Jorge Nuñez Camarena, Antoni Fraguas-Castany, Carlos Piedra Calle, Diego Soza Leiva, Maria Garcia Carrasco, Montsant Jornet-Gibert, Montserrat Monfort-Mira, Alfons Gasset-Teixidor, Francesc Antoni Marcano-Fernández, Isabel Simó- Sánchez, Begoña Mari-Alfonso, Christian Yela-Verdú, Raúl Pellejero-García, Júlia Casas-Codina, Ruben Iglesias- Sanjuan, Pau Balcells-Nolla, Oriol Vila-Sánchez, Mercè Bertrana de Bustos, Pablo Castillón, Martí Bernaus, Saioa Quintas, Olga Gómez, Jordi Salvador, Javier Abarca, Cristina Estrada, Marga Novellas, Francesc Anglès, Alfred Dealbert, Oscar Macho, Alexia Ivanov, Esther Valldosera, Marta Arroyo, Borja Pey, Antoni Yuste, Llorenç Mateo, Julio De Caso, Rafael Anaya, J.L. Higa-Sansone, Angelica Millan, Victoria Baños, Sergio Herrera-Mateo, Hector J. Aguado, Virginia García-Virto, Clarisa Simón-Pérez, Sergio Chavez, María Bragado, María Plata, Enrique Guerado, Encarnacion Cruz, Juan R. Cano, Jose M. Bogallo, Paphon Sa-ngasoongsong, Noratep Kulachote, Norachart Sirisreetreerux, Nachapan Pengrung, Theerawat Chalacheewa, Vanlapa Arnuntasupakul, Teerapat Yingchoncharoen, Bundit Naratreekoon, Miriam A. Kadry, Surendini Thayaparan, Victor Babu, Arash Aframian, Souad Bentoumi, Amrinder Sayan, Ihab Abdlaziz, Marcela P. Vizcaychipi, Patricia Correia, Shashank Patil, Kevin Haire, Amy SE. Mayor, Sally Dillingham, Laura Nicholson, Ben T. Brooke, Joby John, Shashi K. Nanjayan, Martyn J. Parker, Susan O'Sullivan, Meir T. Marmor, Amir Matityahu, Robert T. McClellan, Curt Comstock, Anthony Ding, Paul Toogood, Robert O’Toole, Marcus Sciadini, Jason Nascone, Nathan O’Hara, Scott P. Ryan, Molly E. Clark, Charles Cassidy, Konstantin Balonov, Tristan Weaver, Laura S. Phieffer, Sergio D. Bergese, Andrew J. Marcantonio, Shrikant I. Bangdiwala, Michael H. McGillion, Sanela Dragic-Taylor, Chelsea Maxwell, Sarah Molnar, Jennifer R. Wells, Patrice Forget, Paul Landais, Giovanni Landoni, Ekaterine Popova, Iain K. Moppett, Robin Roberts, null Chairperson, Finlay McAlister, David Sackett, James Wright, UCL - SSS/IONS/CEMO - Pôle Cellulaire et moléculaire, UCL - SSS/IREC/NMSK - Neuro-musculo-skeletal Lab, UCL - SSS/IREC/SLUC - Pôle St.-Luc, UCL - (SLuc) Service d'anesthésiologie, UCL - (SLuc) Service d'orthopédie et de traumatologie de l'appareil locomoteur, and UCL - (SLuc) Service de médecine interne générale

Subjects
Hip Fractures, Nephrology, Humans, Pelvic Bones, Kidney
Abstract

To the Editor: Acute kidney injury (AKI) is a lesser-known complication of hip fracture that may come about owing to decreased kidney perfusion and heightened inflammation from trauma, pain, bleeding, and fasting. Approximately 15%-20% of patients undergoing surgery for a hip fracture develop AKI, with 0.5%-1.8% receiving dialysis. [...]

Published
2022

2. Orthopaedic trauma care during a pandemic: initial responses in the United States and Canada

Author

Chad P. Coles and Todd Swenning

Subjects
Canada, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), business.industry, pandemic, coronavirus, COVID-19, medicine.disease_cause, United States, Clinical/Basic Science Research Article, lcsh:RD701-811, trauma, lcsh:Orthopedic surgery, Emergency medicine, Pandemic, medicine, business, Orthopaedic trauma, Coronavirus
Abstract

As in other countries, COVID-19 had a significant impact on the delivery of Orthopaedic trauma care in North America. Both Canada and the United States had similar experiences and responses to the pandemic, while the burden of disease was significantly greater in the United States. There was significant uncertainty in the early phases of the pandemic, fueled by a lack of knowledge of the pathophysiology and spread of COVID-19, questions surrounding screening protocols, lack of guidelines for managing infected patients, and concern over limited supplies of personal protective equipment. As we gained knowledge and experience, changes were implemented to optimize the delivery of trauma care, some of which may have lasting effects. In this article, we share the experiences and lessons learned in Canada and the United States in response to the pandemic.

Published
2021
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3. A Reevaluation of the Risk of Infection Based on Time to Debridement in Open Fractures: Results of the GOLIATH Meta-Analysis of Observational Studies and Limited Trial Data

Author

Michael J. Bosse, Goliath Investigators, Mara L. Schenker, Khalid Al-Hourani, Paul Tornetta, Anthony Bozzo, Aleksi Reito, Chad P. Coles, Andrew Furey, Clary J. Foote, and Ross Leighton

Subjects
medicine.medical_specialty, Time Factors, medicine.medical_treatment, law.invention, 03 medical and health sciences, Fractures, Open, 0302 clinical medicine, Randomized controlled trial, law, medicine, Humans, Surgical Wound Infection, Orthopedics and Sports Medicine, 030212 general & internal medicine, 030222 orthopedics, business.industry, Risk of infection, General Medicine, Odds ratio, Plastic Surgery Procedures, Confidence interval, Surgery, Increased risk, Treatment Outcome, Debridement, Meta-analysis, Debridement (dental), Observational study, business
Abstract

BACKGROUND Open fractures are one of the leading causes of disability worldwide. The threshold time to debridement that reduces the infection rate is unclear. METHODS We searched all available databases to identify observational studies and randomized trials related to open fracture care. We then conducted an extensive meta-analysis of the observational studies, using raw and adjusted estimates, to determine if there was an association between the timing of initial debridement and infection. RESULTS We identified 84 studies (18,239 patients) for the primary analysis. In unadjusted analyses comparing various "late" time thresholds for debridement versus "early" thresholds, there was an association between timing of debridement and surgical site infection (odds ratio [OR] = 1.29, 95% confidence interval [CI] = 1.11 to 1.49, p < 0.001, I2 = 30%, 84 studies, n = 18,239). For debridement performed between 12 and 24 hours versus earlier than 12 hours, the OR was higher in tibial fractures (OR = 1.37, 95% CI = 1.00 to 1.87, p = 0.05, I2 = 19%, 12 studies, n = 2,065), and even more so in Gustilo type-IIIB tibial fractures (OR = 1.46, 95% CI = 1.13 to 1.89, p = 0.004, I2 = 23%, 12 studies, n = 1,255). An analysis of Gustilo type-III fractures showed a progressive increase in the risk of infection with time. Critical time thresholds included 12 hours (OR = 1.51, 95% CI = 1.28 to 1.78, p < 0.001, I2 = 0%, 16 studies, n = 3,502) and 24 hours (OR = 2.17, 95% CI = 1.73 to 2.72, p < 0.001, I2 = 0%, 29 studies, n = 5,214). CONCLUSIONS High-grade open fractures demonstrated an increased risk of infection with progressive delay to debridement. LEVEL OF EVIDENCE Prognostic Level IV. See Instruction for Authors for a complete description of the levels of evidence.

Published
2020

4. Technique for Removal of Broken InterTAN Integrated Cephalomedullary Screw

Author

Bernard Burgesson and Chad P. Coles

Subjects
musculoskeletal diseases, Nonunion, Bone Screws, Bone Nails, Implant removal, Compression screw, Lag screw, medicine, Humans, Orthopedics and Sports Medicine, Orthodontics, business.industry, Hip Fractures, Fatigue testing, General Medicine, musculoskeletal system, equipment and supplies, medicine.disease, Fracture Fixation, Intramedullary, surgical procedures, operative, Surgery, Broken nail, Implant, Rotational stability, business, Femoral Fractures
Abstract

SUMMARY Pertrochanteric femoral fractures are routinely treated with cephalomedullary nailing, with good success. In the event of nonunion, implant fatigue failure may occur. The Trigen InterTAN system (Smith & Nephew, Memphis, TN) features 2 integrated cephalomedullary screws for improved rotational stability of the proximal segment. The inferior compression screw prevents rotation of the larger, superior lag screw. In the event of inferior screw breakage, the retained portion will prevent the integrated lag screw from being rotated to permit extraction. We present a case of a broken nail as well as a broken integrated screw, and describe a technique for successful implant removal.

Published
2020

5. Open fractures with soft-tissue loss

Author

Chad P. Coles, MD, FRCSC

Subjects
Orthopedic surgery, RD701-811
Abstract

Open fractures with soft-tissue loss remain challenging injuries to treat. These often high-energy fractures are at a higher risk of delayed healing and at much higher risk of infection than open fractures with less significant soft-tissue injury. The initial management of the open wound, flap coverage options, and the timing of definitive coverage all remain areas of controversy, which will be discussed in this article.

Published
2020
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6. Wound Surface Area as a Risk Factor for Flap Complications among Patients with Open Fractures

Author

Bernhard Flatøy, Dominique M. Rouleau, Ripley Worman, Eric Ritchie, Brian Drew, Hilde Apold, J. Adam Smitherman, Kyle J. Jeray, P Beaumont, Kim Madden, Arjun Patil, Karine Tardif, Brad Pilkey, Cathrine Aga, Alexandre Denault, Fathima Adamsahib, Joseph O'Neill, James R. Ringler, Claude T. Moorman, Brian Mullis, Håvard Furunes, Jason Stoneback, Paul A. Martineau, S. Brennan McClure, Karyn Moon, Greg Etherington, Rejean Dumais, Ivan S. Tarkin, Stephanie L. Tanner, Terry Axelrod, Joy M. Bradford-Johnson, Chantal Théorêt, Ellen Langslet, Ali Al-Ashtari, Valda Frizzell, Ria De Gorter, Michel Malo, M.M. (Molly M.) Moore, Andrew R. Evans, Ramnov Andreson, Lauren C. Leffler, Nigar Sultana, Michelle Arakgi, Richard Freeman, Scott E Porter, John Murnaghan, Lisa K. Cannada, Joseph Alderete, Desmond Kwok, Michael D. McKee, Deepali Nassikars, Michael J. Bosse, Richard Jenkinson, Kevin Kuhn, Michael H. Weber, David R. Goetz, Robert Marien, Eric Lenczner, Katrine Milner, Gregory J. Della Rocca, Ajay Gupta, Farhad Moola, Torben Ianssen, Saam Morshed, Meir Marmor, Stephen P. Kingwell, Chetan Metha, Michael Connally, J. David Amirault, François Vézina, Oliver Muller, Joseph R. Hsu, Catherine Coady, Grant E. Garrigues, Diane Nam, Lori Kramer Clark, Taylor Vlack, J. Scott Broderick, Bang Hoang, Rebecca G. Snider, Anne Christine Brekke, Richard T. Laughlin, Ida Sletten, Lisa Buckingham, Jason Vourazeris, Gordon H. Guyatt, Darius Viskontas, Asgeir Amundsen, Travis C. Burns, Elton R Edwards, Edward J. Harvey, David Stephen, Eugene Wai, Michael R. Jabara, Andrea Garza, Austin D. Hill, Kevin R. Gurr, Stephen D. Walter, David J. Bielema, Karl D Shively, John Sadler, Mark D Macleod, Geir Aasmund Hjorthaug, Anthony Beardmore, Markku T Nousiainen, Vivek V. Jabade, Rani Rai, Kelly Trask, Julia Lee, Rena L. Stewart, Paula McKay, Emil H. Schemitsch, Sheila Sprague, Allen Diane, Sebastian Rodriguez-Elizalde, Ryan T. Bicknell, Nicolas Patenaude, Kevin L. Kirk, Paul Tornetta, Joshua A. Baumfeld, Christopher S. Bailey, Douglas G. Altman, Monica Kunz, Robert E. Turcotte, Kristen Walick, David P. Zamorano, Vinod Arora, Bernard Laliberté, Max Talbot, Jerald R. Westberg, Tore Fjalestad, Benjamin B. Barden, Chetan Prabhakar Puram, Andrew Gong, Shalini Ramasunder, Petter Iversen, R. Lee Murphy, Jean François Joncas, Timothy J. Miller, Raymond A. Pensy, Michael J. Maughon, Lori Wood, Robert G. McCormack, Dmitry Tuder, Veronica M R Wadey, Timothy Carey, Kristoff Reid, Patrick Henry, Anthony S. Rhorer, Marc André Magalhaes-Grave, Vinit Yadav, Michael J. Prayson, John Clarke-Jenssen, Vera Halvorsen, Kerry Tai, Narayan J. Karne, Stéphane Leduc, Kathryn Hornbuckle, Melissa M. Earles, Joel S. Finkelstein, Robin R. Richards, Joseph Cox, Tor Nicolaysen, Lisa Blackrick, Arthur Kreitenberg, Aaron T. Creek, Debra L. Sietsema, Peder Bogsti, Mark Glazebrook, Donna Lopez, Martin Bédard, Michael L. Beckish, Jonathan Kwong, Peter A. Siska, John A. Tanksley, Brett D. Crist, François Cabana, Mary Fan, Annie Deshaies, Debra Bartley, Nurit Shadmi, Wesley G. Lackey, Henry Ahn, Rachel M. Reilly, Linda K. Anderson, Dustin M. Price, Frede Frihagen, Brian E. Brigman, David Nelles, Mickey S Cho, Jeff Anglen, Kevin K. Kruse, Melanie MacNevin, Jonathan L. Foret, Jan Egil Brattgjerd, John F. Tilzey, Garland K. Gudger, Steve Rocha, G. Yves Laflamme, Kelly L. Apostle, Utku Kandemir, Aaron Nauth, Ivan Wong, Brian J. Miller, Rudy Reindl, Krishan Rajaratnam, Marie Eve Roger, William D. Fisher, Ash Moaveni, Patrick Yoon, David Sanders, Julia Foxall, Otis Wang, Shea A. Bielby, Maria Manson, Yvonne M. Murtha, Nikoletta Leontaritis, Russell Miller, Terrence J. Endres, Andrew H. Schmidt, Laurie Barron, David Alexander, Dennis W. Mann, H. Michael Lemke, Benjamin S. Koch, Gilbert Ortega, Nikia Hawkins Malone, Rina L. Harman, A. Navaladi Shankar, Parag Sancheti, Mauri Zomar, Dave Brown, Matthan Mammen, Dana J. Farrell, Piotr A Blachut, John D. Adams, Zoe Murdoch, Tom Treseder, Scott T. Watson, Fredrik Nilsen, Matthew Denkers, Wade Gofton, Jennifer Downey, Raymond Topp, Garth Johnson, Sissel Knuts, Raman Johal, Prerana N. Patel, Harvinder Bedi, Milena R. Vicente, Michael Tanzer, Markus Bischoff, Anders Lippert, Pascale Lévesque-Bernier, Hélène Côté, Brian Jolley, Gilbert Moatshe, Christina Tieszer, Richard C. Mather, Roman Trimba, Mohit Bhandari, Henry M Broekhuyse, Janos P. Ertl, Patrick M. Osborn, Michael Biddulph, Neeraj Jain, Grant W. Bennett, Gerard P. Slobogean, Samuel B. Adams, Kelly M. Sullivan, Atul Patil, Warren Kactmas, Mahesh Bhatia, Murat Pekmezci, Siraj Sayeed, David S. Ruch, Lawrence K. O'Malley, Jonas Rydinge, Michael Charlton, Michael S. Kain, Vivek Tyagi, Kathleen Markley, Rajiv Gandhi, Pierre Ranger, Mathias Russ, Dale Williams, Peter Jarzem, Lauren A. Nastoff, Craig Donohue, Gunnar B. Flugsrud, Bernard LaRue, Shelley MacDonald, Trevor Stone, Amy Svotelis, Stéphane Pelet, Mark J. Lemos, Michael Gross, Dean C. Taylor, Matthew Ross, Luc Petitclerc, Robert K. Lark, Jane E. Walker, Pierre Lavallée, Wesley Ghent, Fraser J. Leversedge, C. Glen Richardson, Deanna Lawson, Martin Tynan, Eric Meinberg, Stephen Doig, Jason A. Lowe, Veronica Place, Tim Dwyer, Jeffrey T. Leary, J Andrew I Trenholm, Andrew Chia, William M. Oxner, Richard Holtby, Thomas F. Varecka, Justin W. Langan, Ted Tufescu, Melanese Leonard, Lu Ton, Jeremy A. Hall, S. Samuel Bederman, Steve Csongvay, Bertrand Perey, Adam Dowrick, Stephen H. Finley, Steven A. Olson, Katherine M. Bedigrew, James P. Stannard, Phelan Shea, Leslie Dillender, Dory Boyer, Damian Rispoli, Ashley Carr, Steven Papp, Trigg McClellan, Clifford B. Jones, Erik Nott, Nitin N. Bhatia, Deeba Pourmand, Kelly A Lefaivre, Michael J. Dunbar, Peter J O'Brien, Luc Bédard, Chad P. Coles, Doug Li, Drew Bednar, Albert Yee, Bill Ristevski, Tod Gerlinger, Benoit Benoit, Aaron R. Campbell, Mette Renate Andersen, James P. Waddell, Jean Lamontagne, David A. Volgas, Diane Heels-Ansdell, Andrew J. Marcantonio, Alison P. Toth, David R. Pichora, Min Zhan, Harsha Malempati, Lars Nordsletten, Richard W. Gurich, Kiran M. Doshi, Robert J. Teasdall, Earl R. Bogoch, Matthew D. Karam, David M. Conner, Hans J. Kreder, Guri Ranum Ekås, Dylan J. Watson, Linda Lépine, Tanya Nix, Chris Graham, Tigist Belaye, Are Haukåen Stødle, Aravin Duraikannan, John Magne Hoseth, Nathan N O'Hara, Erick G. Torres, Elise Berg Vesterhus, Anthony E. Johnson, William Min, Michael Ford, Leslie Barnes, Jessica Goldstein, Anil Rai, Samuel G. Agnew, Thomas M. Schaller, Hamish Curry, S. Matthew Hollenbeck, Lorra M. Sharp, Fiona Howells, Abdel Lawendy, Donald Gajewski, Richard Coughlin, Max Esser, Chard Harbour, Stéphane Ricard, Gerald Reardon, Luc Lemire, Julie Fournier, Raely Moon, Brad Petrisor, James R. Ficke, Greg Berry, David Johnston, Allan Hammond, Jennifer T. Hidy, K. Rai, Daniel B. Whelan, Marius Molund, John S. Garfi, Greg Maytok, R. Saravana, Eugene Ek, Matthew Robinson, Emily Keener, Mark Burman, Frédéric Balg, Jeffrey O. Anglen, Fiona Houghton, Stacee W. Clawson, Morten Smedsrud, Claire Sage, Ross Leighton, Timothy R. Daniels, Lyle T. Jackson, Susan Liew, Neelam Jhangiani, Anoop Dubey, Richard M. Wilk, Robert D. Zura, Julian Sernik, Kim Hemlock, and Michael P. Bolognesi

Subjects
Adult, Male, medicine.medical_specialty, Soft Tissue Injuries, Limb salvage, Treatment outcome, Aftercare, Wound surface, Surgical Flaps, Fractures, Open, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Risk Factors, Medicine and Health Sciences, medicine, Humans, 030212 general & internal medicine, Risk factor, Aged, integumentary system, business.industry, Open surgery, Trauma center, Middle Aged, Limb Salvage, Surgery, Logistic Models, Treatment Outcome, 030220 oncology & carcinogenesis, Shock (circulatory), Female, medicine.symptom, business
Abstract

Copyright © 2018 by the American Society of Plastic Surgeons. Background: Soft-tissue complications often dictate the success of limb salvage and the overall outcome of open fractures. Based on prior work at the R Adams Cowley Shock Trauma Center, the authors hypothesize that wounds larger than 200 cm2 are associated with a greater likelihood of both flap-related reoperation and wound complications among patients requiring soft-tissue reconstruction with a rotational flap or free tissue transfer. Methods: This study was a secondary analysis of Fluid Lavage in Open Wounds trial data that included all patients who received a rotational or free tissue flap transfer for an open fracture. The primary outcome was flap-related reoperation within 12 months of injury. The secondary outcome was wound complication, which included events treated operatively or nonoperatively. Multivariable logistic regression was used to assess the association between wound size and outcomes, adjusting for confounders. Results: Seventeen percent of the 112 patients required a flap-related reoperation. A wound size greater than 200 cm2 was not associated with reoperation in an unadjusted model (p = 0.64) or adjusting for Gustilo type (p = 0.70). The sample had an overall wound complication rate of 47.3 percent. Patients with a wound size of greater than 200 cm2 were three times more likely to experience wound complications (OR, 3.05; 95 percent CI, 1.08 to 8.62; p = 0.04) when adjusting for moderate to severe wound contamination and wound closure in the operating room. Conclusion: The findings of this study demonstrate that wound surface area is an integral determinant for wound complication following soft-tissue flap treatment, but found no association between wound surface area and flap-related reoperation rates.

Published
2018
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7. Acute Compartment Syndrome: An Expert Survey of Orthopaedic Trauma Association Members

Author

Chad P. Coles, Jaimo Ahn, George LeBus, Cory A. Collinge, Paul Tornetta, Gudrun Mirick, Orthopaedic Trauma Associationʼs Evidence-based Quality, William T. Obremskey, Andrew H. Schmidt, Peter C. Krause, Clay A. Spitler, and Basem Attum

Subjects
medicine.medical_specialty, Cross-sectional study, medicine.medical_treatment, MEDLINE, Physical examination, Compartment Syndromes, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Orthopedics and Sports Medicine, Practice Patterns, Physicians', Orthopaedic trauma, Societies, Medical, Internet, 030222 orthopedics, medicine.diagnostic_test, business.industry, 030208 emergency & critical care medicine, General Medicine, Evidence-based medicine, Cross-Sectional Studies, Orthopedics, Blood pressure, Health Care Surveys, Acute Disease, Emergency medicine, Orthopedic surgery, Wounds and Injuries, Skin grafting, Surgery, business
Abstract

Objectives The goal of this study was to describe current opinions of orthopaedic trauma experts regarding acute compartment syndrome (ACS). Design Web-based survey. Participants Active Orthopaedic Trauma Association (OTA) members. Methods A 25-item web-based questionnaire was advertised to active members of the OTA. Using a cross-sectional survey study design, we evaluated the perceived importance of ACS, as well as preferences in diagnosis and treatment. Results One hundred thirty-nine of 596 active OTA members (23%) completed the survey. ACS was believed to be clinically important and with severe sequelae, if missed. Responses indicated that diagnosis should be based on physical examination in an awake patient, and that intracompartmental pressure testing was valuable in the obtunded or unconscious patient. The diagnosis of ACS with monitoring should be made using the difference between diastolic blood pressure and intracompartmental pressure (ΔP) of ≤30 mm Hg. Once ACS is diagnosed, respondents indicated that fasciotomies should be performed as quickly as is reasonable (within 2 hours). The consensus for wound management was closure or skin grafting within 1-5 days later, and skin grafting was universally recommended if closure was delayed to >7 days. Conclusions ACS is a challenging problem with poor outcomes if missed or inadequately treated. OTA members demonstrated agreement to many diagnostic and treatment choices for ACS. Level of evidence Therapeutic Level V. See Instructions for Authors for a complete description of the levels of evidence.

Published
2018
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8. Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial

Author

Flavia K Borges, Mohit Bhandari, Ernesto Guerra-Farfan, Ameen Patel, Alben Sigamani, Masood Umer, Maria E Tiboni, Maria del Mar Villar-Casares, Vikas Tandon, Jordi Tomas-Hernandez, Jordi Teixidor-Serra, Victoria RA Avram, Mitchell Winemaker, Mmampapatla T Ramokgopa, Wojciech Szczeklik, Giovanni Landoni, Chew Yin Wang, Dilshad Begum, John D Neary, Anthony Adili, Parag K Sancheti, Abdel-Rahman Lawendy, Mariano Balaguer-Castro, Paweł Ślęczka, Richard J Jenkinson, Aamer Nabi Nur, Gavin CA Wood, Robert J Feibel, Stephen J McMahon, Alen Sigamani, Ekaterine Popova, Bruce M Biccard, Iain K Moppett, Patrice Forget, Paul Landais, Michael H McGillion, Jessica Vincent, Kumar Balasubramanian, Valerie Harvey, Yaiza Garcia-Sanchez, Shirley M Pettit, Leslie P Gauthier, Gordon H Guyatt, David Conen, Amit X Garg, Shrikant I Bangdiwala, Emilie P Belley-Cote, Maura Marcucci, Andre Lamy, Richard Whitlock, Yannick Le Manach, Dean A Fergusson, Salim Yusuf, PJ Devereaux, Laurent Veevaete, Bernard le Polain de Waroux, Patricia Lavand'homme, Olivier Cornu, Karim Tribak, Jean Cyr Yombi, Nassim Touil, Maike Reul, Jigme Tshering Bhutia, Carol Clinckaert, Dirk De Clippeleir, Justin de Beer, Diane L Simpson, Andrew Worster, Kim A Alvarado, Krysten K Gregus, Kelly H Lawrence, Darryl P Leong, Philip G Joseph, Patrick Magloire, Benjamin Deheshi, Stuart Bisland, Thomas J Wood, Daniel M Tushinski, David AJ Wilson, Clive Kearon, David D Cowan, Vickas Khanna, Amna Zaki, Janet C Farrell, Anne Marie MacDonald, Steven CW Wong, Arsha Karbassi, Douglas Steven Wright, Harsha Shanthanna, Ryan Coughlin, Moin Khan, Spencer Wikkerink, Faraaz A Quraishi, Waleed Kishta, Emil Schemitsch, Timothy Carey, Mark D Macleod, David W Sanders, Edward Vasarhelyi, Debra Bartley, George K Dresser, Christina Tieszer, Steven Shadowitz, Jacques S Lee, Stephen Choi, Hans J Kreder, Markku Nousiainen, Monica R Kunz, Ravianne Tuazon, Mopina Shrikumar, Bheeshma Ravi, David Wasserstein, David JG Stephen, Diane Nam, Patrick DG Henry, Stephen M Mann, Melanie T Jaeger, Marco LA Sivilotti, Christopher A Smith, Christopher C Frank, Heather Grant, Leone Ploeg, Jeff D Yach, Mark M Harrison, Aaron R Campbell, Ryan T Bicknell, Davide D Bardana, Katie McIlquham, Catherine Gallant, Samantha Halman, Venkatesh Thiruganasambandamoorth, Sara Ruggiero, William J Hadden, Brian P-J Chen, Stephanie A Coupal, Lisa M McLean, Hemant R Shirali, Syed Y Haider, Crystal A Smith, Evan Watts, David J Santone, Kevin Koo, Allan J Yee, Ademilola N Oyenubi, Aaron Nauth, Emil H Schemitsch, Timothy R Daniels, Sarah E Ward, Jeremy A Hall, Henry Ahn, Daniel B Whelan, Amit Atrey, Amir Khoshbin, David Puskas, Kurt Droll, Claude Cullinan, Jubin Payendeh, Tina Lefrancois, Lise Mozzon, Travis Marion, Michael J Jacka, James Greene, Matthew Menon, Robert Stiegelmahr, Derek Dillane, Marleen Irwin, Lauren Beaupre, Chad P Coles, Kelly Trask, Shelley MacDonald, J Andrew I Trenholm, William Oxner, C Glen Richardson, Niloofar Dehghan, Mehdi Sadoughi, Achal Sharma, Neil J White, Loretta Olivieri, Stephen B Hunt, Thomas R Turgeon, Eric R Bohm, Sarah Tran, Stephen M Giilck, Tom Hupel, Pierre Guy, Peter J O'Brien, Andrew W Duncan, Gordon A Crawford, Junlin Zhou, Yanrui Zhao, Yang Liu, Lei Shan, Anshi Wu, Juan Manuel Muñoz, Philippe Chaudier, Marion Douplat, Michel Henri Fessy, Vincent Piriou, Lucie Louboutin, Jean Stephane David, Arnaud Friggeri, Sebastien Beroud, Jean Marie Fayet, Frankie Ka Li Leung, Christian Xinshuo Fang, Dennis King Hang Yee, Parag Kantilal Sancheti, Chetan Vijay Pradhan, Atul Ashok Patil, Chetan Prabhakar Puram, Madhav Pandurang Borate, Kiran Bhalchandra Kudrimoti, Bharati Anil Adhye, Himanshu Vijaykumar Dongre, Bobby John, Valsamma Abraham, Ritesh Arvind Pandey, Arti Rajkumar, Preetha Elizabeth George, Manesh Stephen, Nitheesh Chandran, Mohammed Ashraf, AM Georgekutty, Ahamad Shaheel Sulthan, S Adinarayanan, Deep Sharma, Satish Prasad Barnawal, Srinivasan Swaminathan, Prasanna Udupi Bidkar, Sandeep Kumar Mishra, Jagdish Menon, Niranjan M, Varghese Zachariah K, Santosh Angad Hiremath, Madhusudhan NC, Abhijit Jawali, Kingsly Robert Gnanadurai, Carolin Elizabeth George, Tatarao Maddipati, Mary KP KP, Vijay Sharma, Kamran Farooque, Rajesh Malhotra, Samarth Mittal, Chavi Sawhney, Babita Gupta, Purva Mathur, Shivanand Gamangati, Vijaylaxmi Tripathy, Prem Haridas Menon, Mandeep S Dhillon, Devendra K Chouhan, Sharanu Patil, Ravi Narayan, Purushotham Lal, Prashanth Nabhirajappa Bilchod, Surya Udai Singh, Uttam Vaidya Gattu, Ravi Prabhakar Dashputra, Prashant Vitthal Rahate, Maurizio Turiel, Giuseppe De Blasio, Riccardo Accetta, Paolo Perazzo, Daniele Stella, Marika Bonadies, Chiara Colombo, Stefania Fozzato, Fabio Pino, Ilaria Morelli, Eleonora Colnaghi, Vincenzo Salini, Giuseppe Denaro, Luigi Beretta, Giacomo Placella, Giuseppe Giardina, Mirko Binda, Anna Marcato, Luca Guzzetti, Fabio Piccirillo, Maurizio Cecconi, HM Khor, Hou Yee Lai, CS Kumar, KH Chee, PS Loh, Kit Mun Tan, Simmrat Singh, Li Lian Foo, Komella Prakasam, Sook Hui Chaw, Meng-Li Lee, Joanne HL Ngim, Huck Wee Boon, Im Im Chin, Ydo V Kleinlugtenbelt, Ellie BM Landman, Elvira R Flikweert, Herbert W Roerdink, Roy B.G. Brokelman, Hannie F Elskamp-Meijerman, Maarten R Horst, Jan-Hein MG Cobben, Anila Anjum, Pervaiz Mehmood Hashmi, Tashfeen Ahmed, Haroon Ur Rashid, Mujahid Jamil Khattak, Rizwan Haroon Rashid, Riaz Hussain Lakdawala, Shahryar Noordin, Naveed Muhammed Juman, Robyna Irshad Khan, Muhammad Mehmood Riaz, Syedah Saira Bokhari, Ayesha Almas, Hussain Wahab, Arif Ali, Hammad Naqi Khan, Eraj Khurshid Khan, Kholood Abid Janjua, Sajjad Hassan Orakzai, Abdus Salam Khan, Khawaja Junaid Mustafa, Mian Amjad Sohail, Muhammad Umar, Siddra Ahmed Khan, Muhammad Ashraf, Muhammad Kashif Khan, Muhammad Shiraz, Ahmad Furgan, Piotr Dąbek, Adam Kumoń, Wojciech Satora, Wojciech Ambroży, Mariusz Święch, Jacek Rycombel, Adrian Grzelak, Jaroslaw Gucwa, Waldemar Machala, Mmampapatla Thomas Ramokgopa, Gregory Bodley Firth, Mwalimu Karera, Maria Fourtounas, Virsen Singh, Anna Biscardi, Muhammad Nasir Iqbal, Ryan Jonathan Campbell, Matimba Lenny Maluleke, Carien Moller, Lerato Nhlapo, Sithombo Maqungo, Margot Flint, Marcin B Nejthardt, Sean Chetty, Rubendren Naidoo, Miriam Garrido Clua, Vicente Molero-Garcia, Joan Minguell-Monyart, Jordi Selga Marsa, Juan A Porcel-Vazquez, Jose-Vicente Andres-Peiro, Marc Aguilar, Jaume Mestre-Torres, Maria J Colomina, Patricia Guilabert, M Luisa Paños Gozalo, Luis Abarca, Nuria Martin, Gemma Usua, Pedro Martinez-Ripol, MA Gonzalez Posada, Pilar Lalueza-Broto, Judith Sanchez-Raya, Jorge Nuñez Camarena, Antoni Fraguas-Castany, Pere Torner, Monsant Jornet-Gibert, Jorge Serrano-Sanz, Jaume Cámara-Cabrera, Mònica Salomó-Domènech, Christian Yela-Verdú, Anna Peig-Font, Laura Ricol, Anna Carreras-Castañer, Luis Martínez-Sañudo, Susana Herranz, Carlos Feijoo-Massó, Mònica Sianes-Gallén, Pablo Castillón, Martí Bernaus, Saioa Quintas, Olga Gómez, Jordi Salvador, Javiera Abarca, Cristina Estrada, Marga Novellas, Mercè Torra, Alfred Dealbert, Oscar Macho, Alexia Ivanov, Esther Valldosera, Marta Arroyo, Borja Pey, Antoni Yuste, Llorenç Mateo, Julio De Caso, Rafael Anaya, JL Higa-Sansone, Angelica Millan, Victoria Baños, Sergio Herrera-Mateo, Hector J Aguado, Gonzalo Martinez-Municio, Ricardo León, Silvia Santiago-Maniega, Ana Zabalza, Gregorio Labrador, Enrique Guerado, Encarnacion Cruz, Juan Ramon Cano, Jose Manuel Bogallo, Paphon Sa-ngasoongsong, Noratep Kulachote, Norachart Sirisreetreerux, Nachapan Pengrung, Theerawat Chalacheewa, Vanlapa Arnuntasupakul, Teerapat Yingchoncharoen, Bundit Naratreekoon, Miriam Adel Kadry, Surendini Thayaparan, Ihab Abdlaziz, Arash Aframian, Arjuna Imbuldeniya, Souad Bentoumi, Sherif Omran, Marcela Paola Vizcaychipi, Patricia Correia, Shashank Patil, Kevin Haire, Amy SE Mayor, Sally Dillingham, Laura Nicholson, Mohamed Elnaggar, Joby John, Shashi Kumar Nanjayan, Martyn J Parker, Susan O'Sullivan, Meir T Marmor, Amir Matityahu, Robert Trigg McClellan, Curt Comstock, Anthony Ding, Paul Toogood, Gerard Slobogean, Katherine Joseph, Robert O'Toole, Marcus Sciadini, Scott P Ryan, Molly E Clark, Charles Cassidy, Konstantin Balonov, Sergio D Bergese, Laura S Phieffer, Alicia A Gonzalez Zacarias, Andrew J Marcantonio, Sanela Dragic-Taylor, Chelsea Maxwell, Sarah Molnar, Jennifer R Wells, Sandra N Ofori, Stephen S Yang, Michael K Wang, Emmanuelle Duceppe, Jessica Spence, Javiera P Vasquez, Francesc Marcano-Fernández, Hyungjoo Ham, Carlos Prada, Terence CH Yung, Isidro Sanz Pérez, Michael J Bosch, Michael R Prystajecky, Chinmoy Chowdhury, James S Khan, Steffan F Stella, Behrouz Heidary, Allen Tran, Katarzyna Wawrzycka-Adamczyk, Yu Chiao Peter Chen, Aránzazu González-Osuna, Grzegorz Biedroń, Anna Wludarczyk, Marco Lefebvre, Jaclyn A Ernst, Bas Staffhorst, Jason D Woodfine, Emad M Alwafi, Marko Mrkobrada, Simon Parlow, Robin Roberts, Finlay McAlister, David Sackett, James Wright, (HIP ATTACK, Investigators), Landoni, G., Faculty of Medicine and Pharmacy, Orthopaedics - Traumatology, Supporting clinical sciences, Emergency Medicine, UCL - SSS/IONS - Institute of NeuroScience, UCL - SSS/IONS/CEMO - Pôle Cellulaire et moléculaire, UCL - SSS/IREC/NMSK - Neuro-musculo-skeletal Lab, UCL - SSS/IREC/SLUC - Pôle St.-Luc, UCL - (SLuc) Service d'anesthésiologie, UCL - (SLuc) Service d'orthopédie et de traumatologie de l'appareil locomoteur, and UCL - (SLuc) Service de médecine interne générale

Subjects
Postoperative Complications/epidemiology, Male, Internationality, Femoral Neck Fractures/epidemiology, Arthroplasty, Replacement, Hip, Myocardial Ischemia, Comorbidity, Time-to-Treatment/statistics & numerical data, 030204 cardiovascular system & hematology, law.invention, Fracture Fixation, Internal, Postoperative Complications, 0302 clinical medicine, Randomized controlled trial, Residence Characteristics, law, Activities of Daily Living, Fracture fixation, Risk of mortality, Medicine and Health Sciences, Fracture Fixation, Internal/methods, Sepsis/epidemiology, 030212 general & internal medicine, Cardiovascular Diseases/mortality, Stroke, Aged, 80 and over, Hip fracture, Residence Characteristics/statistics & numerical data, Infections/epidemiology, General Medicine, Middle Aged, Open Fracture Reduction, Treatment Outcome, Cardiovascular Diseases, Diabetes Mellitus/epidemiology, Female, medicine.medical_specialty, Hip Fractures/epidemiology, Postoperative Hemorrhage, Infections, Early Medical Intervention/methods, Time-to-Treatment, 03 medical and health sciences, Arthroplasty, Replacement, Hip/methods, Early Medical Intervention, Sepsis, Diabetes Mellitus, medicine, Humans, Mortality, Myocardial Ischemia/epidemiology, Aged, Proportional Hazards Models, Postoperative Hemorrhage/epidemiology, Hip Fractures, Proportional hazards model, business.industry, Hemiarthroplasty/methods, Dementia/epidemiology, Delirium, Delirium/epidemiology, medicine.disease, Femoral Neck Fractures, Nursing Homes, Surgery, Open Fracture Reduction/methods, Dementia, Observational study, Hemiarthroplasty, business
Abstract

© 2020 Elsevier Ltd Background: Observational studies have suggested that accelerated surgery is associated with improved outcomes in patients with a hip fracture. The HIP ATTACK trial assessed whether accelerated surgery could reduce mortality and major complications. Methods: HIP ATTACK was an international, randomised, controlled trial done at 69 hospitals in 17 countries. Patients with a hip fracture that required surgery and were aged 45 years or older were eligible. Research personnel randomly assigned patients (1:1) through a central computerised randomisation system using randomly varying block sizes to either accelerated surgery (goal of surgery within 6 h of diagnosis) or standard care. The coprimary outcomes were mortality and a composite of major complications (ie, mortality and non-fatal myocardial infarction, stroke, venous thromboembolism, sepsis, pneumonia, life-threatening bleeding, and major bleeding) at 90 days after randomisation. Patients, health-care providers, and study staff were aware of treatment assignment, but outcome adjudicators were masked to treatment allocation. Patients were analysed according to the intention-to-treat principle. This study is registered at ClinicalTrials.gov (NCT02027896). Findings: Between March 14, 2014, and May 24, 2019, 27 701 patients were screened, of whom 7780 were eligible. 2970 of these were enrolled and randomly assigned to receive accelerated surgery (n=1487) or standard care (n=1483). The median time from hip fracture diagnosis to surgery was 6 h (IQR 4–9) in the accelerated-surgery group and 24 h (10–42) in the standard-care group (p

Published
2020

10. Ankle Fractures: An Expert Survey of Orthopaedic Trauma Association Members and Evidence-Based Treatment Recommendations

Author

Orthopaedic Trauma Associationʼs Evidence-Based Quality Value, Paul Tornetta, Chad P. Coles, Peter C. Krause, Clay A. Spitler, Jaimo Ahn, William T. Obremskey, Andres Rodriguez-Buitrago, Arvind Nana, and Gudrun Mirick

Subjects
medicine.medical_specialty, Evidence-based practice, Cross-sectional study, MEDLINE, Traumatology, Ankle Fractures, 03 medical and health sciences, 0302 clinical medicine, Medicine, Humans, Orthopedics and Sports Medicine, Practice Patterns, Physicians', Association (psychology), Societies, Medical, 030222 orthopedics, Evidence-Based Medicine, business.industry, 030208 emergency & critical care medicine, General Medicine, Evidence-based medicine, medicine.anatomical_structure, Cross-Sectional Studies, Orthopedics, Health Care Surveys, Orthopedic surgery, Practice Guidelines as Topic, Physical therapy, Surgery, Ankle, business
Abstract

Objectives To describe current practice patterns of orthopaedic trauma experts regarding the management of ankle fractures, to review the current literature, and to provide recommendations for care based on a standardized grading system. Design Web-based survey. Participants Orthopaedic Trauma Association (OTA) members. Methods A 27-item web-based questionnaire was advertised to members of the OTA. Using a cross-sectional survey study design, we evaluated the preferences in diagnosis and treatment of ankle fractures. Results One hundred sixty-six of 1967 OTA members (8.4%) completed the survey (16% of active members). There is considerable variability in the preferred method of diagnosis and treatment of ankle fractures among the members surveyed. Most responses are in keeping with best evidence available. Conclusions Current controversy remains in the management of ankle fractures. This is reflected in the treatment preferences of the OTA members who responded to this survey. Level of evidence Therapeutic Level V. See Instructions for authors for a complete description of levels of evidence.

Published
2019

11. Short Versus Long InterTAN Fixation for Geriatric Intertrochanteric Hip Fractures: A Multicentre Head-to-Head Comparison

Author

David Sanders, Christina Tieszer, Wade Gofton, Darius Viskontas, Chad P. Coles, Michael Sellan, Steven Papp, Ross Leighton, Abdel Lawendy, Trevor Stone, Andrew Trenholm, Dianne Bryant, Tim Carey, Allan Liew, and Mark D Macleod

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, law.invention, Intramedullary rod, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Fracture fixation, Medicine and Health Sciences, Humans, Medicine, Internal fixation, Orthopedics and Sports Medicine, Femur, Prospective Studies, Aged, Retrospective Studies, Aged, 80 and over, 030222 orthopedics, Hip fracture, Hip Fractures, business.industry, intertrochanteric hip fractures, intramedullary nail, femur fractures, InterTAN, 030208 emergency & critical care medicine, Retrospective cohort study, Equipment Design, General Medicine, Middle Aged, medicine.disease, Functional Independence Measure, Fracture Fixation, Intramedullary, Surgery, Female, business
Abstract

OBJECTIVE To determine if geriatric intertrochanteric hip fracture patients achieve equivalent postoperative functional status after management with either a short (180-200 mm) or a long (260-460 mm) InterTAN intramedullary device. DESIGN Retrospective review of a prospective randomized control trial. SETTING Four Level I Trauma Centers. PATIENTS/PARTICIPANTS One hundred eight patients with OTA/AO classification 31A-1 and 31A-2 intertrochanteric hip fractures were included in the study. INTERVENTION Internal fixation using an IT device. MAIN OUTCOMES MEASURES Primary outcomes included Functional Independence Measure and Timed Up and Go. Secondary outcomes included blood loss, surgical time, length of stay, adverse events, and mortality. RESULTS Seventy-one short and 37 long IT patients met study inclusion criteria. Demographics were similar between groups. There was no difference in Functional Independence Measure or Timed Up and Go scores between the 2 IT groups at any of the time points collected. Mean operative time was lower in the short IT group than in the long IT group (60 vs. 73 minutes; P = 0.021). A higher proportion of long IT patients had reamed constructs (95% vs. 48% short IT, P < 0.001). Postoperative blood loss was significantly higher in the long IT group without a significant influence on the number of patients requiring transfusion (P = 0.582) or average units transfused (P = 0.982). There was no significant difference in the proportion of postoperative adverse events between the 2 cohorts despite a higher number of peri-implant femur fractures in the short IT group than in the long IT group (5 vs. 1, P = 0.350). CONCLUSIONS Postoperative functional status was not influenced by the length of IT device in the management of geriatric intertrochanteric hip fractures. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Published
2019

12. Open fractures with soft-tissue loss

Author

Chad P. Coles

Subjects
Special Issue on Open Fractures and Fracture-Related Infections, negative pressure wound therapy, Open fracture, medicine.medical_specialty, Open wounds, open fracture, business.industry, medicine.medical_treatment, soft-tissue coverage, orthoplastic, Soft tissue, Surgery, Negative-pressure wound therapy, Medicine, bead pouch, business, Delayed healing
Abstract

Open fractures with soft-tissue loss remain challenging injuries to treat. These often high-energy fractures are at a higher risk of delayed healing and at much higher risk of infection than open fractures with less significant soft-tissue injury. The initial management of the open wound, flap coverage options, and the timing of definitive coverage all remain areas of controversy, which will be discussed in this article.

Published
2020
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13. Open Reduction and Internal Fixation Compared With ORIF and Primary Subtalar Arthrodesis for Treatment of Sanders Type IV Calcaneal Fractures

Author

Ross Leighton, Chad P. Coles, David S Sanders, David Stephen, Richard Buckley, Jeffrey Poon, and Elizabeth Oddone Paolucci

Subjects
medicine.medical_specialty, Visual analogue scale, business.industry, medicine.medical_treatment, Arthrodesis, General Medicine, Surgery, law.invention, medicine.anatomical_structure, Randomized controlled trial, law, Multicenter trial, Fracture fixation, medicine, Physical therapy, Internal fixation, Orthopedics and Sports Medicine, Ankle, business, Reduction (orthopedic surgery)
Abstract

Objectives To compare long-term health outcome of Sanders type IV calcaneal fractures treated with open reduction and internal fixation (ORIF) versus ORIF plus primary subtalar arthrodesis (PSTA). Design Randomized prospective multicenter trial. Setting Four Level 1 trauma hospitals in Canada. Patients Thirty-one patients with 31 Sanders IV displaced intraarticular calcaneal fractures. Intervention Seventeen patients were treated with a standard protocol involving a lateral approach for ORIF. Fourteen patients were treated with a standard protocol involving a lateral approach with ORIF + PSTA. Main outcome measurements Health outcomes were assessed with 4 validated instruments: (1) the Short Form 36 version 2 (SF-36), (2) the Musculoskeletal Functional Assessment Survey, (3) the American Orthopaedic Foot and Ankle Society's Ankle-Hindfoot Scale, and (4) the Visual Analogue Scale. Results From 2004 to 2011, 26 patients (26 displaced intraarticular calcaneal fractures) were followed for a minimum of 2 years (81% follow-up). No statistical difference was found between the results for ORIF compared with ORIF + PSTA: the mean SF-36 physical component scores were, respectively, 30.2 (SD = 11.4) and 37.8 (SD = 10.4) (P = 0.10); the mean Musculoskeletal Functional Assessment Survey scores were 44.2 (SD = 25.6) and 37.9 (SD = 21.5) (P = 0.50); the mean Ankle-Hindfoot Scale scores were 62.5 (SD = 19.6) and 65.8 (SD = 19.2), (P = 0.68); and the mean Visual Analogue Scale scores were 36.8 (SD = 34.7) and 36.0 (SD = 30.7) (P = 0.82). Conclusions We were unable to demonstrate a significant difference between treating Sanders type IV fractures with either ORIF or ORIF + PSTA. It remains the choice of the surgeon and patient to take into account patient specific factors to determine treatment. However, ORIF + PSTA may be advantageous for both patients with Sanders type IV fractures and the health care system as patients heal quickly. Furthermore, ORIF + PSTA may prevent the need for late secondary subtalar fusion adding to increased costs and lost time from work. Level of evidence Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Published
2014
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14. A Multicenter Randomized Control Trial Comparing a Novel Intramedullary Device (InterTAN) Versus Conventional Treatment (Sliding Hip Screw) of Geriatric Hip Fractures

Author

Christina Tieszer, Kelly Trask, Julia Foxall, Ross Leighton, Darius Viskontas, Trevor Stone, Mark D Macleod, David W. Sanders, Christopher S. Bailey, Andrew Trenholm, Debra Bartley, Chad P. Coles, Steven Papp, Wade Gofton, Dianne Bryant, Kevin R. Gurr, Abdel Lawendy, Tim Carey, Mauri Zomar, and Allan Liew

Subjects
musculoskeletal diseases, Male, medicine.medical_specialty, Canada, InterTAN, Bone Screws, sliding hip screw, Prosthesis Design, law.invention, Intramedullary rod, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Risk Factors, intertrochanteric hip fractures, Fracture fixation, Activities of Daily Living, medicine, Prevalence, Medicine and Health Sciences, Humans, Orthopedics and Sports Medicine, 030212 general & internal medicine, Range of Motion, Articular, Geriatric Assessment, Aged, Aged, 80 and over, Fracture Healing, 030222 orthopedics, business.industry, Hip Fractures, Conventional treatment, Geriatric assessment, General Medicine, Recovery of Function, Length of Stay, Middle Aged, Surgery, Fracture Fixation, Intramedullary, Bone screws, Equipment Failure Analysis, Survival Rate, Treatment Outcome, Multicenter study, Female, business, Range of motion
Abstract

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. Objectives: To compare outcomes in elderly patients with intertrochanteric hip fractures treated with either the sliding hip screw (SHS) or InterTAN intramedullary device (IT). Design: Prospective, randomized, multicenter clinical trial. Setting: Five level 1 trauma centers. Patients: Two hundred forty-nine patients 55 years of age or older with AO/OTA 31A1 (43) and OA/OTA 31A2 (206) fractures were prospectively enrolled and followed for 12 months. Intervention: Computer generated randomization to either IT (n = 123) or SHS (n = 126). Main Outcome Measurements: The Functional Independence Measure (FIM) and the Timed Up and Go test (TUG) were used to measure function and motor performance. Secondary outcome measures included femoral shortening, complications, and mortality. Results: Demographics, comorbidities, preinjury FIM scores and TUG scores were similar between groups. Patients (17.2%) who received an IT had limb shortening greater than 2 cm compared with 42.9% who received an SHS (P < 0.001). To determine the importance of preinjury function and fracture stability, we analyzed the subgroup of patients with the ability to walk 150 m independently preinjury and an OA/OTA 31A-2 fracture (n = 70). In this subgroup, patients treated with SHS had greater shortening and demonstrated poorer FIM and TUG scores compared with patients treated with an IT. Conclusions: Overall, most patients with intertrochanteric femur fractures can expect similar functional results whether treated with an intramedullary or extramedullary device. However, active, functional patients have an improved outcome when the InterTAN is used to treat their unstable intertrochanteric fracture. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Published
2017

15. Selection of Outcome Measures for Patients With Hip Fracture

Author

Chad P. Coles, David W. Sanders, Dianne Bryant, Brad Petrisor, George Y. Laflamme, and Kyle J. Jeray

Subjects
medicine.medical_specialty, Arthroplasty, Replacement, Hip, Population, Outcome (game theory), Fracture Fixation, Internal, Quality of life (healthcare), Outcome Assessment, Health Care, Fracture fixation, medicine, Humans, Orthopedics and Sports Medicine, education, Reliability (statistics), education.field_of_study, Hip fracture, Evidence-Based Medicine, business.industry, Recovery of Function, General Medicine, Evidence-based medicine, medicine.disease, Femoral Neck Fractures, Treatment Outcome, Physical therapy, Surgery, Hip Prosthesis, Outcomes research, business
Abstract

In designing a study protocol relating to hip fracture treatment and outcomes, it is important to select appropriate outcome instruments. Before beginning the process of instrument selection, investigators must gain a comprehensive understanding of the condition of interest and have a thorough knowledge of the expected benefits and harms of the proposed intervention. Adequate evidence of an intervention's effectiveness includes indication of impact on the patient's health. We provide a brief discussion about different ways that health and health measurement have been defined, including the International Classification of Function, Disability and Health (ICF), health-related quality of life (HRQOL), and cost-to-benefit analyses. We outline important properties (reliability, validity, sensitivity to change, and responsiveness) that a measurement instrument must demonstrate before being considered an acceptable means to measure outcome. Potential outcome measures relevant to patients with hip fracture are summarized, and important points to consider in the selection of outcome measures for a hypothetical research question in a hip fracture population are discussed.

Published
2009
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16. Interobserver reliability of the Schatzker and Luo classification systems for tibial plateau fractures

Author

Mário Vale, F. J. Seibert, Ramos Acacio, Harish Kurup, Paul Ousema, Golovakha M. Leonidovich, Tomo Havliček, Daniel Sa Da Costa, Valentin Neuhaus, Samy Bouaicha, Peter Kloen, A. Engvall, Anže Kristan, Nikolaos Manidakis, Yoram A. Weil, Theodoros H. Tosounidis, Chegini M H Shahriar, Koroush Kabir, Thomas Mittlmeier, S.A. Meylaerts, Barbara E. Kreis, Milind Merchant, William Dias Belangero, Nikolaos G. Lasanianos, Parag Melvanki, S. Wojtek, Alar Toom, Lars C. Borris, Diederik O. Verbeek, H. Goost, Rodrigo Pesantez, Peter R. Brink, Ole Brink, S.H. van Helden, Max Van Den Bogaert, Marc F. Swiontkowski, J. Vide, Minos Tyllianakis, D. H. Park, Joris R. Lansdaal, George C. Babis, N. Martinelli, Chad P. Coles, Antonio Barquet, Matthew Rg Menon, Jos J. Mellema, Huub Van Der Heide, Frede Frihagen, Richard Jenkinson, Robert D. Zura, Pradeep Choudhari, Brian J. Cross, Christos Garnavos, Kyle J. Jeray, Job N. Doornberg, Marinis Pirpiris, Michel P.J. van den Bekerom, Nikolaos E. Koukoulias, Ewe Juan Yeap, Michael J. Prayson, Anthony Grauls, Ian A. Harris, F. Lijoi, Vincenzo Giordano, Daniel Haverkamp, Axel Jubel, Matthew A. Mormino, Rik J. Molenaars, Peter L. Althausen, Peter Schandelmaier, Heidi Haapasalo, Harold Alonso Villamizar, Balázs Patczai, Inge Van Rensen, J. H. Davenport, Alan Kawaguchi, Emilija Stojkovska Pemovska, Julius A. Bishop, David Ring, Samir Mehta, Tim Schepers, Edward J. Harvey, Henry Broekhuyse, S. G. Kannan, J. Lawrence Marsh, Ladislav Mica, Other departments, Orthopedic Surgery and Sports Medicine, Surgery, University of Zurich, and Mellema, Jos J

Subjects
Schatzker, medicine.medical_specialty, Interobserver reliability, 610 Medicine & health, Computed tomography, Knee Injuries, Plateau (mathematics), Sensitivity and Specificity, 03 medical and health sciences, Imaging, Three-Dimensional, 2732 Orthopedics and Sports Medicine, 0302 clinical medicine, Tibial plateau fractures, X ray computed, medicine, Tibial plateau fracture, Humans, Luo, 030212 general & internal medicine, Reliability (statistics), General Environmental Science, Observer Variation, Orthodontics, 030222 orthopedics, medicine.diagnostic_test, business.industry, Reproducibility of Results, Classification, medicine.disease, Surgery, Tibial Fractures, 10021 Department of Trauma Surgery, Orthopedic surgery, Radiographic Image Interpretation, Computer-Assisted, General Earth and Planetary Sciences, Tomography, X-Ray Computed, 2711 Emergency Medicine, business, Kappa
Abstract

Tibial plateau fracture classification systems have limited interobserver reliability and new systems emerge. The purpose of this study was to compare the reliability of the Luo classification and the Schatzker classification for two-dimensional computed tomography (2DCT) and to study the effect of adding three-dimensional computed tomography (3DCT). Eighty-one observers, orthopedic surgeons and residents, were randomized to either 2DCT or 2D- and 3DCT evaluation of a spectrum of 15 complex tibial plateau fractures using web-based platforms in order to classify according to the Schatzker and according to Luo's Three Column classification. Reliability was calculated with the use of Siegel and Castellan's multirater kappa measure. Kappa values were interpreted according to the categorical rating by Landis and Koch. Overall interobserver reliability of the Schatzker classification was significantly better compared to the Luo classification (kSchatzker=0.32 and kLuo=0.28, P=0.021), however, 'fair' for both fracture classification systems. For the Schatzker classification observers agreed significantly better on 2DCT compared to 2D- and 3DCT (k2DCT=0.37 and k2D+3DCT=0.29, P

Published
2016

17. Functional Outcomes of Severe Bicondylar Tibial Plateau Fractures Treated with Dual Incisions and Medial and Lateral Plates

Author

Stephen K. Benirschke, Chad P. Coles, William J. Mills, M. Bradford Henley, David P. Barei, and Sean E. Nork

Subjects
Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Radiography, Injury Severity Score, Humans, Medicine, Orthopedic Procedures, Orthopedics and Sports Medicine, Reduction (orthopedic surgery), Aged, Retrospective Studies, business.industry, Retrospective cohort study, General Medicine, Perioperative, Middle Aged, medicine.disease, Polytrauma, Sagittal plane, Surgery, Tibial Fractures, medicine.anatomical_structure, Coronal plane, Orthopedic surgery, Female, business, Bone Plates
Abstract

Background: Plate fixation of comminuted bicondylar tibial plateau fractures remains controversial. This retrospective study was performed to evaluate the perioperative results and functional outcomes of medial and lateral plate stabilization, through anterolateral and posteromedial surgical approaches, of comminuted bicondylar tibial plateau fractures. Methods: Over a seventy-seven-month period, eighty-three AO/OTA type-41-C3 bicondylar tibial plateau fractures were treated with medial and lateral plate fixation through two exposures. Injury radiographs were rank-ordered according to fracture severity. Immediate biplanar postoperative radiographs were evaluated to assess the quality of the reduction. The Musculoskeletal Function Assessment (MFA) questionnaire was used to evaluate functional outcome. Results: Twenty-three male and eighteen female patients (average age, forty-six years) who completed the MFA questionnaire were included in the study group. The mean duration of follow-up was fifty-nine months. Two patients had a deep wound infection. Complete radiographic information was available for thirty-one patients. Seventeen (55%) of those patients had a satisfactory articular reduction (≤2-mm step or gap), twenty-eight patients (90%) had satisfactory coronal plane alignment (medial proximal tibial angle of 87° ± 5°), twenty-one patients (68%) demonstrated satisfactory sagittal plane alignment (posterior proximal tibial angle of 9° ± 5°), and all thirty-one patients demonstrated satisfactory tibial plateau width (0 to 5 mm). Patient age and polytrauma were associated with a higher (worse) MFA score (p = 0.034 and p = 0.039, respectively). When these variables were accounted for, regression analysis demonstrated that a satisfactory articular reduction was significantly associated with a better MFA score (p = 0.029). Rank-order fracture severity was also predictive of MFA outcome (p < 0.001). No association was identified between rank-order severity and a satisfactory articular reduction (p = 0.21). The patients in this series demonstrated significant residual dysfunction (p < 0.0001), compared with normative data, with the leisure, employment, and movement MFA domains displaying the worst scores. Conclusions: Medial and lateral plate stabilization of comminuted bicondylar tibial plateau fractures through medial and lateral surgical approaches is a useful treatment method; however, residual dysfunction is common. Accurate articular reduction was possible in about half of our patients and was associated with better outcomes within the confines of the injury severity. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Published
2006
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18. Open Clavicle Fractures and Associated Injuries

Author

Chad P. Coles, Julie Agel, Lisa A. Taitsman, David P. Barei, and Sean E. Nork

Subjects
Adult, Male, Facial trauma, Canada, medicine.medical_specialty, Adolescent, medicine.medical_treatment, Fractures, Open, Scapula, medicine, Humans, Internal fixation, Orthopedics and Sports Medicine, Child, Retrospective Studies, Multiple Trauma, business.industry, Incidence, Trauma center, General Medicine, Middle Aged, medicine.disease, Clavicle, Polytrauma, Surgery, Treatment Outcome, medicine.anatomical_structure, Child, Preschool, Closed head injury, Shoulder girdle, Female, business
Abstract

Objectives To describe the associated injuries, demographic distribution, and management of patients sustaining open clavicle fractures. Design Retrospective case series. Setting A single level-1 trauma center. Patients Twenty patients with open clavicle fractures were identified from a prospectively collected orthopaedic trauma registry. Intervention All patients were managed with surgical irrigation and debridement with or without internal fixation. Results Thirteen patients (65%) had a closed head injury. Fifteen patients (75%) had a significant associated pulmonary injury. In that group, there were 10 patients who had a pneumothorax (7 bilateral). Additionally, 12 patients had rib fractures and 11 had documented pulmonary contusions or effusions. Seven patients (35%) had a cervical or thoracic spine fracture or dislocation. Eight patients (40%) had concomitant scapula fractures. Six patients (30%) had additional ipsilateral upper extremity injuries remote from the shoulder girdle. One patient had a scapulothoracic dissociation. Eleven patients (55%) sustained significant facial trauma including fractures (5 patients), lacerations, and hematomas. Fourteen patients (70%) were treated with open reduction internal fixation. Fifteen patients (75%) were followed to healing (mean: 111 wk, median: 56 wk, range: 13 to 333 wk). There were no other complications related to the operative fixations. There were no known infections or nonunions. Conclusions Open clavicle fractures are a rare injury. Patients often have associated pulmonary and cranial injuries. Ipsilateral upper extremity and shoulder girdle injuries are common, whereas concomitant neurologic and vascular injuries are infrequent. The majority of patients have rapid and uneventful healing of their fractures after surgical treatment.

Published
2006
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19. The Olecranon Osteotomy: A Six-year Experience in the Treatment of Intraarticular Fractures of the Distal Humerus

Author

David P. Barei, Sean E. Nork, Chad P. Coles, Lisa A. Taitsman, Douglas P. Hanel, and M. Bradford Henley

Subjects
Adult, Male, musculoskeletal diseases, Humeral Fractures, medicine.medical_specialty, Adolescent, medicine.medical_treatment, Olecranon, Nonunion, Elbow, Osteotomy, law.invention, Intramedullary rod, law, Elbow Joint, medicine, Humans, Orthopedics and Sports Medicine, Humerus, Aged, Retrospective Studies, Aged, 80 and over, Osteosynthesis, business.industry, General Medicine, Middle Aged, musculoskeletal system, medicine.disease, Surgery, Radiography, medicine.anatomical_structure, Orthopedic surgery, Female, Elbow Injuries, business
Abstract

Objectives: The transolecranon exposure for distal humerus fractures is a suggested technique for improving articular visualization, allowing accurate reduction. Significant osteotomy complications such as nonunion and implant prominence have prompted recommendations for alternate exposures. The purposes of this study are to present the techniques and complications of the olecranon osteotomy for the management of distal humerus fractures, and to evaluate the adequacy of distal humeral and olecranon articular reductions. Design: Retrospective review. Setting: Urban level-1 University trauma center. Patients: One hundred fourteen skeletally mature AO/OTA type 13-C distal humerus fractures were identified from the orthopedic trauma database and formed the study group. Intervention: Seventy fractures (61%), including 42 open injuries, were managed using an intraarticular, chevron-shaped olecranon osteotomy. Osteotomy fixations were performed with an intramedullary screw and supplemental dorsal ulnar wiring, or plate stabilization. In the remaining 44 fractures (39%), soft-tissue mobilizing exposures were performed. Main Outcome Measure: Patient records and radiographs were reviewed to determine injury and operative characteristics, complications, and adequacy of articular reductions. Patient interviews were conducted by telephone to identify any subsequent surgical procedures. Results: The proportion of osteotomies performed increased as fracture complexity increased (P < 0.001). Sixty-seven of 70 patients had adequate follow-up to determine osteotomy union. All osteotomies united. There was 1 delayed union. Sixty-one of 70 patients had adequate follow-up to determine complications associated with ulnar fixations. Five of these patients (8%) underwent elective removal of symptomatic osteotomy fixations. An additional 13 patients had olecranon implants removed in conjunction with other surgical procedures (11 elbow contracture releases, 1 humeral nonunion repair, and 1 chronic draining sinus excision). Symptomatic ulnar fixations in this group could not be reliably ascertained, but may have been present. A total of 18 of 61 patients (29.5%), therefore, had proximal ulna fixations removed. All patients treated using an olecranon osteotomy exposure demonstrated satisfactory radiographic distal humeral articular reductions. Two osteotomies required early revision osteosynthesis secondary to loss of osteotomy reduction. Conclusions: In this study, no osteotomy nonunions were encountered in 67 patients, more than half of which were open injuries. Regardless of which type of fixation is used to secure the osteotomy, secure stabilization must be obtained. Isolated symptomatic olecranon fixation requiring removal occurred in approximately 8% of patients. Although not necessary for all fractures of the distal humerus, the olecranon osteotomy can be useful in the visualization of the complex articular injuries, allowing accurate articular reduction.

Published
2006
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20. Wear-particle-induced osteoclast osteolysis: The role of particulates and mechanical strain

Author

Chad P. Coles, Gail I. Anderson, Ying Fang Chen, and Robyn MacQuarrie

Subjects
musculoskeletal diseases, Materials science, Osteolysis, Surface Properties, Cell Culture Techniques, Biomedical Engineering, Osteoclasts, Receptors, Cytoplasmic and Nuclear, Apoptosis, Antibodies, Receptors, Tumor Necrosis Factor, Bone resorption, Biomaterials, Mice, Osteoprotegerin, Bone Marrow, Osteoclast, medicine, Animals, Particle Size, Cells, Cultured, Glycoproteins, Titanium, Membrane Glycoproteins, Receptor Activator of Nuclear Factor-kappa B, biology, RANK Ligand, Metallurgy, Cell Differentiation, medicine.disease, medicine.anatomical_structure, Solubility, Polyethylene, RANKL, biology.protein, Biophysics, Eicosanoids, Tumor necrosis factor alpha, Chromium Alloys, Rabbits, Stress, Mechanical, Carrier Proteins, Plastics
Abstract

Periprosthetic osteolysis involves osteoclast activation by wear particulates and their exposure to mechanical perturbation through exposure to shear forces generated by periprosthetic fluid as well as interface micromotion. This study aimed to determine the interactions between wear particulates, mechanical stimulation, and osteoclasts. In static cultures, wear particulates increased osteoclast differentiation. Addition of neutralizing antibodies to RANKL (receptor activator of nuclear factor kappa ligand) inhibited the particle-induced increase in osteoclast numbers. Cyclic 5000 microstrains were applied with the use of a custom-built device to marrow-derived cultures to assess the effect on osteoclast differentiation. Mechanical strain application alone decreased osteoclast differentiation, which was further decreased by the addition of particles despite increases in the soluble RANKL to osteoprotegerin (OPG) ratio. Mechanical strain alone induced mature osteoclast apoptosis in a dose-dependent manner. In contrast, in the mature osteoclast model, the addition of nonmetal particulates protected the osteoclasts from becoming apoptopic. Titanium (Ti) and cobalt chromium (CoCr) particles, however, induced osteoclast apoptosis, whereas polyethylene (PE) and polymethylmethacrylate (PMMA) did not. Wear particulates and mechanical stimulation interact via an eicosanoid-dependent pathway to alter osteoclast function and survival. The addition of mechanical perturbation to a particle-laden system thus appears to enhance the potential for osteolytic activity by enhancing osteoclast survival.

Published
2004
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22. CONTRIBUTORS

Author

Henry Ahn, Ghassan B. Alami, Sahal Altamimi, George S. Athwal, Greg K. Berry, Mohit Bhandari, Piotr A. Blachut, Richard A. Boyle, Henry M. Broekhuyse, Richard E. Buckley, Chad P. Coles, Paul J. Duffy, Willliam N. Dust, Alun Evans, Wade Gofton, Christina Goldstein, Chris Graham, Pierre Guy, Jeremy A. Hall, Edward J. Harvey, Michael A. Hickey, Richard Jenkinson, Michael Kelly, Graham J.W. King, Hans J. Kreder, Paul R.T. Kuzyk, G. Yves Laflamme, Abdel-Rahman Lawendy, Kelly A. Lefaivre, Ross K. Leighton, Allan S.L. Liew, Mark D. MacLeod, Dean G. Malish, Scott J. Mandel, Gerard March, Rod Martin, Paul A. Martineau, Randy Mascarenhas, Paul K. Mathew, Robert G. McCormack, Michael D. McKee, Peter J. O'Brien, Kostas P. Panagiotopoulos, Steven Papp, Brad Petrisor, Brad Pilkey, Rudolf Reindl, Dominique M. Rouleau, Marie-Ève Rouleau, David W. Sanders, Emil H. Schemitsch, Rajrishi Sharma, David J.G. Stephen, Trevor B. Stone, Ayman M. Tadros, Max Talbot, James Vernon, James P. Waddell, Don W. Weber, Neil J. White, and Jeff Yach

Published
2010
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