Search

Abstract. Critical bone loss after open fractures, while relatively uncommon, occurs most frequently in high-energy injuries. Fractures of the tibia account for the majority of open fractures with significant bone loss. A number of different surgical strategies exist for treatment of tibial bone loss, all with different advantages and disadvantages. Care should be taken by the surgeon to review appropriate indications and all relevant evidence before selecting a strategy.

Abstract. Case:. A 51-year-old woman with an infected left humeral shaft recalcitrant nonunion presented 3 years after initial injury. This case report focuses on the staged treatment of a 17-centimeter (cm) humeral shaft nonunion with the induced membrane technique (IMT) using a unique fixation construct of dual locked plating around a humeral nail to provide long-lasting fixation and allow for bone graft consolidation. Conclusion:. Large segmental bone loss of the humerus can be treated with the IMT using nail-plate fixation constructs that allow for early mobilization, increased time for bone graft consolidation before hardware failure, and less frequent follow-up.

Abstract. Objectives:. To document discharge locations for geriatric patients treated for a hip fracture before and during the COVID pandemic and subsequent changes in outcomes seen between each cohort. Design:. Retrospective cohort study. Setting:. Academic medical center. Patients/Participants:. Two matched cohorts of 100 patients with hip fracture treated pre-COVID (February–May 2019) and during COVID (February–May 2020). Intervention:. Discharge location and COVID status on admission. Discharge locations were home (home independently or home with health services) versus facility [subacute nursing facility (SNF) or acute rehabilitation facility]. Main Outcome Measurements:. Readmissions, inpatient and 1-year mortality, and 1-year functional outcomes (EQ5D-3L). Results:. In COVID+ patients, 93% (13/14) were discharged to a facility, 62% (8/13) of whom passed away within 1 year of discharge. Of COVID+ patients discharged to an SNF, 80% (8/10) died within 1 year. Patients discharged to an SNF in 2020 were 1.8x more likely to die within 1 year compared with 2019 (P = 0.029). COVID− patients discharged to an SNF in 2020 had a 3x increased 30-day mortality rate and 1.5x increased 1-year mortality rate compared with 2019. Patients discharged to an acute rehabilitation facility in 2020 had higher rates of 90-day readmission. There was no difference in functional outcomes. Conclusions:. All patients, including COVID− patients, discharged to all discharge locations during the onset of the pandemic experienced a higher mortality rate as compared with prepandemic. This was most pronounced in patients discharged to a skilled nursing facility in 2020 during the early stages of the pandemic. If this trend continues, it suggests that during COVID waves, discharge planning should be conducted with the understanding that no options eliminate the increased risks associated with the pandemic. Level of Evidence:. III