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Background: A paucity of knowledge currently exists surroundings the effects of altitude on femur fracture outcomes. The purpose of this study was to determine if altitude plays a significant role in determining the outcome of femoral shaft fractures in the elderly. The authors hypothesized that the additional cardiopulmonary stress of altitude would promote poorer outcomes of those individuals treated at high altitude, especially those individuals whose home residence was located at low altitude. Methods: Medicare part A claims data between 1996 and 2000 were searched and patients with open or closed femoral shaft fractures were identified for the study. The treatment altitude and home residence altitude for each patient was recorded by cross-matching Zip Code information provided in the Medicare part A database with a database providing altitude data by Zip Code. The patients were grouped both by the altitude of treatment and by the difference between the altitude of residence and the altitude of treatment. The data was analyzed for outcome measurements. Results: The study claims data search identified 30,168 patients for the study. For the entire sample, the in-hospital mortality was 4.2%, 30-day mortality was 8.3%, 1-year mortality was 26.3%, and complication rate was 5.7%. Length of stay results demonstrated that patients treated at medium or high altitude had statistically shorter lengths of stay than those treated at low altitude (p < 0.01). Mortality rates and complications were not statistically different for those treated at high, medium, or low altitude with the exception of a slightly lower in-hospital mortality in the medium treatment altitude group (p = 0.04). Additionally, those patients who resided more than 1000 ft below the treatment altitude had shorter lengths of stay than those who resided more than 1000 ft above the treatment altitude (p < 0.01). Those patients who lived within 1000 ft of the treatment hospital or more than 1000 ft below the treatment hospital had fewer days in the intensive care unit (p <0.01, p = 0.01; respectively). Conclusions: Femoral shaft fractures treated at altitude were not associated with increased morbidity and mortality as compared to femoral shaft fractures treated at low altitude. Additionally, patients residing at low altitude and treated at high altitude did not suffer increased morbidity or mortality. [ABSTRACT FROM AUTHOR]

El artículo examina los defectos óseos segmentarios postraumáticos y el tratamiento adecuado. Tradicionalmente, se ha preferido el uso de la amputación como la forma principal de tratamiento. Para salvar las extremedades, también se han usado el injerto esponjoso autólogo masivo y el acortamiento primario. El artículo también explora el uso del injerto óseo libre vascularizado.

The article examines the application of rapid prototyping technique for the performance of trauma surgery. Rapid prototyping is an advanced technology which allows three-dimensional representation of anatomic structure in living objects. Through rapid prototyping, surgeons can perform surgical procedures on solid three-dimensional models before the actual operation. Complex fractures can also be treated and evaluated with improved precision and better clinical outcome through this technique.

Ultra-wideband (UWB) has gained increasing interest for providing real-time positioning to robots in GPS-denied environments. For a robot to act on this information, it also requires its heading. This is, however, not provided by UWB. To overcome this, either multiple tags are used to create a local reference frame connected to the robot or a single tag is combined with ego-motion estimation from odometry or Inertial Measurement Unit (IMU) measurements. Both odometry and the IMU suffer from drift, and it is common to use a magnetometer to correct the drift on the heading; however, magnetometers tend to become unreliable in typical GPS-denied environments. To overcome this, a lightweight particle filter was designed to run in real time. The particle filter corrects the ego-motion heading and location drift using the UWB measurements over a moving horizon time frame. The algorithm was evaluated offline using data sets collected from a ground robot that contains line-of-sight (LOS) and non-line-of-sight conditions. An RMSE of 13 cm and 0.12 (rad) was achieved with four anchors in the LOS condition. It is also shown that it can be used to provide the robot with real-time position and heading information for the robot to act on it in LOS conditions, and it is shown to be robust in both experimental conditions.

Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest form is provided with the online version of the article (http://links.lww.com/JBJS/H799).

Competing Interests: The author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.

Introduction: The objectives for this study were to identify whether diagnostic or procedural errors more commonly resulted in lawsuit, as well as to elucidate how specific variables affected mean indemnity., Methods: Systematic review of English-language articles in the PubMed and Google Scholar databases (through 2020) using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Meta-analysis was performed to estimate measures of proportions and differences in mean indemnity., Results: The estimated probability of lawsuits related to orthopedic trauma in overall studies was 23.3%. There were no significant rate differences between main causes of claims (diagnostic vs procedural errors) and areas of injury (upper vs lower). There was no significant difference of mean indemnity between the probabilities of trauma-related claims, diagnostic error, and procedural error., Conclusion: Non-trauma cases were more likely to result in lawsuit than trauma cases. Procedural errors accounted for most malpractice claims. The average indemnity increased according to the higher diagnostic errors, while the indemnity was lower with a relatively higher proportion of procedural errors. The most common cause of litigation varied between studies; however, among the most cited reasons were missed diagnosis/error in diagnosis, improper/substandard surgical performance, and, though not specifically studied in this analysis, errors of informed consent., Level of Evidence: Economic and Decision Analyses Level VI., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Orthopaedic Trauma Association.)

Background: Open tibial plafond fractures (Orthopaedic Trauma Association and AO Foundation [OTA/AO] 43) are associated with severe complications, including deep infection (closed fractures, 20%; open fractures, 30%), amputation (3%-14%), and nonunion (up to 25%). Circular external fixators (CEFs) can minimize soft tissue injury. This study aimed to report the rate of union and occurrence of severe complications in patients with open tibial plafond fractures treated with CEFs., Methods: A retrospective review of case series was conducted at 3 level I trauma centers. The study included patients older than 18 years with open tibial plafond fractures treated with CEFs. The reported outcomes included union rate, deep infection, operative complications, and limb alignment. The radiographic measurements of anatomic alignment were obtained. Fifty-two patients were included in the study., Results: The primary union rate was 79%. No deep infection occurred in the majority (92%) of patients. No patient required amputation of the affected limb or free flap coverage., Conclusion: Definitive fixation of open tibial plafond fractures with CEFs avoided severe soft tissue complications but resulted in variation in final radiographic alignment., Level of Evidence: Level IV, case series.

Competing Interests: All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. The author certifies that neither he, nor any member of his immediate family, has funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Background: Electrical stimulation (EStim) has been proven to promote bone healing in experimental settings and has been used clinically for many years and yet it has not become a mainstream clinical treatment., Methods: To better understand this discrepancy we reviewed 72 animal and 69 clinical studies published between 1978 and 2017, and separately asked 161 orthopedic surgeons worldwide about their awareness, experience, and acceptance of EStim for treating fracture patients., Results: Of the 72 animal studies, 77% reported positive outcomes, and the most common model, bone, fracture type, and method of administering EStim were dog, tibia, large bone defects, and DC, respectively. Of the 69 clinical studies, 73% reported positive outcomes, and the most common bone treated, fracture type, and method of administration were tibia, delayed/non-unions, and PEMF, respectively. Of the 161 survey respondents, most (73%) were aware of the positive outcomes reported in the literature, yet only 32% used EStim in their patients. The most common fracture they treated was delayed/non-unions, and the greatest problems with EStim were high costs and inconsistent results., Conclusion: Despite their awareness of EStim's pro-fracture healing effects few orthopedic surgeons use it in their patients. Our review of the literature and survey indicate that this is due to confusion in the literature due to the great variation in methods reported, and the inconsistent results associated with this treatment approach. In spite of this surgeons seem to be open to using this treatment if advancements in the technology were able to provide an easy to use, cost-effective method to deliver EStim in their fracture patients.

Objective: To explore the feasibility of identifying anterior cruciate ligament (ACL) allograft implantations and infections using claims., Design: Retrospective cohort study., Methods: We identified ACL reconstructions using procedure codes at 6 health plans from 2000 to 2008. We then identified potential infections using claims-based indicators of infection, including diagnoses, procedures, antibiotic dispensings, specialty consultations, emergency department visits, and hospitalizations. Patients' medical records were reviewed to determine graft type, validate infection status, and calculate sensitivity and positive predictive value (PPV) for indicators of ACL allografts and infections., Results: A total of 11,778 patients with codes for ACL reconstruction were identified. After chart review, PPV for ACL reconstruction was 96% (95% confidence interval [CI], 94%-97%). Of the confirmed ACL reconstructions, 39% (95% CI, 35%-42%) used allograft tissues. The deep infection rate after ACL reconstruction was 1.0% (95% CI, 0.7%-1.4%). The odds ratio of infection for allografts versus autografts was 0.41 (95% CI, 0.19-0.78). Sensitivity of individual claims-based indicators for deep infection after ACL reconstruction ranged from 0% to 75% and PPV from 0% to 100%. Claims-based infection indicators could be combined to enhance sensitivity or PPV but not both., Conclusions: While claims data accurately identify ACL reconstructions, they poorly distinguish between allografts and autografts and identify infections with variable accuracy. Claims data could be useful to monitor infection trends after ACL reconstruction, with different algorithms optimized for different surveillance goals.