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Background: Tibial tuberosity–trochlear groove distance (TT-TG) is often used as a primary metric for surgical decision-making in the treatment of patellofemoral instability (PFI), particularly when considering tibial tubercle transfer. Although TT-TG has high interrater reliability, it is prone to measurement differences caused by the alignment of the patient's leg in a scanner gantry, potentially influencing surgical decision-making. Quantification of this error within the clinical literature remains limited. Purpose: To quantify and specify the error in TT-TG caused by leg-scanner alignment by using detailed topographical landmarks and 3-dimensional (3D) analysis of computed tomography scans of patients with PFI. Study Design: Controlled laboratory study. Methods: Three-dimensional models of knees with PFI were created from computed tomography scans and used to identify TT-TG landmarks. TT-TG was measured using the established 2-dimensional (2D) and 3D methods. A model to estimate the differences between these 2 methods was created, and the orientation of the patients' legs in relation to scanner longitudinal axis was measured to validate this model via linear regression. Interrater reliability was calculated via intraclass correlation coefficients (ICC). Results: A total of 44 knees of patients with PFI were analyzed. Differences between the 2D and 3D methods ranged from -4.0 to 14.7 mm (mean ± SD, 2.7 ± 4.1 mm) with a root mean square difference of 4.8 mm. The TT-TG distance of the 2D method (19.8 ± 7.2 mm) was significantly (P =.045) longer than that of the 3D method (17.1 ± 4.9 mm). The variance of the 2D method was significantly larger than that of the 3D method. In total, 13 (29.5%) of the knees had a difference of >5 mm between 2D and 3D TT-TG. The estimation model had an adjusted r 2 value of 1.00 and a resulting root mean square difference of 0.21 mm. 3D TT-TGs interrater reliability was good to excellent (ICC, 0.94 [95 CI%, 0.81-0.98]). Conclusion: 3D TT-TG can be used to correct scanner-leg alignment errors, some of which are substantial when using only 2D TT-TG measurements. Clinical Relevance: The findings in this study suggest a need for caution and awareness of the potential effects of differences in alignment of the axes of the leg and scanner when using purely 2D TT-TG as a basis for surgical planning. [ABSTRACT FROM AUTHOR]

Objectives: Upper extremity injuries following motorcycle crashes (MCC) incur increased healthcare costs and rehabilitation needs. We aim to characterize the epidemiology of MCC upper extremity injuries and identify factors that influence the severity of and cost of care for upper extremity injuries. Methods: We performed a retrospective cohort analysis of 571 patients with upper extremity injuries after MCC at a level 1 trauma center from 2002 to 2013. We collected data pertaining to demographics, helmet use, toxicology, bony injury, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), hospital length of stay (LOS), and cost. Continuous variables were compared using t-test or Wilcoxon rank test, depending on data distribution, and dichotomous variables were compared using Pearson’s chi-squared or Fisher’s exact tests. Regression models were used to evaluate the effect of intoxication or helmets on injury location, severity, cost of care, and LOS. Results: The incidence of MCC upper extremity injury was 47.5%, with hand and forearm fractures the most common injuries (25.5% and 24.7% of total injuries). Intoxicated patients were more likely to have a high cost of care (p = 0.012), extended LOS (p = 0.038), plastic surgery involvement in their care (p = 0.038), but fewer upper extremity bony injuries (p = 0.019). Non-helmeted patients sustained less upper extremity bony injuries (p

Objective: The purpose of this study was to characterize and compare risk behaviors between motorcyclists and motor vehicle drivers who were involved in accidents and required hospitalization. The study focused on patients who were recently involved in motorcycle collisions (MCCs) and motor vehicle collisions (MVCs). Methods: We identified 63 patients involved in MCCs and 39 patients involved in MVCs who were admitted to our level-1 trauma center from April 2014 to September 2015. These 102 patients completed a questionnaire designed to evaluate risky driving behaviors. Pearson’s chi-squared tests and unpaired two-tailed t-tests were used to evaluate categorical and normally distributed continuous variables, respectively. Multivariable linear regression was used to analyze predictors of risk behavior. Significance was set at p < 0.05. Results: When compared to patients involved in an MCC, patients involved in MVCs were more likely to be female (p = 0.007), drive more frequently (p < 0.001), and never perceive the risk of an accident (p = 0.036). MVC patients were more likely to have admitted to substance use on the day of the accident (p = 0.030), historically drive under the influence of drugs (p = 0.031), drive while tired (p < 0.001), drive while text messaging (p < 0.001), and speed while overtaking vehicles (p = 0.011). Overall, MVC patients engaged in more risk behaviors (3.3 ± 1.3 vs. 2.0 ± 1.5; p < 0.001) and were more likely to engage in multiple risk behaviors (p < 0.001). MVCs were associated with increased risk behavior, even after controlling for protective behaviors, driving history, and demographics (p = 0.045). Conclusions: Within our cohort of trauma patients at our institution, motor vehicle drivers were more likely than motorcyclists to engage in any one risk behavior and engage in a higher number of risk behaviors. In addition, motor vehicle drivers perceived their risk of a potential accident as lower than riding a motorcycle. Education initiatives should focus on motor vehicle driver safety interventions that reduce risk behaviors.