Treatment of Displaced Intra-Articular Calcaneal Fractures with Closed Reduction and Percutaneous Screw Fixation

Conclusions We consider the technique of Forgon and Zadravecz to be an excellent option for the treatment of displaced intra-articular calcaneal fractures in selected patients despite the frequent need for screw removal following fracture-healing.

The "not so simple" ankle fracture: avoiding problems and pitfalls to improve patient outcomes.

Ankle fractures are among the most common injuries managed by orthopaedic surgeons. Many ankle fractures are simple, with straightforward management leading to successful outcomes. Some fractures, however, are challenging, and debate arises regarding the best treatment to achieve an optimal outcome. Some patients have medical comorbidities that increase the risk for complications or may require modifications to standard surgical techniques and fixation methods. Several recent investigations have highlighted the pitfalls in accurately reducing syndesmotic injuries. Controversy remains regarding the number and diameter of screws, the duration of weight-bearing limitations, and the need or timing of screw removal. Open reduction may allow more accurate reduction than standard closed methods. Direct fixation of associated posterior malleolus fractures may provide improved syndesmotic stability. Posterior malleolus fractures vary in size and can be classified based on the orientation of the fracture line. As the size of the posterior malleolus fracture fragment increases, the load pattern in the ankle is altered. Direct or indirect reduction and surgical fixation may be required to prevent posterior talar subluxation and restore articular congruency. The supination-adduction fracture pattern is also important to recognize. Articular depression of the medial tibial plafond may require reduction and bone grafting. Optimal fixation requires directing screws parallel to the ankle joint or using a buttress plate. Identifying ankle fractures that may present additional treatment challenges is essential to achieving a successful outcome. A careful review of radiographs and CT scans, a thorough patient assessment, and detailed preoperative planning are needed to improve patient outcomes.

Revision arthrodesis of the ankle: a 4 cannulated screw compression fixation technique.

No PubMed abstract.

The posterolateral approach to the tibia for displaced posterior malleolar injuries.

Fractures involving the posterior malleolus of the tibia can be difficult to manage. Failure to address these fractures can lead to posterior ankle instability and altered ankle reaction forces. The posterolateral approach to the posterior ankle provides access to both the lateral and posterior malleoli. Displaced fractures of the posterior malleolus can be reduced and fixed under direct visualization through a posterolateral incision. We have had excellent results using this technique for management of displaced posterior malleolar fractures with few complications. Surgeons should be aware of the effectiveness of this technique for managing displaced fractures of the posterior malleolus.

New tool to measure outcomes of brachial plexus injury

The way that clinicians report outcomes of surgery for a traumatic nerve injury involving the arm is not standardized, and it is thus difficult to compare the efficacy of different surgical treatments, according to a study by researchers at Hospital for Special Surgery (HSS) in New York. In a second HSS study, investigators say they have developed a tool to measure outcomes that they hope can be refined and used worldwide.

FDA Panel Narrowly Endorses Bone Graft Device‎

An FDA advisory panel narrowly recommended approval for an investigational bone graft device that uses a growth factor protein to regrow bones in the foot and ankle. The device is called Augment and is made by BioMimetic, which is seeking approval for the device to be an alternative to harvesting a patient's own bone for the fusion procedure.

Battlefield orthopaedic injuries cause the majority of long-term disabilities.

Extremity injuries make up 54% of combat wounds sustained in Operation Iraqi Freedom and Operation Enduring Freedom. In a cohort of war-wounded service members, we identified the conditions secondary to battle injury that result in disqualification from continued service. The Army Physical Evaluation Board records of 464 wounded service members who were injured between October 2001 and January 2005 were reviewed to determine the codes indicating unfitting conditions. Sixty-nine percent of these conditions were orthopaedic. Fifty-seven percent of the injured had unfitting conditions that were orthopaedic only. Of those evacuated from theater with a primary diagnosis of injury to the head, thorax, or abdomen and who suffered an orthopaedic injury as well, 76% had an orthopaedic diagnosis as the primary unfitting condition. Orthopaedic-related disability has a significant impact on the affected patient, the health care system, and, in the case of wounded service members, on military strength and readiness.

The "not so simple" ankle fracture: avoiding problems and pitfalls to improve patient outcomes.

Ankle fractures are among the most common injuries managed by orthopaedic surgeons. Many ankle fractures are simple, with straightforward management leading to successful outcomes. Some fractures, however, are challenging, and debate arises regarding the best treatment to achieve an optimal outcome. Some patients have medical comorbidities that increase the risk for complications or may require modifications to standard surgical techniques and fixation methods. Several recent investigations have highlighted the pitfalls in accurately reducing syndesmotic injuries. Controversy remains regarding the number and diameter of screws, the duration of weight-bearing limitations, and the need or timing of screw removal. Open reduction may allow more accurate reduction than standard closed methods. Direct fixation of associated posterior malleolus fractures may provide improved syndesmotic stability. Posterior malleolus fractures vary in size and can be classified based on the orientation of the fracture line. As the size of the posterior malleolus fracture fragment increases, the load pattern in the ankle is altered. Direct or indirect reduction and surgical fixation may be required to prevent posterior talar subluxation and restore articular congruency. The supination-adduction fracture pattern is also important to recognize. Articular depression of the medial tibial plafond may require reduction and bone grafting. Optimal fixation requires directing screws parallel to the ankle joint or using a buttress plate. Identifying ankle fractures that may present additional treatment challenges is essential to achieving a successful outcome. A careful review of radiographs and CT scans, a thorough patient assessment, and detailed preoperative planning are needed to improve patient outcomes. Hak DJ, Egol KA, Gardner MJ, Haskell A. Instr Course Lect. 2011;60:73-88. PMID:  1553763

Yoga-Based Maneuver Effectively Treats Rotator Cuff Syndrome

Abstract

Objective: To measure efficacy of a simple maneuver in the conservative treatment of rotator cuff syndrome.

Design: Before-and-after study with mean 30-month follow-up (range: 9 months–8 years).

Setting: Private practice.

Participants: Fifty consecutive outpatients with magnetic resonance imaging–confirmed partial or full-thickness supraspinatus tears.

Intervention: A single partial weight-bearing maneuver involving triangular forearm support (TFS) was repeated in physical therapy for a mean 5 sessions (range: 1 session–24 sessions).

Main Outcome Measures: Maximal painless active abduction and flexion before and after performing TFS, pain on maximal abduction and flexion before and after performing TFS, and at mean 2.5-year follow-up.

Results: Mean painless active abduction increased from 73.7° to 162.8° (P < .001; SD = 32.3); mean painless active flexion increased from 84.1° to 165.4° (P < .001; SD = 36.7). In 2.5 years follow-up mean combined painless abduction and flexion active range of motion was 171.5 (P < .001; SD = 14.4). In immediate post-TFS testing and after 2.5 years mean visual analogue scale pain rating during maximal abduction and flexion fell from 5.46 to 0.97 (P < .001; SD = 2.6).

Conclusions: These values compare favorably with most surgical and nonsurgical studies. Triangular forearm support plus physical therapy appear to improve abduction and flexion and reduce pain immediately and in the longer term after rotator cuff syndrome.