Injury
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Numerous classifications have been developed to assess tibial plateau fractures (TPF). Of these, the Schatzker system is the most widely reported in the literature yet this system is limited in its characterisation of morphological fracture features underlying the fracture location. The purpose of this study was to compare 3D morphological features of TPFs across different Schatzker types. ⋯ Assessment of underlying fracture characteristics in addition to fracture location can serve to provide greater detail relating to fracture morphology, which has the potential to assist with both surgical decision making and assessment of postoperative outcomes. Incorporating this information as part of a hierarchical or multifactorial framework for classifying fractures may help distinguish subtle differences between fracture types that are classifiable using the most current systems.
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To quantitatively compare the articular exposure of the proximal tibia with a lateral parapatellar arthrotomy through a straight midline incision (ML) versus a lateral submeniscal arthrotomy through a curvilinear anterolateral incision (AL). ⋯ The midline approach provides more extensive articular exposure of the lateral tibial plateau compared with the anterolateral approach. This improved exposure may offer an advantage when treating fractures not amenable to arthroscopic or minimally invasive techniques. It may be of most use when treating fractures with extension into the posteromedial quadrant of the lateral plateau, fractures with extensive comminution of the lateral plateau, or fractures with complex lateral meniscus tears and fractures with tibial spine involvement.
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The incidence of ankle fractures requiring surgical fixation is increasing. Although there has been increasing evidence to suggest that preoperative opioid use negatively impacts surgical outcomes, literature focusing primarily on ankle fractures is scarce. The purpose of this study was to investigate the relationship between preoperative opioid use and outcomes following ankle fracture open reduction and surgical fixation (ORIF). We hypothesized that patients prescribed higher preoperative oral morphine equivalents (OMEs) would have poorer postoperative outcomes. ⋯ Opioids use prior to ankle fracture surgery is a common scenario. Unfortunately preoperative opioid use is a risk factor for postoperative complications, ER visits, and readmissions. Furthermore this risk is greater with higher dose opioid use. The results of this study suggests that surgeons should encourage decreased opioid use prior to ankle fracture surgery.
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Anterior native hip dislocation remains poorly studied due to the rarity of the injury. The aim of this study was to describe injury characteristics of anterior hip dislocation, detail its initial treatment, and determine the intermediate term outcomes including the rate of conversion to total hip arthroplasty (THA). ⋯ Obturator dislocations occurred twice as frequently as iliac dislocations. Associated acetabular or femoral head fractures are common. Conversion to THA was low, occurring in only 1 of 16 patients not treated with acute arthroplasty. Obturator dislocations and age less than 45 years old at the time of injury were associated with better functional outcome at intermediate term follow-up.
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Observational Study
Fracture location impacts opioid demand in upper extremity fracture surgery.
Opioid sparing protocols should be formulated with appropriate demand. Specific fracture location has been hypothesized as an important predictor of post-operative pain. The purpose of this study is to evaluate the impact of fracture location on perioperative opioid demand after surgery with the hypothesis that this factor would be significantly associated with perioperative opioid demand in upper extremity fracture surgery. ⋯ Level III, retrospective, observational cohort study.