Orthopedics
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Comparative Study
A Comparison of Complications and Union Rates in Intramedullary Nailing of Femoral Shaft Fractures Treated With Open Versus Closed Reduction.
Intramedullary rod fixation is a common technique for treatment of femoral shaft fractures, with both open and closed reduction techniques described. The purpose of this study was to assess union and complication rates among patients treated with open vs closed reduction and intramedullary nailing of closed femoral shaft fractures. A total of 107 patients undergoing intramedullary fixation of nonpathologic femoral shaft fractures (AO/OTA type 32) between January 2012 and June 2017 were retrospectively studied. ⋯ Patients in the open reduction group who had union did so in a mean of 6.2 months (range, 3-12 months) vs a mean of 5.4 months (range, 2-11 months) in the closed reduction group (P=.13). Six patients (16.2%) in the open reduction group and 6 patients (8.6%) in the closed reduction group had a postoperative complication requiring return to the operating room (P=.18). Open reduction and intramedullary nailing results in rates of union, time to union, and rates of significant complications similar to those of closed reduction and intramedullary nailing. [Orthopedics. 2020; 43(2): 103-107.].
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This cohort study of adult (≥50 years) patients aimed to calculate a validated, preoperative frailty deficit index (FI) and used it to compare outcomes following total knee arthroplasty (TKA), primary and revision, from 2005 through 2016. Using multivariable logistic and Cox regression, the authors analyzed whether FI, adjusted for age, predicts outcomes prior to hospital discharge, within 90 days, and within 365 days. They classified 9818 patients undergoing TKA (7920 primary and 1898 revision; median age, 69 years) as frail (21%), vulnerable (39%), and non-frail (40%). ⋯ At no time point were significant associations found with arthrofibrosis, aseptic loosening, or patellar clunk syndrome. One-fifth of patients undergoing primary and revision TKAs are frail and at notable risk for complications. Calculating a preoperative FI should guide pre-habilitation efforts (eg, chronic disease management, wellness) before and postoperative surveillance after TKA. [Orthopedics. 2019; 42(6):335-343.].
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Although several studies now support the use of aspirin for venous thromboembolism (VTE) prophylaxis in primary total hip arthroplasty (THA) and total knee arthroplasty (TKA), the optimal chemoprophylactic agent in revision THA and TKA is not clear. The purpose of this study was to determine if the type of chemoprophylaxis has an effect on the VTE rate in patients undergoing revision total joint arthroplasty (TJA). The second aim was to compare differences in rates of wound drainage in primary and revision TJA stratified by the postoperative chemoprophylaxis used. ⋯ Although revision surgery was an independent risk factor for wound drainage (odds ratio, 3.201; 95% confidence interval, 1.594-6.426; P=.001), it was not a risk factor for VTE (odds ratio, 1.847; 95% confidence interval, 0.423-8.053; P=.414). Revision arthroplasty alone was not associated with an increased rate of VTE. Aspirin is as effective as other chemoprophylactic agents without the increased risk of bleeding in low-risk patients. [Orthopedics. 2019; 42(6):323-329.].
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High-energy open fractures of the tibia are frequently associated with tissue loss, wound contamination, and compromised vascularity that often result in amputation. The management of these severe injuries remains a challenge for orthopedic reconstructive surgeons. Studies have compared the timing of soft tissue coverage of Gustilo type IIIB open tibia fractures with associated outcomes such as rate of deep infection, primary union, length of hospitalization, flap failure, and eventual secondary amputation. ⋯ Motor vehicle accidents were the most common cause of injury, and 83% of patients obtained full weight-bearing status with successful limb salvage. Twenty patients had a secondary amputation, with the cause being refractory osteomyelitis in 52%. This study provides guidance on treating a heterogeneous patient population with severe open tibia fractures typically seen in a large tertiary hospital orthopedic trauma service. [Orthopedics. 2019; 42(5):260-266.].
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Comparative Study
Surgical Outcomes in Endoscopic Versus Open Bursectomy of the Septic Prepatellar or Olecranon Bursa.
In this study, the authors investigated the viability of endoscopic bursectomy as a treatment for septic prepatellar and olecranon bursitis. Conventional treatment of septic bursitis consists of aspiration, antibiotics, and rest. When conservative treatment fails, however, surgical intervention is sometimes required to resolve the infection. ⋯ The authors reported good results, with no wound healing complications and only 1 minor recurrence. They also reported much shorter hospital stays than have been reported both for more conservative treatments of septic bursitis and in other case series on endoscopic bursectomy. The authors conclude that endoscopic bursectomy is a superior alternative to open bursectomy for the treatment of recalcitrant septic prepatellar and olecranon bursitis. [Orthopedics. 2019; 42(4):e381-e384.].