Journal of orthopaedic trauma
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Treatment of greater tuberosity (GT) fractures occurring during anterior shoulder dislocation generally consists of initial closed reduction of the shoulder. Undisplaced fractures are treated conservatively, whereas displaced fractures generally undergo surgical management. Our hypothesis is that many well-reduced GT fractures will migrate. The primary goal of this study is to evaluate the outcomes of GT fractures associated with shoulder dislocation to optimize their management. ⋯ Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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The 2013 Boston Marathon bombing resulted in a mass casualty event that tested the limits of Boston-area trauma centers. The explosions, 12 seconds apart, led to the rapid influx of 124 patients with primarily lower extremity injuries in 5 different adult level 1 trauma centers. This study aimed to examine the existing hospital systems in place for disaster scenarios at the time of the event and identify areas for improvement. ⋯ The experience at our institution led to the implementation of a more robust communication infrastructure and reinforced the value of preparatory drills. Within the Orthopaedic Surgery Department, we developed a more robust organizational hierarchy for mass casualty events and implemented a multitrauma follow-up clinic. We believe that it is the responsibility of every hospital to have systems in place to handle the rapid arrival of patients with multiple-trauma, and we hope that others can learn from our experience.
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The biomechanical difficulty in fixation of a Vancouver B1 periprosthetic fracture is purchase of the proximal femoral segment in the presence of the hip stem. Several newer technologies provide the ability to place bicortical locking screws tangential to the hip stem with much longer lengths of screw purchase compared with unicortical screws. This biomechanical study compares the stability of 2 of these newer constructs to previous methods. ⋯ Proximal fixation stability is likely improved with the use of bicortical locking screws as compared with traditional unicortical screws and cable techniques. In this study with a limited sample size, we found the addition of cerclage cables to unicortical screws may not offer much improvement in biomechanical stability of unstable B1 fractures.
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Intraarticular screw perforation is a common complication of open reduction and internal fixation of proximal humerus fractures. The purpose of this study was to (1) determine the sensitivity and specificity of the fluoroscopic images used to evaluate whether a screw tip has perforated into the glenohumeral joint, and (2) determine the specific fluoroscopic views that best evaluate screw position in the humeral head. ⋯ Screws that are completely located within the bone of the proximal humerus will never appear on C-arm images as intraarticular. However, screws that are intraarticular may appear to be completely located within the bone of the proximal humerus on some C-arm images. A sensitivity of 100% for detecting intraarticular screws for 8 of the 9 screws' exit locations and 90% for the posterior-inferior screw can be achieved by imaging the proximal humerus in 25-degree internal rotation, neutral, and 25-degree external rotation with the C-arm in neutral cant at rainbow 25-degree roll over, neutral rainbow, and rainbow 25-degree roll back for a total of 9 images.
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The purpose of this analysis is to report on the epidemiology and clinical implications of traumatic proximal tibiofibular dislocation (PTFD). ⋯ Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.