Journal of orthopaedic trauma
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To describe and investigate the injury pattern and outcomes of high-energy transsyndesmotic ankle fracture dislocations, or "Logsplitter" injuries, in which the talus is axially wedged into the tibiofibular joint. ⋯ Transsyndesmotic ankle fracture dislocations, or "Logsplitter" injuries, represent an exceptional pattern of high-energy fractures with significant syndesmotic disruption, potential soft tissue compromise, and possible associated plafond injuries. Careful attention to radiographic findings can identify unique fracture characteristics relative to operative decision-making. Outcomes are comparable to those of high-energy pilon fractures, thereby providing the treating surgeon with prognostic information.
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The aim of our study was to assess the intersubject and intrasubject variations of distal tibiofibular syndesmosis on computed tomography (CT) scans and to define standardized measures to verify syndesmosis reduction. ⋯ If P translation of the fibula is present, malreduction should be considered. Sagittal translation measurements are not affected by the size of the joint or the gender of the patient, in contrast to traditionally used cross-sectional measurement methods.
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Much attention has been given to lower extremity amputations that occur more than 90 days after injury, but little focus has been given to analogous upper extremity amputations. The purpose of this study was to determine the reason(s) for desired amputation and the common complications after amputation for those combat-wounded service members who underwent late upper extremity amputation. ⋯ Service members undergoing late upper extremity amputation seem to have different pre- and postoperative complications than those patients undergoing late lower extremity amputations. It was common for the amputee to not wear their prostheses and to experience similar complications after amputation, albeit in a less severe form.
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Emergency medicine (EM) physicians are frequently responsible for evaluating and treating patients with urgent or emergent musculoskeletal conditions, so it is critical that they achieve a basic level of proficiency in musculoskeletal medicine. However, inadequacies in musculoskeletal education have previously been documented among medical students, residents, and attending physicians in a number of specialties. The goal of this study was to assess the proficiency with musculoskeletal medicine among EM physicians in particular. ⋯ Significant deficiencies in musculoskeletal education exist among EM physicians in training and attending staff. Given the frequency with which these physicians evaluate and treat acute musculoskeletal conditions, additional resources should be committed to their training.
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There is substantial variation in the classification and management of scapula fractures. The first purpose of this study was to analyze the interobserver reliability of the OTA/AO classification and the New International Classification for Scapula Fractures. The second purpose was to assess the proportion of agreement among orthopaedic surgeons on operative or nonoperative treatment. ⋯ The New International Classification was more reliable. Body and process fractures generated more disagreement than intraarticular fractures and need further clear definitions.