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The standard treatment of calcaneus fractures is a lateral plate and screw construct. Patients at our institution have been treated with a lateral locking plate combined with one retrograde screw inserted in the oblique plane to allow immediate weight bearing. The purpose of this study was to determine whether addition of a oblique screw to a lateral plate construct increases stability.A Sanders 2B fracture (AO/OTA 83-C2) was created in 8 pairs (16 total specimens) of cadaveric feet. All were repaired using a lateral locking plate/screws construct. One specimen in each pair was chosen randomly to receive an additional oblique screw. The specimens were tested with cyclic load of up to 800 N. Movement at the fracture sites and subsidence of the talus were tracked with a three-dimensional video analysis system.Talar subsidence was not significantly affected by the presence of the additional oblique screw (p = 0.22). The sustentaculum fragment in the case of the screw repair moved 0.39 mm while the same fragment without the additional screw repair displaced 0.12 mm (p 0.01). Two repairs with and one repair without the additional screw failed during longer-term cyclic loading.The two repair types were not statistically different in regards to talar subsidence. While statistical significance resulted in the comparison of sustentaculum fragment movement, the amount of movement did not reach a level of clinical relevance. This study demonstrated immediate stability and durability of the additional screw construct with high volume weight bearing loads.

Implant removal comprises 5% of all orthopaedic surgery procedures performed annually. Surgical indications range from implant failure, infection, non-union, and symptomatic hardware. Intra-operatively, surgeons need to prepare for complications including bony overgrowth, cold-welding, broken screws, and stripped screw heads. Large anatomic dissections required for complete hardware removal place the patient at increased risk of complications due to increased operating time and larger dissections. The authors present a safe and effective technique for the partial removal of surgical implants. The technique utilizes a high-speed burr to cut surgical plates, minimizing the total dissection and operative time. Sterile surgical laps covered in water-based lubricant capture metal debris to reduce tissue contamination as well as surgeon exposure to metal particles.

Background It is unknown if surgical approach or use of previous traumatic wounds for open fracture instrumentation has an impact on patient complications or outcomes. This study sought to compare infection and nonunion rates in the staged treatment of open tibia fractures where the traumatic wound was re-opened during definitive fixation versus when they were not. Methods A retrospective review was performed on all patients at a single institution level 1 trauma center. All patients who had a minimum of 1 year clinical and radiographic outcomes were included. Primary outcome measures were incidence of infection and nonunion. Groups of patients were compared based on surgical approach for definitive fixation. Results A total of 96 patients were included – 48 patients received definitive treatment and wound closure during initial management of the open fracture (group 1), 22 patients had staged fixation through new incisions (group 2), and 26 patients had their traumatic wound reopened during definitive fixation (group 3). Rates of infection were 10.4%, 31.8% and 11.5% respectively (p = 0.15). Rates of nonunion were 20.8%, 27.3% and 30.8% (p = 1.0). No statistically significant differences in regards to primary outcomes were found between the staged fixation groups. Multiple logistic regression also showed no difference in infection or nonunion when controlling for known risk factors. Conclusion For open tibia fractures that underwent staged fixation, no significant differences in infection or nonunion were observed between procedures that involved reopening the traumatic wound versus procedures performed through new incisions. The presence of a distal tibia periarticular fracture was found to be independently associated with infection risk.