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Background: Ankle fracture displacement is an important outcome in clinical research examining the effectiveness of surgical and rehabilitation interventions. However, the assessment of displacement remains subjective without well-described or validated measurement methods. The aim of this study was to assess inter- and intrarater reliability of ankle fracture displacement radiographic measures and select measurement thresholds that differentiate displaced and acceptably reduced fractures. Methods: Eight fellowship-trained orthopaedic surgeons evaluated a set of 26 postoperative ankle fracture radiographs on 2 occasions. Surgeons followed standardized instructions for making 5 measurements: coronal displacement (3) talar tilt (1), and sagittal displacement (1). Inter- and intraobserver interclass correlations were determined by random effects regression models. Logistic regression was used to determine the optimal sensitivity and specificity for the measurements with the highest correlation. Results: Three of the 5 measures had excellent interobserver reliability (correlation coefficient > 0.75): (1) coronal plane distance between the lateral border of tibia and lateral border of talus, (2) coronal plane talar tilt, and (3) sagittal plane displacement. The threshold that best discriminated displaced from well-aligned fractures was 2 mm for coronal plane distance (sensitivity 82.1%, specificity 85.4%), 3 degrees for talar tilt (sensitivity 80.4%, specificity 82.2%), and 5 mm for sagittal plane distance (sensitivity 83.9%, specificity 84.9%). Conclusion: This study identified 3 reliable measures of ankle fracture displacement and determined optimal thresholds for discriminating between displaced and acceptably reduced fractures. These measurement criteria can be used for the design and conduct of clinical research studying the impact of surgical treatment and rehabilitation interventions. [ABSTRACT FROM AUTHOR]

Background: Supination-adduction (SAD) type II ankle fractures can have medial tibial plafond and talar body impaction. Factors associated with the development of posttraumatic arthritis can be intrinsic to the injury pattern or mitigated by the surgeon. We hypothesize that plafond malreducton and talar body impaction is associated with early posttraumatic arthrosis. Methods: A retrospective cohort of skeletally mature patients with SAD ankle fractures at 2 level 1 academic trauma centers who underwent operative fixation were identified. Patients with a minimum of 1-year follow-up were included. The presence of articular impaction identified on CT scan was recorded and the quality of reduction on final intraoperative radiographs was assessed. The primary outcome was radiographic ankle arthrosis (Kellgren-Lawrence 3 or 4), and postoperative complications were documented. Results: A total of 175 SAD ankle fractures were identified during a 10-year period; 79 patients with 1-year follow-up met inclusion criteria. The majority of injuries resulted from a high-energy mechanism. Articular impaction was present in 73% of injuries, and 23% of all patients had radiographic arthrosis (Kellgren-Lawrence 3 or 4) at final follow-up. Articular malreduction, defined by either a gap or step >2 mm, was significantly associated with development of arthrosis. Early treatment failure, infection, and nonunion was rare in this series. Conclusion: Malreduction of articular impaction in SAD ankle fractures is associated with early posttraumatic arthrosis. Recognition and anatomic restoration with stable fixation of articular impaction appears to mitigate risk of posttraumatic arthrosis. Investigations correlating postoperative and long-term radiographic findings to patient-reported outcomes after operative treatment of SAD ankle fractures are warranted. Level of Evidence: Level IV, retrospective case series. [ABSTRACT FROM AUTHOR]

Radiographic imaging is integral to the diagnosis and treatment of orthopedic injuries. Previous studies have shown that orthopedists consistently underestimate the price of implants, but their knowledge of imaging charges is unknown. This study evaluated whether orthopedic residents and faculty could accurately estimate charges of imaging modalities at their respective institutions. A survey with 10 common imaging studies was sent to 8 academic level I trauma centers. Participants estimated the total charge of each imaging modality. This was compared with the actual charge at their institution. Seven centers produced 162 responders: 74 faculty and 88 residents. The differences between the estimated cost and the billing charge were calculated and broken down by training level and imaging modality. Overall, imaging charges were underestimated by 31% (P<.001), with 19.4% of estimates being within 20% of actual charges (95% confidence interval, 19.1-19.9). There was no difference between training levels (P=.69). There was greater than 1000% variation in charges between institutions. Orthopedists across training levels underestimate hospital charges associated with common imaging studies, and there is a large variation in charges between centers. Awareness of charges is important because charges affect clinical decision making and are relevant to practicing both cost-conscious and clinically sound medicine. [Orthopedics. 2019; 42(5):e454-e459.]. [ABSTRACT FROM AUTHOR]

Background: 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).Methods: A cross-sectional study was performed at a single urban academic Level 1 trauma center for patients who sustained traumatic anterior hip dislocations from 2010-2017. Baseline demographic, injury, and treatment data were recorded. Patients were contacted to inquire about subsequent surgery and complete functional outcome questionnaires. Available post-operative radiographs were also reviewed.Results: Thirty-two anterior hip dislocations met inclusion criteria and were included in the study. 69% of dislocations were obturator dislocations and 31% iliac dislocations. Only 22% were simple dislocations with the remainder having an associated femoral head fracture and/or acetabular fracture. Iliac dislocations were more likely to be associated with acetabular fractures and require surgical treatment while obturator dislocations were more likely to be simple dislocations or have femoral head fractures. Excluding two patients treated with acute THA at the time of injury, follow-up information was available for 16 patients at a minimum of eighteen months from the time of injury. Only one required subsequent conversion to THA. For the remaining fifteen patients, modified Harris hip scores (mHHS) averaged 82.6, PROMIS global physical health averaged 51.9, and PROMIS global mental health averaged 48.3 with mean follow-up of 4.2 years. mHHS was significantly higher for obturator dislocations and a negative association was seen with age.Conclusions: 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. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study was to determine the degree of disability that geriatric patients with sacral U-type fractures experience., Methods: Patients older than 65 years presenting from 2013 to 2019 with a U-type sacral fracture were included. Patient demographics, treatment type, preinjury domicile, preinjury use of assistive devices, and neurologic deficits were recorded. Outcomes included mortality, return to preinjury domicile, and use of assistive devices for mobility., Results: Among 46 patients in the treatment period, ground-level fall was the most common mechanism of injury (60.8%). Thirty-four patients (74%) were treated surgically, most commonly with closed percutaneous fixation (n = 27). Thirteen percent of patients died during the admission. At the final follow-up, 14 (45%) had not returned to their prior domicile and 18 (58%) required more supportive assistive devices. Seventy-three percent of patients who presented delayed required a new gait aid, compared with 47% presenting acutely. Between those presenting with low-energy versus high-energy mechanisms, similar rates of need were observed for new assistive devices (50% low and 73% high) and lack of return to preinjury domicile (40% low, 50% high)., Discussion: Many geriatric patients were disabled by or died after sustaining a sacral U-type fracture, highlighting the morbidity regardless of high-energy or low-energy trauma., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)

Tibial plateau fractures are a common injury treated by orthopaedic trauma surgeons. Depression of the articular surface of the tibial plateau is often an associated injury pattern. The methods used to address depressed tibial plateau fractures can vary, as it has yet to be determined if the type of bone void filler utilized affects the long-term functional outcomes of patients with tibial plateau fractures. A 28-question survey was created to better elucidate the current practices used by orthopaedic surgeons and the factors influencing the selection of bone void fillers for treatment of these injuries. The survey was distributed online to Orthopaedic Trauma Association (OTA) members. There were 106 orthopaedic surgeons that completed the survey with a wide range of responses. The survey determined the current practice of orthopaedic surgeons varies widely when selecting bone void fillers in the treatment of depressed tibial plateau fractures. (Journal of Surgical Orthopaedic Advances 32(3):156-159, 2023).

Ankle fractures are among the most common fractures encountered by orthopaedic surgeons and, in the setting of tibiotalar instability, are usually treated surgically. Although orthopaedic surgeons from diverse educational backgrounds often feel comfortable treating such fractures, many controversies and clinical challenges remain. A detailed understanding of the unique issues presented by each patient as well as the best available treatments are required to optimize outcome. Given the unforgiving soft-tissue envelope and the particular importance of both precise reduction and absolute stability, poorly conceived and executed surgery will predictably end in compromised patient outcomes. The purpose of this manuscript is to update practicing surgeons on the best strategies for improving patient outcome after ankle fracture. The focus will be on some of the more nuanced, controversial, and complex ankle fracture-related topics, both in terms of decision making and technical execution. These will include the optimal management of posterior malleolus fractures and syndesmosis injuries as well as the best strategies to minimizing risks in poor hosts such as diabetics, obese patients, and the frail elderly. We will also provide a framework with which surgeons can approach the salvage of patients in whom the initial management has failed.