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OBJECTIVE: This American Organization of Nurse Executives study examined perceptions of staff nurses, nurse managers, and nurses in other organizational roles as part of an initiative examining CNO turnover. Here, we report findings that complete the 3-phased effort to better understand how nurse executive turnover affects the work environment and patient care. BACKGROUND: The CNO plays a key role in promoting nurse satisfaction and improving quality, safety, and effectiveness in healthcare organizations. However, little is known about the impact of nurse executive turnover on staff, managers, or patient care delivery. METHODS: An online survey was used to gather participants' views. RESULTS: Approximately 1,277 nurses employed in hospitals across the United States responded to this survey. They reported that their CNO listened and responded to staff and backed up staff in decision making, even when doing so involved conflicts with physicians. However, they also perceived that the CNO was not always visible on units and accessible to staff and had less power and authority than other top-level hospital executives in the organization. CONCLUSION: Strategies are needed to address the concerns of staff nurses and managers who are left behind when CNO turnover occurs. [ABSTRACT FROM AUTHOR]

Organizational knowledge of nurse turnover costs is important, but gathering these data frequently may not always be feasible in today's fast-paced and complex healthcare environment. The author presents a method to inflation adjust baseline nurse turnover costs using the Consumer Price Index. This approach allows nurse executives to gain current knowledge of organizational nurse turnover costs when primary data collection is not practical and to determine costs and potential savings if nurse retention investments are made. [ABSTRACT FROM AUTHOR]

This is the second article in a 2-part series focusing on nurse turnover and its costs. Part 1 (December 2004) described nurse turnover costs within the context of human capital theory, and using human resource accounting methods, presented the updated Nursing Turnover Cost Calculation Methodology. Part 2 presents an application of this method in an acute care setting and the estimated costs of nurse turnover that were derived. Administrators and researchers can use these methods and cost information to build a business case for nurse retention. [ABSTRACT FROM AUTHOR]

Objectives: To compare anterior hook plating with established fixation constructs biomechanically and report outcomes and complications in a cohort of patella fractures treated with the technique., Design: Laboratory-based biomechanical study and clinical multicenter retrospective cohort study., Setting: 2 US Level 1 trauma centers., Patients/participants: 51 patients (28 M and 23 F) with 30 simple transverse and 21 comminuted patella fractures. Thirty-six cadaveric patellae were used for the biomechanical study., Intervention: Biomechanical-dorsal plating was compared with cerclage wiring and modified tension band cable fixation in a comminuted patella fracture model in 36 cadaveric patellae. Constructs were tested at 0° and 45 degrees of flexion. Clinical-we reviewed a consecutive series of patella fractures in 2 centers for outcome and complications., Main Outcome Measurements: Biomechanical-construct stiffness. Clinical-reduction, union, complications, and range of motion., Results: Stiffness was greatest in dorsal plating at both 0° and 45 degrees. Dorsal plating (976 N, 1643 N) > modified tension band (317 N, 297 N) > cerclage (89.8 N, 150.3 N) at 0 and 45 degrees, respectively. 51 patients with patella fractures had them fixed with dorsal 2.7-mm mini fragment plates including a distal to proximal lag screw through the plate from the nose of the patella. 9 cases were small distal fragments not easily managed with screws and cables. All patients were followed up to union. There were 2 infections (1 superficial and 1 deep with nonunion), and 5 had implant removal (9.8%)., Conclusions: Dorsal plating is biomechanically and clinically superior to modified tension band and cerclage techniques in comminuted patella fractures. This method allows for fixation of small distal pole fractures., Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence., Competing Interests: The authors report no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: The main 2 forms of treatment for extraarticular proximal tibial fractures are intramedullary nailing (IMN) and locked lateral plating (LLP). The goal of this multicenter, randomized controlled trial was to determine whether there are significant differences in outcomes between these forms of treatment., Design: Multicenter, randomized controlled trial., Setting: 16 academic trauma centers., Patients/participants: 108 patients were enrolled. 99 patients were followed for 12 months. 52 patients were randomized to IMN, and 47 patients were randomized to LLP., Intervention: IMN or lateral locked plating., Main Outcome Measurements: Functional scoring including Short Musculoskeletal Functional Assessment, Bother Index, EQ-5Dindex and EQ-5DVAS. Secondary measures included alignment, operative time, range of motion, union rate, pain, walking ability, ability to manage stairs, need for ambulatory aid and number, and complications., Results: Functional testing demonstrated no difference between the groups, but both groups were still significantly affected 12 months postinjury. Similarly, there was no difference in time of surgery, alignment, nonunion, pain, walking ability, ability to manage stairs, need for ambulatory support, or complications., Conclusions: Both IMN and LLP provide for similar outcomes after these fractures. Patients continue to improve over the course of the year after injury but remain impaired even 1 year later., Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: The 2 main forms of treatment for distal femur fractures are locked lateral plating and retrograde nailing. The goal of this trial was to determine whether there are significant differences in outcomes between these forms of treatment., Design: Multicenter randomized controlled trial., Setting: Twenty academic trauma centers., Patients/participants: One hundred sixty patients with distal femur fractures were enrolled. One hundred twenty-six patients were followed 12 months. Patients were randomized to plating in 62 cases and intramedullary nailing in 64 cases., Intervention: Lateral locked plating or retrograde intramedullary nailing., Main Outcome Measurements: Functional scoring including Short Musculoskeletal Functional Assessment, bother index, EQ Health, and EQ Index. Secondary measures included alignment, operative time, range of motion, union rate, walking ability, ability to manage stairs, and number and type of adverse events., Results: Functional testing showed no difference between the groups. Both groups were still significantly affected by their fracture 12 months after injury. There was more coronal plane valgus in the plating group, which approached statistical significance. Range of motion, walking ability, and ability to manage stairs were similar between the groups. Rate and type of adverse events were not statistically different between the groups., Conclusions: Both lateral locked plating and retrograde intramedullary nailing are reasonable surgical options for these fractures. Patients continue to improve over the course of the year after injury but remain impaired 1 year postoperatively., Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Workplace violence (WPV) against nurses has a negative impact on the nurses and the care they provide. Formal reporting of WPV is necessary to understand the nature of violent incidents, develop proactive coping strategies, and provide support for nurses affected by WPV., Purpose: This study explored the relationships among nurses' WPV experiences, burnout, patient safety, and the moderating effect of WPV-reporting culture on these relationships., Methods: This descriptive cross-sectional study used secondary data collected from 1781 nurses at a large academic medical center., Results: Workplace violence increased nurse burnout, which in turn negatively affected patient safety. A strong WPV-reporting culture increased the negative effect of WPV on burnout but mitigated the negative effect of burnout on patient safety., Conclusions: The findings indicate that nurses may perceive WPV-reporting behavior as a stressor. Violence-reporting systems and procedures need to be improved to reduce the burden of reporting., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Maximal left ventricular wall thickness (MLVWT) is a risk factor for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). In adults, the severity of left ventricular hypertrophy has a nonlinear relationship with SCD, but it is not known whether the same complex relationship is seen in childhood. The aim of this study was to describe the relationship between left ventricular hypertrophy and SCD risk in a large international pediatric HCM cohort., Methods: The study cohort comprised 1075 children (mean age, 10.2 years [±4.4]) diagnosed with HCM (1-16 years) from the International Paediatric Hypertrophic Cardiomyopathy Consortium. Anonymized, noninvasive clinical data were collected from baseline evaluation and follow-up, and 5-year estimated SCD risk was calculated (HCM Risk-Kids)., Results: MLVWT Z score was <10 in 598 (58.1%), ≥10 to <20 in 334 (31.1%), and ≥20 in 143 (13.3%). Higher MLVWT Z scores were associated with heart failure symptoms, unexplained syncope, left ventricular outflow tract obstruction, left atrial dilatation, and nonsustained ventricular tachycardia. One hundred twenty-two patients (71.3%) with MLVWT Z score ≥20 had coexisting risk factors for SCD. Over a median follow-up of 4.9 years (interquartile range, 2.3-9.3), 115 (10.7%) had an SCD event. Freedom from SCD event at 5 years for those with MLVWT Z scores <10, ≥10 to <20, and ≥20 was 95.6%, 87.4%, and 86.0, respectively. The estimated SCD risk at 5 years had a nonlinear, inverted U-shaped relationship with MLVWT Z score, peaking at Z score +23. The presence of coexisting risk factors had a summative effect on risk., Conclusions: In children with HCM, an inverted U-shaped relationship exists between left ventricular hypertrophy and estimated SCD risk. The presence of additional risk factors has a summative effect on risk. While MLVWT is important for risk stratification, it should not be used either as a binary variable or in isolation to guide implantable cardioverter defibrillator implantation decisions in children with HCM.

Introduction: Acute exercise can modulate the excitability of the nonexercised upper limb representation in the primary motor cortex (M1). Measures of M1 excitability using transcranial magnetic stimulation (TMS) are modulated after various forms of acute exercise in young adults, including high-intensity interval training (HIIT). However, the impact of HIIT on M1 excitability in older adults is currently unknown. Therefore, the purpose of the current study was to investigate the effects of lower limb cycling HIIT on bilateral upper limb M1 excitability in older adults., Methods: We assessed the impact of acute lower limb HIIT or rest on bilateral corticospinal excitability, intracortical inhibition and facilitation, and interhemispheric inhibition of the nonexercised upper limb muscle in healthy older adults (mean age 66 ± 8 yr). We used single and paired-pulse TMS to assess motor evoked potentials, short-interval intracortical inhibition, intracortical facilitation, and the ipsilateral silent period. Two groups of healthy older adults completed either HIIT exercise or seated rest for 23 min, with TMS measures performed before (T0), immediately after (T1), and 30 min after (T2) HIIT/rest., Results: Motor evoked potentials were significantly increased after HIIT exercise at T2 compared with T0 in the dominant upper limb. Contrary to our hypothesis, we did not find any significant change in short-interval intracortical inhibition, intracortical facilitation, or ipsilateral silent period after HIIT., Conclusions: Our findings demonstrate that corticospinal excitability of the nonexercised upper limb is increased after HIIT in healthy older adults. Our results indicate that acute HIIT exercise impacts corticospinal excitability in older adults, without affecting intracortical or interhemispheric circuitry. These findings have implications for the development of exercise strategies to potentiate neuroplasticity in healthy older and clinical populations., (Copyright © 2021 by the American College of Sports Medicine.)

Objective: To compare immediate quality of open reduction of femoral neck fractures by alternative surgical approaches., Design: Retrospective cohort study., Setting: Twelve Level 1 North American trauma centers., Patients: Eighty adults 18-65 years of age with isolated, displaced, OTA/AO type 31-B2 or -B3 femoral neck fractures treated with internal fixation., Intervention: Thirty-two modified Smith-Petersen anterior approaches versus 48 Watson-Jones anterolateral approaches for open reduction performed by fellowship-trained orthopaedic trauma surgeons., Main Outcome: Reduction quality as assessed by 3 senior orthopaedic traumatologists as "acceptable" or "unacceptable" on AP and lateral postoperative radiographs., Results: No difference was observed in the rate of acceptable reduction by modified Smith-Petersen (81%) versus Watson-Jones (81%) approach (risk difference null, 95% confidence interval -17.4% to 17.4%, P = 1.00) with 90.4% panel agreement (Fleiss' weighted κ = 0.63, P < 0.01). Stratified analyses did not identify a significant difference in the rate of acceptable reduction between approaches when stratified by Pauwels angle, basicervical or transcervical fracture location, or posterior comminution. The Smith-Petersen approach afforded a better reduction when preoperative skeletal traction was not applied (RR = 1.67 [95% CI 1.10-2.52] vs. RR = 0.87 [95% CI 0.70-1.08], P = 0.006)., Conclusions: No difference was observed in the quality of open reduction of displaced femoral neck fractures in young adults when a Watson-Jones anterolateral approach versus a modified Smith-Petersen anterior approach was performed by orthopaedic trauma surgeons., Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence., Competing Interests: All ICMJE Conflict of Interest Forms for authors and are on file with the publication and can be viewed on request: Joseph T. Patterson: AOTrauma North America: research support. Keisuke Ishii: Naradewa: research support. C. B. Jones: Arizona Orthopaedic Society: board or committee member, Dignity Health: employee, Journal of Bone and Joint Surgery—American: Editorial or governing board, Journal of Orthopaedics and Traumatology: Editorial or governing board, Lippincott: IP royalties, Orthopaedic Trauma Association OTA—grant: Research support, OsteConcentric: Paid consultant, IP royalties, Stryker: Paid consultant; Paid presenter or speaker. R. K. Leighton: AAOS: Board or committee member, Canadian Orthopaedic Association: board or committee member, DePuy, A Johnson & Johnson Company: Other financial or material support; paid presenter or speaker, Etex: paid consultant, Smith & Nephew: other financial or material support; paid presenter or speaker, Stryker: other financial or material support; paid presenter or speaker, Synthes: paid presenter or speaker; research support, Zimmer: paid presenter or speaker. T. Miclau: AO Foundation: board or committee member, Arquos: paid consultant; stock or stock Options, Baxter: research support, Bone Therapeutics: paid consultant, Globus Medical: other financial or material support, Inman Abbott Society: board or committee member, International Combined Orthopaedic Research Societies: board or committee member, International Orthopaedic Trauma Association: board or committee member, KCI: other financial or material support, NXTSENS: paid consultant, Orthopaedic Research Society: board or committee member, Orthopaedic Trauma Association: board or committee member, Osteosynthesis and Trauma Care Foundation: board or committee member, San Francisco General Hospital Foundation: board or committee member, Stryker: other financial or material support, Surrozen: paid consultant, Synthes: paid consultant. B. H. Mullis: Indiana Orthopaedic Society: board or committee member, KCI: paid consultant, Orthopaedic Trauma Association: Board or committee member. W. T. Obremskey: Journal of Bone and Joint Surgery - American: editorial or governing board, Journal of Orthopaedic Trauma: editorial or governing board, Journal of the American Academy of Orthopaedic Surgeons: editorial or governing board, Orthopaedic Trauma Association: board or committee member, Southeastern Fracture Consortium: board or committee member. R. F. Ostrum: Bioventus: paid consultant; paid presenter or speaker, Journal of Orthopaedics and Traumatology: editorial or governing board, SLACK Incorporated: publishing royalties, financial, or material support, Wolters Kluwer Health—Lippincott Williams & Wilkins: Editorial or governing board; publishing royalties, financial, or material support. J. S. Reid: Clinical Orthopaedics and Related Research: editorial or governing board, Journal of Orthopaedics and Traumatology: editorial or governing board, Limb Lengthening and Reconstruction Society: board or committee member, ROM3 now ROMtech: Stock or stock Options, Smith & Nephew: paid consultant, Synthes: paid consultant; research support, Zimmer: research support. Andrew H. Schmidt: ActivOrtho: stock or stock options, Conventus Orthopaedics: stock or stock options, Conventus Orthopedics: paid consultant, Enova Illumination, Inc.: stock or stock options, Epien: stock or stock options, Epix VAN: stock or stock options, JBJS Essential Surgical Techniques: editorial or governing board, Journal of Knee Surgery: editorial or governing board, Journal of Orthopaedic Trauma: editorial or governing board, Abbott Medical: paid consultant (spouse), Thieme, Inc.: publishing royalties, financial or material support, Twin Star Medical: stock or stock options. David C. Teague: Journal of Orthopaedic Trauma: Editorial or governing board, Orthopaedic Trauma Association: board or committee member. P. Tornetta III: Journal of Orthopaedic Trauma: editorial or governing board, Smith & Nephew: IP royalties Wolters Kluwer Health—Lippincott Williams & Wilkins: publishing royalties, financial or material support. S. Morshed: Orthopaedic Trauma Association: board or committee member. The remaining authors report no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Purkinje fibers (PFs) control timing of ventricular conduction and play a key role in arrhythmogenesis in heart failure (HF) patients. We investigated the effects of HF on PFs., Methods: Echocardiography, electrocardiography, micro-computed tomography, quantitative polymerase chain reaction, immunohistochemistry, volume electron microscopy, and sharp microelectrode electrophysiology were used., Results: Congestive HF was induced in rabbits by left ventricular volume- and pressure-overload producing left ventricular hypertrophy, diminished fractional shortening and ejection fraction, and increased left ventricular dimensions. HF baseline QRS and corrected QT interval were prolonged by 17% and 21% (mean±SEMs: 303±6 ms HF, 249±11 ms control; n=8/7; P =0.0002), suggesting PF dysfunction and impaired ventricular repolarization. Micro-computed tomography imaging showed increased free-running left PF network volume and length in HF. mRNA levels for 40 ion channels, Ca 2+ -handling proteins, connexins, and proinflammatory and fibrosis markers were assessed: 50% and 35% were dysregulated in left and right PFs respectively, whereas only 12.5% and 7.5% changed in left and right ventricular muscle. Funny channels, Ca 2+ -channels, and K + -channels were significantly reduced in left PFs. Microelectrode recordings from left PFs revealed more negative resting membrane potential, reduced action potential upstroke velocity, prolonged duration (action potential duration at 90% repolarization: 378±24 ms HF, 249±5 ms control; n=23/38; P <0.0001), and arrhythmic events in HF. Similar electrical remodeling was seen at the left PF-ventricular junction. In the failing left ventricle, upstroke velocity and amplitude were increased, but action potential duration at 90% repolarization was unaffected., Conclusions: Severe volume- followed by pressure-overload causes rapidly progressing HF with extensive remodeling of PFs. The PF network is central to both arrhythmogenesis and contractile dysfunction and the pathological remodeling may increase the risk of fatal arrhythmias in HF patients.

Objectives: To determine the factors associated with successful union and eradication of infection in the setting of staged procedures to treat obviously infected nonunions of long bones. We hypothesize that patients with positive intraoperative cultures obtained at the time of definitive surgery for infected nonunions are more likely to have persistent nonunion than those with negative cultures., Design: Multicenter retrospective review., Setting: Eight academic Level 1 trauma centers., Patients/participants: Patients who underwent staged management for obviously infected nonunion of a long bone., Main Outcome Measurements: For each patient, initial fracture management, management of retained implants, number of debridements, grafting, bacteriology, antibiotic course, bone defect management, soft-tissue coverage, and definitive surgery performed were reviewed., Results: A total of 134 patients were treated with staged procedures for obviously infected nonunion of a long bone (mean age 49 years, 60% open fractures, and mean follow-up 22 months). During definitive procedures, 120 patients had intraoperative cultures taken with 43% having positive cultures. For culture-positive patients, 41 patients achieved eventual union and 10 had persistent nonunion. Of 69 culture-negative patients, 66 achieved eventual union and 3 had persistent nonunion. The number of patients with union versus persistent nonunion was statistically significant between culture-positive and culture-negative groups (P = 0.015)., Conclusions: Management of infected nonunion in long bones with staged treatments before definitive fixation are beneficial but ultimately less effective when performed in the setting of positive bacterial cultures at the time of definitive management., Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence., Competing Interests: The authors report no conflict of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: To compare patient admission comorbidity profiles, length of stay, readmission rate, postoperative complications, mortality rate, and cost of care between acute geriatric hip fractures (HF) and elective total hip arthroplasties (THA)., Methods: Retrospective cohort., Setting: Multicenter health care system., Patients: Eighteen thousand forty-two geriatric HF treated with operative fixation or arthroplasty and 8761 elective total hip patients were reviewed., Main Outcome Measurements: Charlson Comorbidity Index, length of stay, ICU admission, readmission rate, postoperative complications, mortality rates, and cost of care., Results: Medical comorbidities: chronic pulmonary disease, chronic kidney disease, coronary artery disease, heart failure, liver cirrhosis, and cerebrovascular disease were higher in HF patients as was mean Charlson Comorbidity Index (P < 0.001). Albumin was lower and HgbA1c higher in HF patients (P < 0.001). Average length of stay was 5.0 versus 2.6 days (P < 0.001) with 8.5% of HF patients being managed in the ICU versus 1.8% of THA patients. Readmission rates for HF and THA patients were 21.4% and 6.2%, respectively (P < 0.001). Minor and major complications were higher in the HF cohort (P < 0.001), as were 30-day (1.97% vs. 0.17%) and 1-year mortality rates (3.49% vs. 0.40%) (P < 0.001). Mean hospital cost of care was nearly 15,000 US dollars more expensive in HF patients when compared to the elective THA cohort (P < 0.001)., Conclusions: HF patients have increased comorbidity burdens, lengths of stay, ICU admissions, readmission rates, complications, mortality, and costs of care than patients with elective total hip arthroplasty. In the era of pay for quality performance, health systems must reconcile the difference between these 2 patient cohorts., Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Objectives: Describe the incidence of venous thromboembolism (VTE) in patients with pelvic and lower extremity long bone trauma in the setting of modern prophylaxis., Design: Retrospective health-system database study., Setting: Multi-center health care system., Patients: Database query from 2010 to 2017 identified 11,313 adult trauma patients who received open reduction internal fixation of pelvic, acetabular, femoral neck, or intertrochanteric fractures, or received intramedullary nailing (IMN) of the femoral or tibial shaft. Patients with incomplete prophylaxis, prior history of VTE, coagulopathy, or concomitant lower extremity fracture were excluded., Intervention: Mechanical and chemical VTE prophylaxis following pelvic or lower extremity fracture fixation., Main Outcome Measurements: VTE rates., Results: The overall VTE rate was 0.82% [0.39% deep venous thromboses (DVT); 0.43% pulmonary emboli (PE)]. By procedure, pelvic open reduction and internal fixation (ORIF) and femoral IMN had the highest VTE rates 1.70% (0.98% DVT; 0.78% PE) and 1.33% (0.75% DVT; 0.58% PE), whereas tibial IMN had the lowest incidence of VTE 0.34% (0.17% DVT; 0.17% PE). Among hip fractures, femoral neck ORIF had a VTE rate of 0.98% (0.59% DVT; 0.39% PE), whereas intertrochanteric ORIF had lower rates of 0.59% (0.20% DVT; 0.39% PE)., Conclusions: Despite adherence to modern VTEp protocols, nonpreventable VTE occur in 0.82% of pelvic and lower extremity orthopaedic trauma patients. Incidence ranged between 0.34% and 1.70% depending on injury/fixation method with the highest rate observed in pelvis ORIF followed by femoral IMN. In the era of pay for quality performance, it is important for health systems and auditing agencies to reconcile the difference between preventable and nonpreventable VTEs., Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Objectives: To determine (1) which factors are associated with the choice to perform an open reduction and (2) by adjusting for these factors, if the choice of reduction method is associated with reoperation., Design: Retrospective cohort study with radiograph and chart review., Setting: Twelve Level 1 North American trauma centers., Patients: Two hundred thirty-four adults 18-65 years of age with an isolated, displaced, OTA/AO type 31-B2 or type 31-B3 femoral neck fracture treated with internal fixation with minimum of 6-month follow-up or reoperation. Exclusion criteria were pathologic fractures, associated femoral head or shaft fractures, and primary arthroplasty., Intervention: Open or closed reduction technique during internal fixation., Main Outcome: Cox proportional hazard of reoperation adjusting for propensity score for open reduction based on injury, demographic, and medical factors. Reduction quality was assessed by 3 senior orthopaedic traumatologists as "acceptable" or "unacceptable" on AP and lateral postoperative radiographs., Results: Median follow-up was 1.5 years. One hundred six (45%) patients underwent open reduction. Reduction quality was not significantly affected by open versus closed approach (71% vs. 69% acceptable, P = 0.378). The propensity to receive an open reduction was associated with study center; younger age; male sex; no history of injection drug use, osteoporosis, or cerebrovascular disease; transcervical fracture location; posterior fracture comminution; and surgery within 12 hours. A total of 35 (33%) versus 28 (22%) reoperations occurred after open versus closed reduction (P = 0.056). Open reduction was associated with a 2.4-fold greater propensity-adjusted hazard of reoperation (95% confidence interval 1.3-4.4, P = 0.004). A total of 35 (15%) patients underwent subsequent total hip arthroplasty or hemiarthroplasty., Conclusions: Open reduction of displaced femoral neck fractures in nonelderly adults is associated with a greater hazard of reoperation without significantly improving reduction. Prospective randomized trials are indicated to confirm a causative effect of open versus closed reduction on outcomes after femoral neck fracture., Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Conducting high-quality research in hospitals can be challenging. Surveys are a cost-effective method to collect data and conduct research studies in hospitals. However, survey response rates can present a challenge to researchers. This article explores targeted techniques that can be used to maximize the survey response rates among nurses and nurse managers.

Objectives: Rapid response teams (RRTs) are one innovation previously deployed in U.S. hospitals with the goal to improve the quality of care. Sustaining RRTs is important to achieve the desired implementation outcomes, reduce the risk of program investment losses, and prevent employee disillusionment and dissatisfaction. This study sought to examine factors that do and do not support the sustainability of RRTs., Methods: The study was conceptually guided by an adapted version of the Planning Model of Sustainability. A multiple-case study was conducted using a purposive sample of 2 hospitals with high RRT sustainability scores and 2 hospitals with low RRT sustainability scores. Data collection methods included (a) a hospital questionnaire that was completed by a nurse administrator at each hospital; (b) semistructured interviews with leaders, RRT members, and those activating RRT calls; and (c) a review of internal documents. Quantitative data were analyzed using descriptive statistics; qualitative data were analyzed using content analysis., Results: Few descriptive differences were found between hospitals. However, there were notable differences in the operationalization of certain factors between high- and low-sustainability hospitals. Additional sustainability factors other than those captured by the Planning Model of Sustainability were also identified., Conclusions: The sustainability of RRTs is optimized through effective operationalization of organizational and project design and implementation factors. Two additional factors-individual and team characteristics-should be included in the Planning Model of Sustainability and considered as potential facilitators (or inhibitors) of RRT sustainability.

Objectives: To compare pain after operative versus nonoperative pelvic ring injuries with unilateral sacral fractures., Design: Prospective, multicenter, observational., Setting: Sixteen trauma centers., Patients/participants: Skeletally mature patients with pelvic ring injury and minimally displaced unilateral zone 1 or 2 sacral fractures and without anteroposterior compression injuries., Main Outcome Measurements: Pelvic displacement was documented on injury plain radiographs and computed tomography scans; a 10 point Visual Analog Scale (VAS) was used to evaluate pain was obtained in the anterior and posterior pelvic ring during the time of union (12 weeks)., Results: One hundred ninety-four patients with unilateral sacral fractures displaced less than 5 mm, mean age of 38.7, and mean Injury Severity Score of 14.5 were included. Ninety-nine percent had lateral compression injuries, and 62% were in zone 1. Seventy-four percent were treated nonoperatively. Nonoperative patients had more zone 1 fractures (71%, P = 0.004). Nonoperative patients reported mean VAS 2.7 points higher in the posterior pelvis (P = 0.01) and 1.9 points higher anteriorly (P = 0.11) 24 hours after injury compared with patients treated operatively. After 3 months, nonoperative patients reported higher VAS scores than operative patients: 4.0 versus 2.9 posteriorly (P = 0.019) and 3.2 versus 2.3 anteriorly (P = 0.035)., Conclusions: For sacrum fractures with minimal or no displacement, slight differences in the VAS were noted within 24 hours after injury or surgery, but limited differences were seen at 3 months for either operatively treated minimally or undisplaced sacrum fractures. It is unknown whether this represents clinical relevance. These differences were below the minimally important clinical difference for VAS scores for other orthopaedic conditions., Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Objectives: To evaluate unilateral sacral fractures and compare those treated operatively versus nonoperatively to determine indications for surgery., Design: Prospective, multicenter, observational study., Setting: Sixteen trauma centers., Patients/participants: Skeletally mature patients with pelvic ring injury and unilateral zone 1 or 2 sacral fractures and without anteroposterior compression injuries., Main Outcome Measurements: Injury plain anteroposterior, inlet, and outlet radiographs and computed tomography scans of the pelvis were evaluated for fracture displacement., Results: Three hundred thirty-three patients with unilateral sacral fractures and a mean age of 41 years with a mean Injury Severity Score of 15 were included. Ninety-two percent sustained lateral compression injuries, and 63% of all fractures were in zone 1. Thirty-three percent of patients were treated operatively, including all without lateral compression patterns. Operative patients were more likely to have zone 2 fractures (54%) and to have posterior cortical displacement (29% vs. 6.2%), both with P < 0.001. Over 60% of all patients had no posterior displacement. Mean rotational displacements comparing the injured side versus the intact side were no different for patients treated operatively compared with those treated nonoperatively., Conclusions: Most unilateral sacral fractures are minimally or nondisplaced. Many patients with radiographically similar fractures were treated operatively and nonoperatively by different surgeons. This suggests an opportunity to develop consistent indications for treatment., Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Objectives: To evaluate the association between the timing of hip fracture surgery with postoperative length of stay and outcomes., Design: Retrospective review using the American College of Surgeons National Surgical Quality Improvement Program database., Setting: National inquiry database incorporating 140 academic and private medical centers., Patients: Seventeen thousand four hundred fifty-nine patients who underwent surgery for a hip fracture between 2006 and 2013 were identified from the National Surgical Quality Improvement Program database., Intervention: Surgical management of hip fractures was performed at the discretion of participating surgeons., Outcome Measure: Thirty-day outcomes including postoperative length of stay, readmission rates, reoperation rates, complications, and mortality rates., Results: Of the 17,459 patients, 4107 (23.5%) were operated on within 24 hours, 8740 (50.1%) within 24-48 hours, and 4612 (26.4%) more than 48 hours after hospital admission. Increased time to surgery was associated with longer postoperative hospital length of stay. Prolonged time to surgery did not adversely affect postoperative outcomes., Conclusions: Although a delay in the management of hip fractures is associated with an increase in postoperative hospital length of stay, 30-day postoperative outcomes are not adversely affected in patients undergoing hip fracture fixation., Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Objective: To determine whether percutaneous transiliac-transsacral screw fixation improves pain, ambulation, length of stay, and the rate of disposition to home in patients with sacral fragility fractures., Design: Retrospective cohort study., Setting: Single academic Level 1 trauma center., Patients/participants: Elderly patients who presented with an isolated sacral fragility fracture between August 2015 and August 2017. Of the 41 patients included in the study, 16 were treated operatively and 25 were treated nonoperatively., Intervention: Percutaneous transiliac-transsacral screw fixation., Main Outcome Measurements: Pain, ambulation, length of stay, complications, and disposition., Results: Patients treated operatively reported a greater improvement in pain as measured by the visual analog scale (3.9 vs. 0.6 points, P < 0.001). At the time of discharge, 100% of surgically treated patients were able to ambulate compared with 72% in the nonoperative group (P = 0.03). Average distance ambulating at the time of discharge was higher in the operative group (95 vs. 35 ft, P < 0.01). Length of stay was similar between the 2 groups (3.6 days in operative group vs. 4.2 days in nonoperative group, P = 0.5). Of the patients treated operatively, 75% were discharged to home compared with only 20% in the nonoperative group (P < 0.001). There were no complications related to surgery., Conclusions: Percutaneous transiliac-transsacral screw fixation of sacral fragility fractures lessens pain, improves ambulation, and increases the rate of disposition to home. Further investigation is needed to determine if surgical fixation provides benefit regarding medium- and long-term outcome variables., Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Objectives: To compare mechanism of injury, fracture pattern, displacement, clinical, and radiographic outcome of isolated acetabular fractures (group 1) versus acetabular fractures associated with a pelvic ring injury (group 2)., Design: Retrospective cohort comparative analysis., Setting: Private orthopaedic practice associated with a level one teaching trauma center., Main Outcome Measurements: Mechanism of injury, fracture pattern, displacement and treatment, Glasgow Coma Scale, Injury Severity Score, leg length discrepancy (LLD), and hip dysplasia., Patients: Thirty-two children (group 1: 12 fractures; group 2: 25) were classified as 9 A1, 21 A3, 3 B1, 3 B2, and 1 B3 OTA/AO types. Eighteen children (22 fractures) were included with average follow-up of 33.3 months (6-84). The average age was 12.8 years (4-16)., Results: Main fracture pattern (75%) in group 1 was a posterior wall fracture (A1) caused by falls and sports in 50%. Six socket injuries had a hip dislocation, present only in group 1 (P < 0.001). The majority (84%) in group 2 had anterior wall/column (A3) fractures, caused by traffic accidents (88%). Fracture displacement in group 1 was higher than in group 2 (3.8 vs. 0.8 mm; P = 0.009). Group 2 had a lower Glasgow Coma Scale (P = 0.031) and a higher Injury Severity Score (P < 0.001). Nine (24%) fractures were treated operatively, significantly more were in group 1 (P < 0.001). Three (14%) children had complications including (LLD) (2) or hip dysplasia (2)., Conclusion: Compared with isolated pediatric acetabular fractures, fractures associated with pelvic ring injuries have less displacement and are less likely to require operative treatment, but they show more associated injuries. Because of potential hip joint growth disturbance, LLD and hip dysplasia can occur., Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Previous research suggests that the care provided to trauma patients could be improved by including early screening and management of emotional distress and psychological comorbidity. The Trauma Collaborative Care (TCC) program, which is based on the principles of well-established models of collaborative care, was designed to address this gap in trauma center care. This article describes the TCC program and the design of a multicenter study to evaluate its effectiveness for improving patient outcomes after major, high-energy orthopaedic trauma at level 1 trauma centers. The TCC program was evaluated by comparing outcomes of patients treated at 6 intervention sites (n = 481) with 6 trauma centers where care was delivered as usual (control sites, n = 419). Compared with standard treatment alone, it is hypothesized that access to the TCC program plus standard treatment will result in lower rates of poor patient-reported function, depression, and posttraumatic stress disorder.

Patients surgically treated for infection after extremity fractures are typically discharged with a 6- to 12-week antibiotic regimen. Intravenous (IV) antibiotics are associated with significant cost and potential complications of deep vein thrombosis, line clotting, and sepsis. Many of the pathogens that cause musculoskeletal infection have both oral (PO) and IV antibiotic options with adequate bioavailability and antibacterial effect, yet IV antibiotics remain the standard of care absent evidence that PO options are clinically as efficacious. The POvIV study is a prospective, multicenter, randomized trial to compare PO with IV antibiotic therapy in patients with postoperative wound infections after extremity fractures. Patients between the ages of 18 and 84 who have a culture-positive surgical site infection after internal fixation for fracture repair or arthrodesis are approached for this study, and if they provide consent, are randomly assigned to receive either PO or IV antibiotics. Antibiotic selection is based on culture and sensitivity results. Randomization determines the route of administration. Patients are followed for 1 year after study enrollment. This study will be the largest prospective randomized trial to evaluate the safety and effectiveness of PO antibiotic use for treatment of postoperative wound infections. Results will inform clinician decisions on antibiotic delivery in patients with postoperative wound infections.

Neuroimaging evidence suggests that human Brodmann area 5 (BA5) within the superior parietal lobule contributes to movement planning. However, a causal role for the contribution of BA5 to preparatory processes has yet to be reported. We used paired-pulse transcranial magnetic stimulation to investigate the influence of human BA5 on corticospinal excitability during movement preparation in the context of a GO/NO-GO task. Functional connectivity between BA5 and the ipsilateral primary motor cortex (M1) was investigated by probing corticospinal output to the first dorsal interosseous muscle of the right hand. Results indicate that BA5 influences M1 during movement preparation in a task-specific manner: motor-evoked potentials are suppressed in the context of a NO-GO versus GO task. These findings provide evidence that human BA5 participates in movement preparation and differentiates between whether a movement is withheld or executed.

Objective: Review the impact of unexpected positive cultures from definitive surgery for nonunion regarding postoperative treatment and ultimate result., Designs: Retrospective multicenter case series., Setting: Three level-one trauma centers., Patients: Six-hundred sixty-six consecutive nonunions were treated during the study period. Four-hundred fifty-three cases (68%) were considered at risk for indolent infection (prior open fracture, surgery, or infection) and had cultures taken at the time of definitive surgery., Intervention: Intraoperative cultures during definitive operative treatment of nonunions., Main Outcome Measurement: The incidence of "surprise" positive cultures was determined, and the course of the patients was documented including the use of antibiotics, surgery performed, and the outcome regarding infection and union., Results: Ninety-one (20%) cases had a surprise positive culture despite negative inflammatory markers. Most of bacteria isolated from the cultures were Staphylococcus species. Eight (9%) of the ninety-one cultures were considered probable contaminants and no antibiotics were given, 5 of these patients healed. The other 83 patients were treated with antibiotics, initially 66 (80%) healed and 12 (14%) remained infected. Eighty-two percent of patients with augmentation healed as compared with 86% of those not grafted., Conclusions: The treatment of nonunions is challenging, and in patients with a history of surgery or open fracture, we found that 20% had positive intraoperative cultures from the definitive surgery. We recommend intraoperative cultures for all patients undergoing revision surgery. The use of culture-specific antibiotics is justified based on the overall low rate of infection in this complex population and the high rate of chronic infection (25%) for those treated as contaminants. Patients may be counseled that a positive culture after nonunion surgery is a treatable problem but does increase the risk of infection and additional surgery as compared with those with a negative intraoperative culture., Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Objectives: The purpose of this study was to determine the incidence and pattern of the knee injury associated with acetabular fractures., Design: Retrospective cohort study., Setting: Three level I and one level II trauma centers., Patients: A total of 1273 skeletally mature patients treated at 4 trauma centers between November 2004 and December 2013 for acetabular fractures were retrospectively identified from orthopaedic trauma databases., Intervention: Analysis of all acetabular fractures with knee injury regarding type of acetabular fracture, mechanism of injury, energy of injury, pattern of the knee injury, knee examination findings at initial presentation, intraoperative and on follow-up, requirement for surgery/conservative management, and the associated injuries. The clinical data entered during inpatient stay and office visits were analyzed., Main Outcome Measures: Incidence and pattern of the knee injury., Results: One hundred ninety-three of 1273 patients (15%) were found to have ipsilateral knee symptoms within a period of 1 year from the date of injury. The patterns of knee injury included 56 fractures (29%), 49 ligamentous lesions (25%), and 88 miscellaneous (46%) causes including bone bruises, wounds, and swelling. Associated injuries included 85 patients with ipsilateral hip dislocation (45%), 59 pelvic injuries (31%), 61 extremity injuries (32%), 38 head injuries (20%), 37 chest injuries (20%), 23 abdominal and genitourinary injuries (12%), and 7 injuries of the spine (4%)., Conclusion: Based on this study, we conclude that knee injuries associated with high-energy acetabular fractures constitute a significant portion of the patient population. Ligament injuries are frequently overlooked and thorough clinical evaluation and utilization of magnetic resonance imaging in selected cases will help in early detection and prevention of long-term complications., Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Objective: To characterize the timing, indications, and "success rates of secondary interventions, dynamization and exchange nailing, in a large series of tibial nonunions" (dynamization and exchange nailing are types of secondary interventions)., Setting: Retrospective multicenter analysis from level 1 trauma hospitals., Patients: A total of 194 tibia fractures that underwent dynamization or exchange nailing for delayed/nonunion., Intervention: Records and radiographs to characterize demographic data, fracture type, and cortical contact after tibial nailing were gathered. The radiographic union score for tibias (RUST) and the timing of intervention and time to union were calculated., Main Outcome Measures: The primary outcome was success of either intervention, defined as achieving union, with the need for further intervention defining failure. Other outcomes included RUST scores at intervention and union, and timing to intervention and union for both techniques. Two-tailed t tests and Fisher exact with P set at <0.05 for significance were used as indicated., Results: A total of 194 tibia fractures underwent dynamization (97) or exchange nailing (97). No statistical differences were found between groups with demographic characteristics. The presence of a fracture gap (P = 0.01) and comminuted fractures (P = 0.002) was more common in the exchange group. The success rates of the interventions and RUST scores were not different when performed before versus after 6 months; therefore, data were pooled. The RUST scores at the time of intervention were not different for successful or failed dynamizations (7.13 vs. 7.07, P = 0.83) or exchanges (6.8 vs. 7.3, P = 0.37). Likewise, the time to successful versus failed dynamization (165 vs. 158 days, P = 0.91) or exchange nailing (224 vs. 201 days, P = 0.48) was not different. No cortical contact or a gap was a statistically negative factor for both exchange nails (P = 0.09) and dynamizations (P = 0.06). When combined, the success in the face of a gap was 78% versus 92% when no gap was present (P = 0.02)., Conclusions: Previous literature has few reports of the success rates of secondary interventions for tibial nonunions. The indications for dynamization and exchange were similar. Comminuted fractures, and fractures with no cortical contact or "gap" present after intramedullary nailing, favored having an exchange nail performed over dynamization. Fracture gap was also found to be a negative prognostic factor for both procedures. Overall, this study demonstrates high rates of union for both interventions, making them both viable options., Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Objective: To evaluate the effect of syndesmotic disruption on the functional outcomes of Weber B, SE4 ankle fractures treated operatively., Setting: Multicenter trauma hospitals., Patients: Data were prospectively gathered during a previous, multicenter randomized trial including 242 patients (136 women, 106 men) from 9 trauma centers with operatively treated Weber B SE4 ankle fractures. There were 81 patients (35%) with syndesmotic instability confirmed intraoperatively after fibula fixation., Intervention: Functional evaluations were performed postoperatively at 6, 12, 26, and 52 weeks. The presence of symptomatic hardware and peroneal tendon discomfort was evaluated with 9-12 months of follow-up., Main Outcome Measures: Functional outcomes evaluated included Short Musculoskeletal Function Assessment (SMFA), Bother index, and American Orthopaedic Foot and Ankle Society (AOFAS) scores. The recovery curve of the 2 groups was analyzed using a mixed linear regression analysis for repeated measures and included gender and race in the model. Symptomatic hardware and peroneal tendon discomfort were compared between the 2 groups with a χ analysis., Results: The adjusted mean linear regression analyses demonstrated that patients without a syndesmotic injury had better functional outcomes for some outcome measures. SMFA scores at 12 weeks were statistically lower in patients without syndesmotic injury (P = 0.02), but not at other visits. AOFAS scores were significantly higher (P = 0.0006), and Bother index trended toward lower results (P = 0.07) in patients without syndesmotic injury at all time points. Isolated analyses (T-tests) at 1 year demonstrated a difference in the SMFA (P = 0.04) and Bother index (P = 0.05), but not the AOFAS (P = 0.21). Men consistently demonstrated better recovery than women for all outcomes, whereas race was not significant for any measure. Symptomatic hardware and peroneal tendon irritation was not statistically different between the groups., Conclusions: The recovery curves after ankle fractures were different based on syndesmotic injury. However, the difference was at the limit of clinical significance. Syndesmotic injury has a slightly detrimental effect on outcomes of operatively treated Weber B SE4 fractures., Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Objectives: To determine outcomes in the treatment of distal tibial fractures treated with intramedullary nails., Design: Retrospective analysis., Setting: Level I trauma center with follow-up in a private orthopaedic practice., Main Outcome Measurements: Radiographic determination of alignment, nonunion, and malunion, clinical outcome (range of motion, and implant-associated complaints), wound complications, and fibular fixation., Patients: A total of 105 patients with OTA/AO type A and C tibial fractures (<11 cm from the joint line) treated with intramedullary nailing., Results: Distance of the fracture from the joint line averaged 6.1 cm (range, 0-11). Mean follow-up was 25.6 months (range, 12-74). Nonunion occurred in 20 (19%) fractures and were significantly associated with open fractures (P = 0.012), wound complications (P < 0.001), and the need for fibular fixation (P = 0.007). Sagittal plane alignment averaged 2.5 degrees (±4.4) valgus. Malunion occurred in 25 (23.8%) fractures and again were significantly associated with open fractures (P = 0.045). Fifty (47.6%) patients had implant-related pain, which resolved in 27 (54.0%) after removal., Conclusions: Intramedullary nailing of distal tibial fractures is a suitable treatment option. Acceptable alignment and range of motion can be achieved. Both nonunions and malunions were significantly associated with open fractures, wound complications, and fibular fixation. Implant removal was needed in 25% of cases., Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Objectives: What is the return to function after an isolated proximal humerus or tibial plafond fracture?, Design: Prospective observational., Setting: Orthopaedic outpatient clinics., Patients/participants: Consecutive patients were enrolled with isolated proximal humerus (N = 155) and tibial plafond fractures (N = 120)., Intervention: None., Main Outcome Measurements: Musculoskeletal Function Assessment., Results: Patients who sustained isolated proximal humerus or tibial plafond fractures showed gradual improvement over 1 year. Women consistently demonstrated greater dysfunction than men at 6, 9, and 12 months after tibial plafond fracture. Age had an impact on return to function after injury for both fractures. Younger patients (18-29 years) with either type of injury tended to have better scores compared with the older patients., Conclusions: Detailed analysis of this data demonstrates variation in patient-based outcomes during recovery from a proximal humerus or tibial plafond fracture. These data need to be reviewed in the context of the individual patient when following a patient's recovery., Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Objective: The aim of this study was to examine current research related to nurse fatigue and identify effective prevention strategies., Background: Work-related fatigue negatively affects patient safety and nurses' well-being and increases employer costs. Preventing fatigue and minimizing its negative consequences require knowledge of the contributing factors if effective interventions are to be designed and implemented., Methods: This review targeted original research (2002-2013) examining fatigue among nurses working in acute care settings., Results: Nurses experience high rates of fatigue. Shifts longer than 12 hours contribute to increased fatigue and errors, but the evidence was inconsistent with regard to age and fatigue level. Individual lifestyle, unit culture, and organization policies influence the prevalence and intensity of work-related fatigue., Conclusions: Preventing work-related fatigue requires multifaceted approaches involving the organization, the clinical unit, and the individual.

Currently, the market for orthopaedic trauma surgeons is varied. The market consists of university employed, university private, medical group employed, medical group private, private employed, private contracted, and private. Each option has its positives and negatives. The orthopaedic trauma surgeon needs to determine which setting is appropriate for his/her given needs and wants. An experienced mentor(s) is invaluable for advice and guidance. The surgeon then needs to find an administrative leader to initiate, implement, and evaluate certain processes to succeed.

Objectives: To determine the reliability of the Orthopaedic Trauma Association (OTA) Open Fracture Classification., Design: Video-based reliability study., Setting: Orthopedic meetings and grand rounds., Patients/participants: Orthopedic surgeons., Intervention: None., Main Outcome Measurements: Interobserver reliability assessment classification., Results: The results demonstrate the system to have high reliability and much improvement compared with published Gustilo-Anderson classification reliability studies. Overall interrater reliability (κ) values were highest for arterial injury, with near perfect agreement across all raters and within each value. Skin injury, bone loss, and contamination demonstrated moderate to substantial levels of agreement. Muscle injury had the most disagreement between raters but still demonstrating a fair level of interrater agreement, which is a level of agreement superior to the literature related to the Gustilo-Anderson classification. Levels of agreement were similar between attending surgeons and residents for all categories., Conclusions: This study, which included a diverse multicenter multinational cohort of orthopaedic surgeons and residents, of the OTA Open Fracture Classification demonstrated moderate to excellent interobserver reliability.

Objectives: To evaluate the outcome of operatively treated unstable displaced diaphyseal clavicle fractures with anterior-inferior 2.7-mm dynamic compression plate (DCP) fixation., Design: Retrospective review of clavicle fractures., Setting: Level-1 trauma teaching center., Patients/participants: One hundred twenty-nine clavicle fractures., Intervention: An anterior-inferior approach to clavicle fractures was used with the application of a 2.7-mm DCPs., Main Outcome Measurement: Radiographic assessment of healing and complication rates., Results: One hundred twenty-five fractures healed (97%). Postoperative complications included 1 superficial wound problem, 3 deep wound problems, 5 nonunions, and 4 prominent implants requiring removal in 3., Conclusions: Anterior-inferior placement of 2.7-mm DCPs seems safe and is associated with minimal complications., Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.