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Background: Bicondylar tibial plateau fractures pose many treatment challenges due to their complex fracture patterns and associated soft tissue compromise. We aim to evaluate outcomes of acute ORIF (aORIF) versus staged ORIF (sORIF) of high energy bicondylar tibial plateau fractures. Methods: We retrospectively reviewed 186 patients at two high-volume Level I trauma centers. One hundred one patients underwent aORIF and 85 underwent sORIF between 2011 and 2019. Clinical outcomes of interest included operative time, wound dehiscence, superficial and deep infection, nonunion, flap coverage, arthrodesis, and early conversion to arthroplasty. Results: Patients had a median follow up of 12 months (6–98 months). The sORIF group had a higher ISS (p = 0.02) and a higher rate of open fractures (24.7% vs 11.9%, p = 0.03). The groups were statistically similar in other demographics and co-morbidities. Operative time was significantly shorter in the aORIF group (157 vs 213 min., p < 0.001). There was no statistical difference in wound dehiscence, deep infection, flap coverage, nonunion, unplanned reoperation, or post-traumatic arthritis between groups. However, aORIF was associated with a significantly lower rate of superficial infection (p = 0.01), arthroplasty (p = 0.003) and unplanned reoperation (p = 0.005). Subgroup analysis of only the 41C3 fractures showed a lower rate of superficial infections in the aORIF group (p = 0.04). No difference in complications was found between the fracture subgroups. Conclusion: We found no increased risk of complications with aORIF compared to sORIF for bicondylar tibial plateau fractures. While not all injuries may be appropriate for aORIF, our results demonstrate the safety of aORIF when patients are properly selected by experienced fracture surgeons. Level of evidence: Level III. [ABSTRACT FROM AUTHOR]

Study Design: Review article., Objective: To provide a comprehensive review and update on the evaluation and management of Hangman's fractures., Summary of Background Data: Hangman's fractures are the second most common fracture of the C2 vertebrae, and the prevalence is increasing with our aging population. Although these injuries are associated with good clinical outcomes and low rates of neurologic injury, they must be promptly recognized and treated according to patient and fracture factors., Methods: A review of the literature., Results: Neurologic injuries are uncommon in typical Hangman's fractures but are more of a concern in atypical Hangman's fractures due to lack of dissociation of the posterior ring of C2. The nonoperative treatment of stable type I, II, and atypical fractures with external immobilization leads to excellent long-term outcomes as does the operative treatment of unstable type IIa, III, and atypical fractures., Conclusions: Stable injury patterns can be treated with immobilization alone, whereas unstable injury patterns necessitate surgical treatment. Prompt diagnosis and treatment Hangman's fractures is paramount, and when managed properly, patients can have excellent clinical and neurologic outcomes., Competing Interests: B.L. reports participation in the Medtronic Biologics advisory board for spine related-fusion technologies. The remaining authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Study Design: A retrospective review., Objective: The purpose of this study is to trend PROMIS PF scores following lumbar fusion surgery, and to investigate how the presence of functional comorbidities affects PROMIS PF scores. Additionally, we compare trends in PROMIS PF scores to the Oswestry Disability Index (ODI) and to PROMIS Pain Interference (PI) scores., Summary of Background Data: National Institute of Health's (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) domain has been validated in spine surgery. However, little is known about how PROMIS-PF scores are affected by functional comorbidities and how these scores change in patients recovering from lumbar fusion surgery over time. In this study, we hypothesize that functional comorbidities negatively affect recovery., Methods: We retrospectively identified 1,893 patients who underwent thoracolumbar, lumbar, or lumbosacral fusion for degenerative conditions between 01/02/2014 and 01/07/2022. We summarized PF at 3-month intervals for 2 years following surgery between those with and without functional comorbidity, defined as the presence of congestive heart failure (HF), chronic obstructive pulmonary disease (COPD), cerebrovascular disease (CVD), or paraplegia. Mixed effects multivariable regressions were used to model between group trends in PF through 2 years post-operatively controlling for age, gender, indication, and surgical invasiveness. The minimally clinically important difference (MCID) was defined as 5+ point improvement from baseline in PF., Results: The cohort includes 1,224 (65%) patients without functional comorbidity and 669 (35%) with functional comorbidity. The mean age was 65.0 and Charlson index was 1.0 in the cohort without functional comorbidity compared to 65.4 and 3.8 in the cohort with functional comorbidity (P=0.552 and P<0.001 respectively). The groups were otherwise similar with respect to surgical invasiveness index, vertebral levels, and spine diagnosis (all P>0.05). At 24 months post operatively, the functional comorbidity group had a 2.5 point lower absolute PF score and a 1.3 point less improvement from baseline (P=0.012 and 0.190 respectively). 19.3% of patients in the functional comorbidity group achieved the MCID compared to 80.9% in patients without a functional comorbidity (P<0.001)., Conclusion: Based on PROMIS PF scores, patients with functional comorbidities do not recover to the same extent and are less likely to achieve an MCID compared to patients without baseline functional comorbidities. PROMIS-PF can help benchmark patients along their recovery, and other metrics may be needed to better understand the recovery of patients with functional comorbidities., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: To compare the likelihood of spiral fracture of the humerus using torsional load to failure after intraosseous biceps tenodesis at the position of the arthroscopic suprapectoral tenodesis versus the subpectoral meta-diaphyseal location., Methods: Eight matched pairs of humeri were dissected. Unicortical tenodesis holes were drilled, either at the bottom of the bicipital groove (group 1) or just below the pectoralis major tendon insertion (subpectoral) in the humeral diaphysis (group 2). Tenodesis was performed in a 7-mm bone tunnel, with suture fixation distal to this site using 2 separate 2-mm holes, secured with No. 2 polyester suture. Each humerus was potted in plaster and mounted to a hydraulic torsional load frame, consistent with previously validated models for creating humeral spiral fractures. External rotation torque was applied to each humerus distally until fracture occurred. The paired t test was used to compare the 2 groups., Results: Fracture occurred at the subpectoral cortical drill hole in all 8 specimens in group 2. In group 1, only 2 fractures occurred through the tenodesis hole, with spiral fracture resulting in the diaphysis of the humerus in 6 of 8 specimens. Average torque to failure measured 31.35 Nm in group 1 and 25.08 Nm in group 2; the difference was statistically significant ( P < .0001)., Conclusions: Subpectoral cortical drill holes for biceps tenodesis were shown to be a stress riser for humeral spiral fracture. Suprapectoral cortical drill holes were shown to be significantly less of a stress riser. The amount of torque required to fracture the humerus through the subpectoral drill holes was less than with the suprapectoral drill holes. Only 2 fractures occurred through the suprapectoral tenodesis holes, and significantly more torque was required to create these fractures., Clinical Relevance: Clinically, the difference between suprapectoral and subpectoral tenodesis fracture potential should be considered when selecting a tenodesis location., (© 2020 by the Arthroscopy Association of North America. Published by Elsevier Inc.)