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Drains are used in plastic surgery to remove excess fluid while ameliorating complications. However, there is a paucity of evidence supporting guiding parameters on when to discontinue a drain. The aim of our study was to determine whether two of the most common parameters, drain volume 24 hours before removal or postoperative day, are valid indicators for drain removal.A retrospective chart review was conducted for surgical operations performed by our division between July 2014 and May 2019. Of the 1308 patients, 616 had a drain and a complete record. Demographics, medical history, operative time, antibiotic use, anatomic site, donor/recipient, and complication type were recorded. Complications were defined as events that deviated from expected postoperative course or required pharmacological/procedural intervention.In total, 544 patients were in the no complication group, and 72 were in the complication group. The complication group patients had drains removed later than patients in the no complication group (15.7 days versus 12.5 days,Our data suggest neither postoperative day nor 24-hour volume before drain removal are valid indicators for removal. Late removal correlates with more complications; however, persisting output leading to later removal may be predictive of an impending complication rather than delays in drain removal causing the complication.

Category: Trauma; Ankle Introduction/Purpose: Intramedullary fixation of the distal fibula in unstable ankle fractures provides an alternative treatment strategy to traditional techniques and may reduce the complication profile. While often reserved for soft-tissue protection or elderly patients, the indications for this technique continue to expand. The purpose of this study was to evaluate the radiographic outcomes of ankle fractures treated with intramedullary fixation of the distal fibula with screw or flexible fixation of the syndesmosis. Methods: A retrospective case-series was performed of patients >18 years old with unstable ankle fractures treated at a single institution. Patients were treated with intramedullary fixation of the distal fibula and screw or suture-button fixation of the syndesmosis if indicated. Radiographic parameters measured included the medial clear space, tibiofibular overlap, tibiofibular clear space, talocrural angle, and fracture displacement. Fracture pattern, comorbidities, and postoperative complications were also assessed. Results: Fourteen patients (6 males, 8 females) with torsional ankle fractures (71% SER-IV patterns) were included in the study with a mean follow-up period of 5 months. Five patients had suture-button fixation and one patient had trans-syndesmotic screw fixation of the syndesmosis. All patients had improvement in radiographic parameters following surgical stabilization. Medial clear space decreased from a mean of 5.6 +- 3.1mm to 2.8 +- 0.79mm (pConclusion: This case-series demonstrates the successful use of intramedullary fixation of distal fibula fractures in unstable ankle injuries with good radiographic and clinical outcomes. The use of an intramedullary device does not preclude trans-syndesmotic screw or suture-button fixation of concomitant syndesmotic injuries. Orthopedic surgeons can consider this treatment strategy as an alternative to traditional techniques.

Intertrochanteric (IT) femur fractures are common injuries with an estimated incidence of more than 400,000 annually in the United States.[1] IT fractures can be classified as “stable” or “unstable,” and this classification implies that implant selection for stabilization affects the success of fixation.[2,3] Failures after fixation include fracture shortening, peri-implant fracture, implant cutout, nonunion, and varus collapse. Although failure of IT fracture fixation is uncommon, improper implant selection or unfavorable fracture patterns, especially when combined with poor bone quality, leads to more frequent failures.[4] Revision fixation, with or without bone grafting or osteotomy, has good outcomes in younger patients, but has high complication and failure rates for elderly patients.[5] Hip arthroplasty for older patients is available as a salvage procedure with improved pain and mobility scores but has a complication rate as high as 47%.[6–8] Given that primary treatment failures lead to high morbidity in geriatric patients, increased understanding of the fracture patterns may improve these patients’ outcomes by reducing predictable implant-associated failures. “Stable” IT fracture patterns have a fracture obliquity that compresses with physiologic loading and requires a lateral wall of the femoral shaft that will buttress the proximal fracture fragment if it settles.[9,10] Therefore, correct assessment of the morphology of the lateral wall is critical. Lateral wall morphology has taken on such importance that in 2018 the AO/OTA Fracture and Dislocation Compendium was updated for pertrochanteric femur fractures.[11] The differentiation between groups 31A1 and 31A2 is now defined by the lateral wall height (LWH) or thickness (LWT). The LWT is defined as the distance in millimeters measured from a reference point 3 cm below the innominate tubercle of the greater trochanter and angled 135° upward to the fracture line on the plain film anteroposterior radiograph. That radiograph is ideally a traction view with the leg in neutral rotation, which is not the typical image that is obtained in the emergency room. 31A2 fractures are defined as having a lateral wall thickness of less than 20.5 mm and are classified as “unstable.”[12,13] Radiographic assessment of the lateral wall on plain images, even with a traction view (a source of patient discomfort and not routinely obtained), can be difficult, unreliable, and misleading compared with assessment using a CT scan.[14–16] At our institution, many hip fractures get a CT scan of their pelvis and abdomen as part of their initial assessment by the general surgery trauma service. We use the CT to help assess lateral wall integrity, determine fracture stability, and guide implant selection. To do this, we developed novel CT measurements to quantify the morphology of the lateral wall. We hypothesized that CT measurements of the lateral wall (LWA) are more accurate than plain x-ray radiograph measurements, can better classify fractures as stable or unstable, and are predictive of failure when a SHS is used.