Aims

Isolated fractures of the ulnar diaphysis are uncommon, occurring at a rate of 0.02 to 0.04 per 1,000 cases. Despite their infrequency, these fractures commonly give rise to complications, such as nonunion, limited forearm pronation and supination, restricted elbow range of motion, radioulnar synostosis, and prolonged pain. Treatment options for this injury remain a topic of debate, with limited research available and no consensus on the optimal approach. Therefore, this trial aims to compare clinical, radiological, and functional outcomes of two treatment methods: open reduction and internal fixation (ORIF) versus nonoperative treatment in patients with isolated ulnar diaphyseal fractures.

Acute Compartment Syndrome (ACS) is an orthopaedic emergency that can develop after a wide array of etiologies. In this pilot study the MY01 device was used to assess its ease of use and its ability to continuously reflect the intracompartmental pressure (ICP) and transmit this data to a mobile device in real time. This preliminary data is from the lead site which is presently expanding data collection to five other sites as part of a multi-center study.

Patients with long bone trauma of the lower or upper extremity posing a possibility of developing compartment syndrome were enrolled in the study. Informed consent was obtained from the patients. A Health Canada licensed continuous compartmental pressure monitor (MY01) was used to measure ICP. The device was inserted in the compartment that was deemed most likely to develop ACS and ICP was continuously measured for up to 18 hours. Fractures were classified according to the AO/OTA classification. Patient clinical signs and pain levels were recorded by healthcare staff during routine in-patient monitoring and were compared to the ICP from the device. Important treatment information was pulled from the patient's chart to help correlate all of the patient's data and symptoms.

The study period was conducted from November 2020 through December 2021. Twenty-six patients were enrolled. There were 17 males, and nine females. The mean age was 38 years (range, 17–76). Seventeen patients received the device post-operatively and nine received it pre-operatively. Preliminary results show that post-operative ICPs tend to be significantly higher than pre-operative ICPs but tend to trend downwards very quickly. The trend in this measurement appears to be more significant than absolute numbers which is a real change from the previous literature. One patient pre-operatively illustrated a steep trend upwards with minimal clinical symptoms but required compartment release at the time of surgery that exhibited no muscle necrosis. The trend in this patient was very steep and, as predicted, predated the clinical findings of compartment syndrome. This trend allows an early warning signal of the absolute pressure, to come, in the compartment that is being assessed by the device.

Preliminary results suggest that this device is reliable and relatively easy to use within our institutions. In addition it suggests that intracompartmental pressures can be higher immediately post-op but lower rapidly when the patient does not develop ACS. These results are in line with current literature of the difference between pre and post-operative baselines and thresholds of ICP, but are much more striking, as continuous measurements have not been part of the data set in most of past studies.

Further elucidation of the pressure thresholds and profiles are currently being studied in the ongoing larger multicenter study and will add to our understanding of the critical values. This data, plus the added value of continuous trends in the pressure, upwards or downwards, will aid in preventing muscle necrosis during our management of these difficult long bone fractures.

The management of periprosthetic distal femur fractures is an issue of increasing importance for orthopaedic surgeons. Because of the expanding indications for total knee arthroplasty (TKA) and an aging population with increasingly active lifestyles there has been a corresponding increase in the prevalence of these injuries. The management of these fractures is often complex because of issues with obtaining fixation around implants and dealing with osteopenic bone or compromised bone stock. In addition, these injuries frequently occur in frail, elderly patients, and the early restoration of function and ambulation is critical in these patients. There remains substantial controversy with respect to the optimal treatment of periprosthetic distal femur fractures, with some advocating for Locked Plating (LP), others Retrograde Intramedullary Nailing (RIMN) and finally those who advocate for Distal Femoral Replacement (DFR). The literature comparing these treatments, has been infrequent, and commonly restricted to single-center studies. The purpose of this study was to retrospectively evaluate a large series of operatively treated periprosthetic distal femur fractures from multiple centers and compare treatment strategies.

Patients who were treated operatively for a periprosthetic distal femur fracture at 8 centers across North America between 2003 and 2018 were retrospectively identified. Baseline characteristics, surgical details and post-operative clinical outcomes were collected from patients meeting inclusion criteria. Inclusion criteria were patients aged 18 and older, any displaced operatively treated periprosthetic femur fracture and documented 1 year follow-up. Patients with other major lower extremity trauma or ipsilateral total hip replacement were excluded. Patients were divided into 3 groups depending on the type of fixation received: Locked Plating, Retrograde Intramedullary Nailing and Distal Femoral Replacement. Documented clinical follow-up was reviewed at 2 weeks, 3 months, 6 months and 1 year following surgery. Outcome and covariate measures were assessed using basic descriptive statistics. Categorical variables, including the rate of re-operation, were compared across the three treatment groups using Fisher Exact Test.

In total, 121 patients (male: 21% / female: 79%) from 8 centers were included in our analysis. Sixty-seven patients were treated with Locked Plating, 15 with Retrograde Intramedullary Nailing, and 39 were treated with Distal Femoral Replacement. At 1 year, 64% of LP patients showed radiographic union compared to 77% in the RIMN group (p=0.747). Between the 3 groups, we did not find any significant differences in ambulation, return to work and complication rates at 6 months and 1 year (Table 1). Reoperation rates at 1 year were 27% in the LP group (17 reoperations), 16% in the DFR group (6 reoperations) and 0% in the RIMN group. These differences were not statistically significant (p=0.058).

We evaluated a large multicenter series of operatively treated periprosthetic distal femur fractures in this study. We did not find any statistically significant differences at 1 year between treatment groups in this study. There was a trend towards a lower rate of reoperation in the Retrograde Intramedullary Nailing group that should be evaluated further with prospective studies.

For any figures or tables, please contact the authors directly.

Distracted driving is now the number one cause of death among teenagers in the United States of America according to the National Highway Traffic Safety Administration. However, the risks and consequences of driving while distracted spans all ages, gender, and ethnicity. The Distractions on the Road: Injury eValuation in Surgery And FracturE Clinics (DRIVSAFE) Study aimed to examine the prevalence of distracted driving among patients attending hospital-based orthopaedic surgery fracture clinics. We further aimed to explore factors associated with distracted driving.

In a large, multi-center prospective observational study, we recruited 1378 adult patients with injuries treated across four clinics (Hamilton, Ontario, Toronto, Ontario, Calgary, Alberta, Halifax, Nova Scotia) across Canada. Eligible patients included those who held a valid driver's license and were able to communicate and understand written english. Patients were administered questions about distracted driving. Data were analyzed with descriptive statistics.

Patients average age was 45.8 years old (range 16 – 87), 54.3% male, and 44.6% female (1.1% not disclosed). Of 1361 patients, 1358 self-reported distracted driving (99.8%). Common sources of distractions included talking to passengers (98.7%), outer-vehicle distractions (95.5%), eating/drinking (90.4%), music listening/adjusting the radio (97.6%/93.8%), singing (83.2%), accepting phone calls (65.6%) and daydreaming (61.2%). Seventy-nine patients (6.3%), reported having been stopped by police for using a handheld device in the past. Among 113 drivers who disclosed the cause of their injury as a motor vehicle crash (MVC), 20 of them (17%) acknowledged being distracted at the time of the crash. Of the participants surveyed, 729 reported that during their lifetime they had been the driver in a MVC, with 226 (31.1%) acknowledging they were distracted at the time of the crash.

Approximately, 1 in 6 participants in this study had a MVC where they reported to be distracted. Despite the overwhelming knowledge that distracted driving is dangerous and the recognition by participants that it can be dangerous, a staggering amount of drivers engage in distracted driving on a fairly routine basis. This study demonstrates an ongoing need for research and driver education to reduce distracted driving and its devastating consequences.

The benefit of using a long intramedullary device for the treatment of geriatric intertrochanteric hip fractures is unknown. The InterTAN device (Smith and Nephew, Memphis TN) is offered in either Short (180–200 mm) or Long (260–460 mm) constructs and was designed to provide stable compression across primary intertrochanteric fracture fragments. The objective of our study was to determine whether Short InterTANs are equivalent to Long InterTANs in terms of functional and adverse outcomes for the treatment of geriatric intertrochanteric hip fractures.

108 patients with OTA classification 31A–1 and 31A–2 intertrochanteric hip fractures were included in our study and prospectively followed at one of four Canadian Level-1 Trauma Centres. Our primary outcomes included two validated primary outcome measures: the Functional Independence Measure (FIM), to measure function, and the Timed Up and Go (TUG), to measure motor performance. Secondary outcome measures included blood loss, length of procedure, length of stay and adverse events. A pre-injury FIM was measured by retrospective recall and all postoperative outcomes were assessed on postoperative day 3, at discharge, at 6 weeks, 3 months, 6 months and 12 months postoperatively. Unpaired t-tests and Chi-square tests were used for the comparison of continuous and categorical variables respectively between the Short and Long InterTAN groups. A statistically significant difference was defined as p<0.05.

Our study included 71 Short InterTAN and 37 Long InterTAN patients with 31A–1 and 31A–2 intertrochanteric hip fractures. Age, sex, BMI, side, living status and comorbidities were similar between the two groups. The mean operative time was significantly lower in the Short InterTAN group (61 mins) as compared to the Long InterTAN group (71 mins)(p0.05). There were 5 periprosthetic femur fractures in the short InterTAN group versus 1 in the long InterTAN group. Non-mechanical adverse outcomes such as myocardial infarction, pulmonary embolism, urinary tract infections, pneumonia and death all had similar incidence rates between the two InterTAN groups.

Both the Short and Long InterTAN patient cohorts displayed similar improvements in performance and overall function over the course of a year following intertrochanteric hip fracture fixation. The recorded operative times for Short InterTAN fixation were significantly shorter than those recorded for the Long InterTAN patients. Alternatively, a significantly higher proportion of Short InterTAN patients sustained periprosthetic femur fractures within a year of implantation as compared to the Long InterTAN group.

Introduction: Surgical fixation of intra-articular distal femoral fractures has been associated with nonunion & varus collapse. The soft tissuestripping associated with this fracture andthe surgical exposure have been factors associated with delayed union & infection. The limited soft tissue exposure has been lauded the as a solution to this fracture. However, it has occurred with the new fixation as well.(Locked Plate)

Aims: This study is an attempt to look at the fixation. Does the LISS system improve the results of this difficult fracture? Is there truly a difference in the outcome of this fracture utilizing the Locked plate system or is the percieved difference due to the surgical mini invasive approach.

Patients & Methods: One hunderd & forty patients were screened, only 53 were randomized and fixed in six academic centers over 5 years. All C3 fractures were excluded as they were felt not to be treatable by the DCS device, but they were treated appropiately. 35 females and 18 males were included in the study and randomized appropiatley.

Results: Fifty-three patients were randomized, 28 had the LISS implant and 25 had the DCS utilized. There were 3 nonunions in the LISS group plus two patients with early loss of reduction that required reoperation in the early post operative period. One patient developed arthrofibrosis requiring arthroscopic release and subsequently the implant failed necessitating refixation. In the DCS group, only one nonunion reported & required second surgery. This translated to a reoperation rate of 21% in the LISS group compared to 4% with DCS.

Conclusion: This prospective randomized multicentre trial showed a difference when comparing the LISS to the DCS in the supracondylar distal femur fractures.

The Canadian Orthopaedic Trauma Society was started in an endeavour to answer the difficult problem of obtaining enough patients to perform top-quality research into fractures. By maintaining a high standard, including randomised study design, inclusivity, open discussion among surgeons and excellent long-term follow-up, this group has become a leader in the orthopaedic research community. This annotation describes the short history, important components and spirit necessary to build a research community or team which will function well despite the difficult research environment facing individual surgeons.

This multi-center randomized prospective trial examined fixation for distal femoral fractures by standardizing the surgical approach as minimally invasive. Fifty three patients at six Canadian trauma centers were randomized via the Lead Centre (Halifax Infirmary, Dal-housie University, Halifax, CANADA) into 2 groups of 28 LISS and 25 DCS respectively. The AO C3 group was excluded from randomization. In the LISS group, three fractures went on to non-union and two fractures were complicated by early loss of fixation. A further LISS patient had removal of all metalwork when removal of individual prominent screws proved impossible due to cold-welding. In the DCS group, one fracture was complicated by non-union.

The difference between the two groups proved very statistically significant. (P< 0.05)

In this trial, the LISS proved more technically demanding and a higher re-operation rate was evident. At the Lead Centre, the LISS has been abandoned in favor of the DCS or LCP Condylar Plate performed via a minimally invasive approach.

The ideal bearing surface for total hip arthroplasty is still an area of debate.Increasing numbers of total hip replacements are being done in the younger patient population.Ceramic-on-ceramic bearings have gained popularity due to their low wear rate.However, ceramic fractures with subsequent catastrophic failures have been reported. This study reports on early results of ceramic-on-ceramic total hip replacements.

This is a study analyzing a prospectively collected data for seventy-five ceramic-on-ceramic total hip replacements with minimum follow up of eighteen months. Average age at time of surgery was forty-seven years. This study focused on the complications of this ceramic population. Complications included: One posterior dislocation, two intra-operative calcar fractures that needed wiring, one intra-operative fracture of the acetabular liner, two cases of impingement (one which resulted in a revision), and one periprosthetic fracture. The two patients that required further surgery were the periprosthetic fracture after a fall and one for component impingement. No revisions were performed for loosening or catastrophic failures. No wear, loosening, or osteolysis was seen on radiographs. The SF-12, WOMAC, and Harris Hip scores were not significantly different from other reported hip series.

Ceramic-on-ceramic bearing surfaces in total hip arthroplasty are a safe option with outcome equivalent to standard THR in the short term. Ceramic Hips may provide a more durable prosthesis, especially in young and active patients. Intra-operative technical guidelines that may enhance the quality of the results will be presented and fully disclosed.

Antegrade femoral nailing through the greater trochanter, using nails designed for piriformis entry, is associated with varus and iatrogenic comminution. Nails designed for greater trochanter insertion theoretically reduce these complications, but clinical outcomes comparing these to piriformis entry remain unknown. We compared femoral shaft fracture repair with a nail designed for trochanteric entry to an identical nail without a trochanteric bend inserted through the piriformis fossa.

The trochanteric nail was easier to insert with decreased operative and fluoroscopy time. It resulted in equally high union rates, low complication rates, and functional results similar to conventional nailing through the piriformis fossa.

Trochanteric antegrade nailing of the femur is thought to be advantageous over conventional antegrade nailing due to improved ease of insertion, but is unproven. This study compares results of femoral shaft fracture treatment using a nail designed specifically for trochanteric entry, Trigen TAN, to results using an identical nail without a trochanteric bend inserted through the piriformis fossa, Trigen FAN.

A femoral nail specially designed for trochanteric insertion resulted in equally high union rates, equally low complication rates, and functional results similar to conventional antegrade femoral nailing through the piriformis fossa. As a result of increased ease of insertion, decreased operative time and decreased fluoroscopy time, the greater trochanter entry portal, coupled with an appropriately designed nail, represents a rational alternative for antegrade femoral nailing.

Insertion of a specially designed femoral nail though the trochanter is faster, easier, and requires less fluoroscopy time than conventional antegrade nailing through the piriformis fossa.

Overall, there was < 10° malalignment and no iatrogenic fracture comminution. The average operative time was 21% greater using the FAN nail than using the TAN nail, (p=.08). The average fluoroscopy time was 61% greater for the FAN group than for the TAN group, (p< .05). Trends in functional outcome (Lower Extremity Measure) were similar for both groups.

One hundred and eight patients treated for a femoral shaft fracture were included in this study. Ninety-eight patients were treated with either a Trigen TAN nail (n=38) or Trigen FAN nail (n=53); seventeen patients with insufficient follow-up were excluded from analysis.

Funding:Smith & Nephew, Memphis TN

Reducing exposure to radiation is a concern to physicians and supporting staff. Little is known about the factors leading to increased exposure in intramedullary nailing of long bone fractures. This study examines antegrade and retrograde nailing of femur and tibia fractures. Factors that increased radiation exposure were obesity, severely comminuted fractures, nails inserted through the piriformis fossa, and insertion of more locking bolts in femoral nails. In addition, femoral nails required more radiation exposure than tibial nails.

Exposure to radiation is a concern to physicians. The purpose of this study was to determine factors associated with increased radiation exposure with intramedullary nailing of long bone fractures.

Femoral nailing through the piriformis fossa, highly comminuted fractures, insertion of more locking bolts (femur), and obesity are each associated with the higher radiation exposure.

Factors associated with increased radiation exposure are identified for tibial and femoral nailing.

Radiation exposure was higher for nailing of femur fractures (ninety-two seconds) compared to nailing of tibia fractures (sixty seconds). Exposure was greatest for insertion through the piriformis fossa (one hundred and twenty-one seconds) and least for retrograde insertion (seventy-four seconds) and intermediate for insertion through the trochanter (eighty-seven seconds). Obese patients (BMI > 30) had higher exposure times for both femoral (obese-one hundred and sixty seconds, non-obese-eighty-five seconds) and tibial nailing (obese-seventy-nine seconds, non-obese-fifty-five seconds). Only the most severely comminuted fracture patterns (Winquist IV) were associated with increased fluoroscopy time. Increasing number of interlocking bolts was associated with higher exposure for the femur but not the tibia.

One hundred and thirty-nine consecutive patients treated with intramedullary nailing for either a femoral shaft (OTA 32, n=71) or tibial shaft (OTA 42, n=68) fracture were prospectively evaluated in this IRB approved study. Radiation exposure (c-arm fluoroscopy time) was measured. Femur fractures were treated with either a retrograde nail (n=24), an antegrade nail inserted through the piriformis fossa (n=20), or an antegrade nail inserted through the tip of the greater trochanter (n=27).

Funding: Smith & Nephew

Purpose: To assess patients quality of life, pain, and functional limitations with with endstage ankle arthritis (EAA) and compared this to a similar cohort of patients with endstage hip arthritis (EHA).

Methods: Preoperative data (Short Form SF36) was collected prospectively from patients (n=130) with end stage ankle arthritis and compared to a similar cohort of patients (n=130) with end stage hip arthritis. Patients with ankle arthritis were registered in the Canadian Orthopedic Foot and Ankle Society (COFAS) multi-center study investigating the clinical outcome of ankle arthroplasty and fusion and patients with hip arthritis were randomly selected from the Halifax Joint Replacement Registry Database.

Results: All symptom and functional SF36 subscales for patients with EAA or EHA, were approximately two standard deviations below normal population scores. All differences between ankle and hip SF36 subscales scores were less than 4 points (40% of STD) in both direct and adjusted comparisons. A direct comparison of SF36 scores revealed that patients with EAA had significantly worse mental health according to the SF36 Mental Component Summary Score (MCS) (p= 0.0059), physical limitations with work and daily activities - role physical score (p= < 0.0001), and general health (p= 0.0004). Patients with EHA reported poorer physical function (p= 0.0007) although the Physical Component Summary Score (PCS) for the SF36 was not significant (p= 0.0510). Total Summary SF36, Physical Component Summary (PCS), bodily pain, vitality, role-emotional, social functioning, and mental health subscales were all not significantly different between cohorts (p> 0.05).

Conclusions: Patients with EAA have devastating losses of quality of life, which are comparable to patients with EHA. These findings suggest that increased resources should be directed towards alleviating the severe pain and disability associated with ankle arthritis.

This prospective randomized multicenter study compares two methods of bone defect treatment in tibial plateau fractures: a bioresorbable calcium phosphate paste (Alpha-BSM) that hardens at body temperature to give structural support versus Autogenous iliac bone graft (AIBG).

One hundred and eighteen patients were enrolled with a 2:1 randomization, Alpha-BSM to AIBG. There was a significant increased rate of non-graft related adverse affects and a higher rate of late articular subsidence (three to nine month period) in the AIBG group.

A bioresorbable calcium phosphate material is recommended in preference to the gold standard of AIBG for bone defects in tibial plateau fractures.

This prospective randomized multicenter study was undertaken to compare two methods of bone defect treatment: a bioresorbable calcium phosphate paste (Alpha-BSM –DePuy, Warsaw, IN) that hardens at body temperature to give structural support and is gradually resorbed by a cell-mediated bone regenerating mechanism versus Autogenous iliac bone graft (AIBG).

One hundred and eighteen adult acute closed tibial plateau fractures, Schatzker grade two to six were enrolled prospectively from thirteen study sites in North America from 1999 to 2002. Randomization occurred at surgery with a FDA recommendation of a 2–1 ratio, Alpha BSM (seventy-eight fractures) to AIBG (forty fractures). Only internal fixation with standard plate and screw constructs was permitted. Follow-up included standard radiographs and functional studies at one year, with a radiologist providing independent radiographic review.

The two groups exhibited no significant differences in randomization as to age, sex, race, fracture patterns or fracture healing. There was however, a significant increased rate of non-graft related adverse affects in the AIBG group. There was an unexpected significant finding of a higher rate of late articular subsidence in the three to nine month period in the AIBG group.

Recommendations for the use of AIBG for bone defects in tibial plateau fractures should be discouraged in favor of bioresorbable calcium phosphate material with the properties of Alpha BSM. We believe further randomized studies using AIBG as a control group for bone defect support of articular fractures are unjustified.

A bioresorbable calcium phosphate material is recommended in preference to the gold standard of AIBG for bone defects in tibial plateau fractures.

Funding: DePuy, Warsaw, IN.

Retrospective data over an eight-year period was collected on twenty-four young patients with non-union of a femoral neck fracture who were followed to union. The cause of each nonunion was identified and a classification of the nonunions was established in order clarify treatment options. Patients were treated by a single surgeon. The treatment protocol was based on the classification of the femoral neck nonunion. There were no nonunions in the treated patients; however two patients who showed signs of avascular necrosis prior to treatment ultimately developed AVN.

Femoral neck nonunion occurs in 20–30% of displaced femoral neck fractures. If the femoral head is viable, the treatment goal is femoral neck union to maintain it. Treatment options depend on the cause of nonunion. To clarify treatment options, a classification of nonunions was developed.

The treatment regime developed was based on the type of nonunion. We believe that subclassification of the femoral nonunion improves the selection of treatment options. This classification-based treatment does not reduce the incidence of avascular necrosis, but does seem to guarantee union while permitting excellent function of the hip joint

A classification system based on the cause of the non-union clarifies treatment options to maintain the femoral head and produce union of the femoral neck.

Based on the analysis a classification proposal relating to treatment was developed. In the original treatment group there were no nonunions but two cases of ultimate avascular necrosis— both showed signs of AVN on bone scan prior to treatment.

Classifications:

Type I – Inadequate fixation or non-anatomic reduction (eight patients)

Type II – Loss of fixation with displacement (fourteen patients)

Type III (Rare) – Fibrous nonunion with no displacement and intact fixation (two patients)

Twenty-four patients were treated by one surgeon and followed to union over eight years. The results were examined retrospectively to categorize cause of non-union and treatment protocol. A classification system that describes classes of nonunions and treatment for each type was developed.

Purpose: To comapre the clinical results and costs of a non-modular, all-polyethylene tibial component versus a modular tibial component in patients older than 70.

Methods: A multi-center (London, Ontario; Halifax, Nova Scotia) prospective randomized clinical trial was designed to compare modular metal-backed versus an all polyethylene tibial component in patients over 70 years. Primary outcome measures include Knee Society Clinical Rating System, WOMAC, SF-12, Kaplan-Meier Survivorship.

Results: Between September 1995 and August 1997, 127 total knee replacements (Genesis I, Smith & Nephew) were randomized to receive either a non-modular (all-polyethylene) tibial baseplate or a modular (metal-backed) baseplate. Minimum follow-up was 8 years. Excluding patients who died or became disabled due to medical problems, no consistent significant differences have been seen in regard to the WOMAC, SF-12, and Knee Society scores between the two groups. Kaplan-Meier Survivorship is 93% with a mean survival time of 9.36 years for the non-modular group and 94.1% with a mean survival time of 9.49 years for the modular group. The cost saving in the non-modular group was approximately $800 per TKR without any compromise in clinical outcome.

Conclusions: There was no difference found in the clinical outcome scores between an all polyethylene tibial baseplate and a modular tibial component in patients over 70 years of age. Non-modular tibial baseplates have a list price of 23–65% the cost of their modular counterparts. A high mortality rate exists in this age group limiting the numbers available for longer term review. The use of an all polyethylene tibial component is a cost effective and clinically successful alternative in the older patient requiring total knee replacement.

Purpose: The Less Invasive Stabilization System (LISS), Dynamic Condylar Screw (DCS) and Condylar Buttress Plate (CBP) are three common fixation methods for supracondylar femur fractures. The DCS and CBP are compression plates while the LISS uses locking screws to transfer load from bone to plate without compression. We developed a study to determine if the theoretical biomechanical advantages of the LISS would be evident in laboratory testing.

Methods: Identical AO type C fractures were created in eighteen composite femurs and fixed with either LISS, CBP, or DCS (6 each). Roentgen Stereophotogrammetric Analysis (RSA) was used for analysis. Reference markers were implanted into each bone segment. Biplanar x-rays were taken to give a three-dimensional representation of the fracture. The femurs were loaded axially in an Instron 1350 and subjected to cyclic loading (50kg ± 25 for 50000 cycles). After loading, the bones were x-rayed to determine relative motion between fracture segments. To examine inducible displacement under static loading, the femurs were x-rayed in an unloaded and loaded (50 kg) condition. Again, RSA was used for analysis.

Results: RSA-CMS software was used to analyze relative motion between the bone segments. After cyclic loading, the condylar buttress plate showed significantly more permanent deformation between the medial condyle and shaft of the femur than the DCS or LISS. Under static load, the LISS showed greater displacement than the other devices between the medial condyle and shaft, and between the lateral condyle and shaft.

Conclusions: The LISS demonstrated less permanent deformation but greater inducible deformation between the medial femoral condyle and femoral shaft, compared to the DCS and CBP. The results were statistically significant. These results may have clinical implications regarding the choice of fixation devices for this difficult fracture pattern.

Funding : Other Education Grant

Funding Parties : Capital Health Research Grant

The purpose of our study was to compare the performance of a new intramedullary reaming device to a contemporary reaming system. The new intramedullary reaming device was the Synthes Reamer/Irrigator/Aspirator reamer (RIA) which differs from contemporary reaming devices in that it has a built-in irrigation and aspiration system to reduce the intramedullary pressures and temperatures associated with reaming. An in-vivo cadaver model was developed to quantify intramedullary pressure, temperature, speed and force of reaming. The results showed significant differences in intramedullary pressures with no significant differences in speed and force of reaming.

The purpose of our study was to compare the performance of a new intramedullary reaming device to a contemporary reaming system.

The Synthes Reamer/Irrigator/Aspirator reamer (RIA) produced significantly lower peak and average intramedullary pressures during reaming with no significant differences in speed and force of reaming.

A reaming system with a built-in irrigation/aspiration could possibly reduce the morbidity and mortality associated with the reaming of long bone fractures. There were significantly lower minimum, maximum and average proximal and distal intramedullary pressures with the RIA reamer. There were no significant differences in force or speed of reaming. No temperature changes were noted with either reaming system.

A cadaveric model was developed to compare the RIA reaming system to a contemporary reaming system. Pressures were measured with pressure transducers inserted proximally and distally. Temperatures were measured with thermocouples inserted adjacent to isthmus. Force of reaming was measured with a load cell distally. Speed was calculated from data collected from a linear voltage displacement transducer. Fifteen, matched pairs of frozen, unpreserved femurs were reamed using both reaming systems and the data collected. Canals were reamed to a diameter two centimeters greater than the templated canal size. Data was collected and analyzed with paired t-tests (p< .05).

Embolic material within the cardiovascular system has been shown to increase morbidity and mortality in susceptible individuals. Embolization is related to increased intramedullary pressures. The RIA reamer, as a result of its built-in irrigation/aspiration capacity, produces lower intramedullary pressures. This may have clinical significance.

Funding: This work was supported by Synthes (West Chester, PA)

These results support the use of an injectable, in situ hardening calcium phosphate paste to prevent the early loss of calcaneal height and maintain a more anatomic calcaneal reduction.

The purpose of this prospective randomized controlled trial was to determine whether ORIF plus an injectable bioresorbable calcium phosphate paste (_-BSM) is superior or inferior to ORIF alone in the treatment of calcaneal bone voids encountered after operative treatment of displaced intraarticular fractures of the calcaneus.

Forty-four patients (forty-eight displaced intraarticular calcaneal fractures necessitating operative fixation) presenting to a Level One trauma center were enrolled into the study and randomized 1:1 to receive ORIF and injection of _-BSM or ORIF alone. All patients had a standardized ORIF thru a lateral approach by a single surgeon (R.B.).

The primary outcome measure was the maintenance of post- operative Bohler’s angle at six weeks, three months, and six months. Other outcome measures included the SF-36 and LEM (Lower Extremity Measure) Score at six months.

Five patients with seven calcaneal fractures were lost to follow up leaving thirty-nine patients with forty-one calcaneal fractures (85%) for analysis. Twenty-one were randomized into the ORIF and _-BSM group and twenty into the ORIF alone group. There was no statistical difference between the two groups with regard to age, sex, mechanism of injury, initial Bohler’s angle, or type of fracture.

There was no difference between the groups in the degree of collapse of Bohler’s angle at six weeks and three months when compared to initial post-operative values. However, at six months the mean collapse of the _-BSM and ORIF group was 5.6° and ORIF alone was 10.6°. This was statistically significant (p< 0.01).

Funding: Industry supported: DePuy, a Johnson & Johnson Company

Analysis and data collection performed independently.