Locked Plating vs. Nailing for Proximal Tibia Fractures: A Multicenter RCT

OBJECTIVES: The main two forms of treatment for extraarticular proximal tibial fractures are intramedullary nailing and locked lateral plating. 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: Sixteen academic trauma centersPatients/Participants: 108 patients were enrolled. 99 patients were followed for 12 months. 52 patients were randomized to intramedullary nailing (IMN) and 47 patients were randomized to locked lateral plating (LLP). INTERVENTION: Intramedullary nailing or lateral locked plating. MAIN OUTCOME MEASUREMENTS: Functional scoring including SMFA, 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 post injury. Similarly, there was no difference in terms of time of surgery, alignment, nonunion, pain, walking ability, ability to manage stairs, need for ambulatory support or complications. CONCLUSIONS: Both intramedullary nailing and locked lateral plating provide for similar outcomes following these fractures. Patients continue to improve over the course of the year following injury but remain impaired even one year later

Locked Lateral Plating vs. Retrograde Nailing for Distal Femur Fractures: A Prospective Multicenter Randomized Trial

OBJECTIVES: The main two 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: Prospective, multicenter randomized controlled trial. SETTING: 20 academic trauma centersPatients/Participants: 160 patients with distal femur fractures were enrolled. 126 patients were followed 12 months. Patients were randomized to plating in 62 cases and to intramedullary nailing in 64 cases. INTERVENTION: Lateral locked plating or retrograde intramedullary nailing. MAIN OUTCOME MEASUREMENTS: Functional scoring including SMFA, 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 post injury. There was more coronal plane valgus in the plating group, which approached statistical significance. Range of motion, walking ability & 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 following injury, but remain impaired one year post operatively. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence

2018 international consensus meeting on musculoskeletal infection: Research priorities from the general assembly questions

Musculoskeletal infections (MSKI) remain the bane of orthopedic surgery, and result in grievous illness and inordinate costs that threaten healthcare systems. As prevention, diagnosis, and treatment has remained largely unchanged over the last 50 years, a 2nd International Consensus Meeting on Musculoskeletal Infection (ICM 2018, https://icmphilly.com) was completed. Questions pertaining to all areas of MSKI were extensively researched to prepare recommendations, which were discussed and voted on by the delegates using the Delphi methodology. The questions, including the General Assembly (GA) results, have been published (GA questions). However, as critical outcomes include: (i) incidence and cost data that substantiate the problems, and (ii) establishment of research priorities; an ICM 2018 research workgroup (RW) was assembled to accomplish these tasks. Here, we present the result of the RW consensus on the current and projected incidence of infection, and the costs per patient, for all orthopedic subspecialties, which range from 0.1% to 30%, and $17,000 to$150,000. The RW also identified the most important research questions. The Delphi methodology was utilized to initially derive four objective criteria to define a subset of the 164 GA questions that are high priority for future research. Thirty-eight questions (23% of all GA questions) achieved the requisite &gt; 70% agreement vote, and are highlighted in this Consensus article within six thematic categories: acute versus chronic infection, host immunity, antibiotics, diagnosis, research caveats, and modifiable factors. Finally, the RW emphasizes that without appropriate funding to address these high priority research questions, a 3rd ICM on MSKI to address similar issues at greater cost is inevitable.</p