Correction to: Cluster identification, selection, and description in Cluster randomized crossover trials: the PREP-IT trials

An amendment to this paper has been published and can be accessed via the original article

Fluorescence-Guided Surgical Debridement of Chronic Osteomyelitis Utilizing Doxycycline Bone Labeling: A Technical Trick Revived

The present manuscript discusses the concept of fluorescence-guided surgical debridement of chronic osteomyelitis in the orthopaedic patient based upon a two-fold mechanism, natural fluorescence of healthy bone combined with bone labeling by tetracyclines. The senior author prefers preoperative administration of oral doxycycline 100 mg twice daily for at least 1 month. The excitation source of choice is an ordinary blacklight, as this is both cost-effective and readily attainable. Intraoperatively, viable bone is noted to fluoresce a greenish hue which is then used to guide the debridement. Previous studies have demonstrated that bleeding bone is not a reliable indicator of a bone’s true metabolic state. This technical trick will offer orthopaedic surgeons an adjunct to their treatment algorithm of chronic osteomyelitis

Holding Traction During CT: Simple Tricks to Maintain Reduction in the Lower Extremity

Traction is one of the pillars of orthopaedic injury management, as it can provide both temporizing and definitive treatment for anatomic malalignment associated with joint dislocations and fractures. In the realm of modern orthopaedic care, post-traction imaging provides the surgeon with information about resting fracture position and the overall effects of traction that are critical to preoperative planning. However, there are often circumstances in which an orthopaedic surgery provider is faced with the discrepancy between the proper sequence of orthopaedic care and the need for emergent, advanced imaging to evaluate other organ systems. In other words, they are often forced to choose between holding manual traction and sustaining high radiation exposure versus permitting subpar imaging to be obtained without traction. Out of necessity to optimize occupational health and orthopaedic care, the techniques described in this manuscript were developed. The primary aim of the present manuscript is to describe these simple, cost-effective, and mobile techniques in detail, while providing rationale for their value in the toolbox of the orthopaedic provider

Backout of Distal Interlocking Screws After Retrograde Femoral Nailing With a Novel Device: A Case Series

Objective: To report upon a series of patients who have experienced the backout of distal interlocking screws after retrograde femoral nailing with the DePuy Synthes RFN-Advanced Retrograde Femoral Nailing System (DePuy Synthes, Raynham, MA). Design: Retrospective case series. Patients: Twenty-seven skeletally mature patients with femoral shaft or distal femur fractures who underwent operative fixation with the DePuy Synthes RFN-Advanced Retrograde Femoral Nailing System with 8 patients subsequently experiencing backout of distal interlocking screws. Intervention: The study intervention included retrospective review of patient charts and radiographs. Main Outcome Measure: The incidence rate of distal interlocking screw backout. Results: Thirty percent of patients experienced the backout of at least 1 distal interlocking screw (mean: 1.625) after undergoing retrograde femoral nailing with the RFN-Advanced system. Thirteen total screws backed out postoperatively. Screw backout was identified an average of 61 days postoperatively (range: 30–139 days). All patients complained of implant prominence and pain along the medial or lateral aspect of the knee. Five patients elected to return to the operating room to remove the symptomatic implant. The oblique distal interlocking screws comprised 62% of screw backouts. Conclusions: Given the high incidence rate of this complication, the associated costs of reoperation, and patient discomfort, we believe that a further investigation into this implant complication is warranted. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence

Backout of Distal Interlocking Screws After Retrograde Femoral Nailing With a Novel Device: A Case Series

Objective: To report upon a series of patients who have experienced the backout of distal interlocking screws after retrograde femoral nailing with the DePuy Synthes RFN-Advanced Retrograde Femoral Nailing System (DePuy Synthes, Raynham, MA). Design: Retrospective case series. Patients: Twenty-seven skeletally mature patients with femoral shaft or distal femur fractures who underwent operative fixation with the DePuy Synthes RFN-Advanced Retrograde Femoral Nailing System with 8 patients subsequently experiencing backout of distal interlocking screws. Intervention: The study intervention included retrospective review of patient charts and radiographs. Main Outcome Measure: The incidence rate of distal interlocking screw backout. Results: Thirty percent of patients experienced the backout of at least 1 distal interlocking screw (mean: 1.625) after undergoing retrograde femoral nailing with the RFN-Advanced system. Thirteen total screws backed out postoperatively. Screw backout was identified an average of 61 days postoperatively (range: 30–139 days). All patients complained of implant prominence and pain along the medial or lateral aspect of the knee. Five patients elected to return to the operating room to remove the symptomatic implant. The oblique distal interlocking screws comprised 62% of screw backouts. Conclusions: Given the high incidence rate of this complication, the associated costs of reoperation, and patient discomfort, we believe that a further investigation into this implant complication is warranted. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence

Backout of Distal Interlocking Screws After Retrograde Femoral Nailing With a Novel Device: A Case Series

Objective: To report upon a series of patients who have experienced the backout of distal interlocking screws after retrograde femoral nailing with the DePuy Synthes RFN-Advanced Retrograde Femoral Nailing System (DePuy Synthes, Raynham, MA). Design: Retrospective case series. Patients: Twenty-seven skeletally mature patients with femoral shaft or distal femur fractures who underwent operative fixation with the DePuy Synthes RFN-Advanced Retrograde Femoral Nailing System with 8 patients subsequently experiencing backout of distal interlocking screws. Intervention: The study intervention included retrospective review of patient charts and radiographs. Main Outcome Measure: The incidence rate of distal interlocking screw backout. Results: Thirty percent of patients experienced the backout of at least 1 distal interlocking screw (mean: 1.625) after undergoing retrograde femoral nailing with the RFN-Advanced system. Thirteen total screws backed out postoperatively. Screw backout was identified an average of 61 days postoperatively (range: 30–139 days). All patients complained of implant prominence and pain along the medial or lateral aspect of the knee. Five patients elected to return to the operating room to remove the symptomatic implant. The oblique distal interlocking screws comprised 62% of screw backouts. Conclusions: Given the high incidence rate of this complication, the associated costs of reoperation, and patient discomfort, we believe that a further investigation into this implant complication is warranted. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence

Variability of orthopedic physician fracture location identification: Implications for bone stimulator treatment

Introduction Aseptic non-union is a significant complication in approximately 5% of long-bone fractures. External bone stimulation treatment is often attempted before more invasive surgical interventions. Bone stimulators can have favorable results, but have a limited 1.7 cm therapeutic radius. This study evaluated the accuracy by which clinicians locate a fracture on a cadaveric model. This has implications for the clinician\u27s ability to accurately counsel patients on daily bone stimulator placement. Additionally, physicians (orthopedic attending surgeons and residents) were compared with pre-clinical (M1 and M2) medical students to evaluate if higher levels of training improved accuracy. Hypothesis Orthopedic physicians and pre-clinical medical students will localize a radiographic fracture within 1.7 cm less than 100% of the time, which represents the ideal consistency for patient care. Furthermore, orthopedic physicians will achieve a higher percentage accuracy than pre-clinical medical students. Materials and methods The sample included 20 orthopedic physicians and 16 pre-clinical medical students. Upper (radius) and lower (tibia) extremity cadaver models were prepared by inducing a single, transverse diaphyseal fracture. Plain reference radiographs of each model were obtained. Participants placed a radiopaque marker onto each model at the perceived fracture location, and radiographs were taken to document placement. Perpendicular marker-to-fracture distance was measured to the nearest mm along each bone\u27s long axis using the PACS system. Results Placement within the therapeutic radius was achieved by 70–80% of physicians, and 69–75% of medical students. In the remaining participants, improper placement distances were lower among physicians than among medical students (radius: 2.1 ± 0.5 vs. 3.6 ± 0.9 cm, p = 0.02; tibia: 2.6 ± 0.5 vs 3.5 ± 0.5 cm, p = 0.89). Discussion In two cadaveric fracture models, up to 30% of orthopedic surgeons perceived a fracture location to be outside a bone stimulator\u27s 1.7 cm therapeutic radius. This finding suggests that physicians and their patients may benefit from additional methods for specifying the location of a non-union before commencing daily bone stimulator treatment. Level of evidence Level IV, prospective cohort study-evidence from a well-designed prospective cohort study

Variability of orthopedic physician fracture location identification: Implications for bone stimulator treatment

Introduction Aseptic non-union is a significant complication in approximately 5% of long-bone fractures. External bone stimulation treatment is often attempted before more invasive surgical interventions. Bone stimulators can have favorable results, but have a limited 1.7 cm therapeutic radius. This study evaluated the accuracy by which clinicians locate a fracture on a cadaveric model. This has implications for the clinician\u27s ability to accurately counsel patients on daily bone stimulator placement. Additionally, physicians (orthopedic attending surgeons and residents) were compared with pre-clinical (M1 and M2) medical students to evaluate if higher levels of training improved accuracy. Hypothesis Orthopedic physicians and pre-clinical medical students will localize a radiographic fracture within 1.7 cm less than 100% of the time, which represents the ideal consistency for patient care. Furthermore, orthopedic physicians will achieve a higher percentage accuracy than pre-clinical medical students. Materials and methods The sample included 20 orthopedic physicians and 16 pre-clinical medical students. Upper (radius) and lower (tibia) extremity cadaver models were prepared by inducing a single, transverse diaphyseal fracture. Plain reference radiographs of each model were obtained. Participants placed a radiopaque marker onto each model at the perceived fracture location, and radiographs were taken to document placement. Perpendicular marker-to-fracture distance was measured to the nearest mm along each bone\u27s long axis using the PACS system. Results Placement within the therapeutic radius was achieved by 70–80% of physicians, and 69–75% of medical students. In the remaining participants, improper placement distances were lower among physicians than among medical students (radius: 2.1 ± 0.5 vs. 3.6 ± 0.9 cm, p = 0.02; tibia: 2.6 ± 0.5 vs 3.5 ± 0.5 cm, p = 0.89). Discussion In two cadaveric fracture models, up to 30% of orthopedic surgeons perceived a fracture location to be outside a bone stimulator\u27s 1.7 cm therapeutic radius. This finding suggests that physicians and their patients may benefit from additional methods for specifying the location of a non-union before commencing daily bone stimulator treatment. Level of evidence Level IV, prospective cohort study-evidence from a well-designed prospective cohort study

Variability of orthopedic physician fracture location identification: Implications for bone stimulator treatment

Introduction Aseptic non-union is a significant complication in approximately 5% of long-bone fractures. External bone stimulation treatment is often attempted before more invasive surgical interventions. Bone stimulators can have favorable results, but have a limited 1.7 cm therapeutic radius. This study evaluated the accuracy by which clinicians locate a fracture on a cadaveric model. This has implications for the clinician\u27s ability to accurately counsel patients on daily bone stimulator placement. Additionally, physicians (orthopedic attending surgeons and residents) were compared with pre-clinical (M1 and M2) medical students to evaluate if higher levels of training improved accuracy. Hypothesis Orthopedic physicians and pre-clinical medical students will localize a radiographic fracture within 1.7 cm less than 100% of the time, which represents the ideal consistency for patient care. Furthermore, orthopedic physicians will achieve a higher percentage accuracy than pre-clinical medical students. Materials and methods The sample included 20 orthopedic physicians and 16 pre-clinical medical students. Upper (radius) and lower (tibia) extremity cadaver models were prepared by inducing a single, transverse diaphyseal fracture. Plain reference radiographs of each model were obtained. Participants placed a radiopaque marker onto each model at the perceived fracture location, and radiographs were taken to document placement. Perpendicular marker-to-fracture distance was measured to the nearest mm along each bone\u27s long axis using the PACS system. Results Placement within the therapeutic radius was achieved by 70–80% of physicians, and 69–75% of medical students. In the remaining participants, improper placement distances were lower among physicians than among medical students (radius: 2.1 ± 0.5 vs. 3.6 ± 0.9 cm, p = 0.02; tibia: 2.6 ± 0.5 vs 3.5 ± 0.5 cm, p = 0.89). Discussion In two cadaveric fracture models, up to 30% of orthopedic surgeons perceived a fracture location to be outside a bone stimulator\u27s 1.7 cm therapeutic radius. This finding suggests that physicians and their patients may benefit from additional methods for specifying the location of a non-union before commencing daily bone stimulator treatment. Level of evidence Level IV, prospective cohort study-evidence from a well-designed prospective cohort study