Technique for Application of an External Fixator to the Lateral Column of the Foot

Summary: High-energy torsional injuries to the forefoot may result in severe disruption of the lateral column of the foot. Compression fractures of the cuboid or distallateral calcaneus are commonly associated with ligament injuries represented as joint subluxations and/or dislocations. Restoration of the lateral column may be achieved with the application of an external fixator device and adjunctive internal fixation. The details of this surgical technique are presented, as well as indications and contraindication

Foot and Ankle Fellowship Websites

Category: Other Introduction/Purpose: The Internet has been reported to be the first informational resource for many fellowship applicants. Despite being a popular resource, no accessibility or quality standards exist for fellowship websites. The objective of this study was to assess the accessibility of orthopaedic foot and ankle fellowship websites and to evaluate the quality of information provided via program websites. Methods: The American Orthopaedic Foot and Ankle Society (AOFAS) and the Fellowship and Residency Electronic Interactive Database (FREIDA) fellowship databases were accessed to generate a comprehensive list of orthopaedic foot and ankle fellowship programs. The databases were reviewed for links to fellowship program websites and compared with program websites accessed from a Google search. Accessible fellowship websites were then analyzed for the quality of recruitment and educational content pertinent to fellowship applicants. Results: Forty-seven orthopaedic foot and ankle fellowship programs were identified. The AOFAS database featured direct links to 7 (15%) fellowship websites with the independent Google search yielding direct links to 29 (62%) websites. No direct website links were provided in the FREIDA database. Thirty-six accessible websites were analyzed for content. Program websites featured a mean 44% (range, 5-75%) of the total assessed content. The most commonly presented recruitment content was a program description featured on 94% of fellowship websites. The most commonly presented educational content was a description of fellow operative experience featured on 83% of websites. Conclusion: There is substantial variability in the accessibility and quality of orthopaedic foot and ankle fellowship websites. Comparison of the results of our study with those of similar investigations indicates a paucity of fellowship websites presenting comprehensive program information to applicants. Recognition of deficits in accessibility and content quality may assist foot and ankle fellowships in improving program information online

Early Complications Following Osteosynthesis of Distal Radius Fractures

Background: Distal radius fractures (DRFs) are common geriatric fractures with the overall incidence expected to increase as the population continues to age. The purpose of this investigation was to compare the short-term complication rates in geriatric versus nongeriatric cohorts following osteosynthesis of DRFs. Methods: The American Board of Orthopaedic Surgery (ABOS) part II database was queried for adult DRF cases performed from 2007 to 2013. Current Procedural Terminology codes were used to identify cases treated via osteosynthesis. Patient demographic information and reported complication data were analyzed. Comparisons between geriatric (age ≥65 years) and nongeriatric (age <65 years) patients were performed. Results: From 2007 to 2013, a total of 9867 adult DRFs were treated via osteosynthesis by ABOS part II candidates. Geriatric patients comprised 28% of the study cohort. Mean age of the geriatric and nongeriatric cohorts was 74 ± 7 and 46 ± 13 years, respectively. There was a greater proportion of female patients ( P < .001) in the geriatric cohort as compared with the nongeriatric cohort. The geriatric cohort demonstrated higher rates of anesthetic complications ( P = .021), iatrogenic bone fracture ( P = .021), implant failure ( P = .031), loss of reduction ( P = .001), unspecified medical complications ( P = .007), and death ( P = .017) than the nongeriatric cohort. The geriatric cohort also showed lower rates of nerve palsy ( P = .028) when compared with the nongeriatric cohort, though no differences in rates of secondary surgery were noted between the two cohorts. Conclusion: Increased rates of complications related to poor bone quality and poor health status may be expected among geriatric patients following osteosynthesis of DRFs. However, geriatric and nongeriatric patients have similarly low rates of secondary surgery. Future studies are needed to delineate the economic, functional, and societal impact of geriatric DRFs treated via osteosynthesis

A Comparison of Outcomes following Plate versus Pin Fixation of Metacarpal Shaft and Neck Fractures

Background:. The aim of this study is to compare clinical and radiographic outcomes of open reduction and internal fixation versus closed reduction and percutaneous pinning of metacarpal fractures in relation to anatomic and surgical variables. Methods:. Electronic medical records at two institutions were reviewed for patients who underwent surgical intervention for metacarpal fractures. Data were collected from those who underwent reduction and internal fixation with either plates or Kirschner wires (K-wires). Inclusion criteria included minimum postoperative follow-up of 60 days and age 18 years or older. Exclusion criteria included insufficient radiographic data, previously attempted closed reduction with immobilization, pathologic fracture mechanism, history of previous trauma or surgery to the affected bone, and fixation technique other than plate or K-wire. Results:. We reviewed data for patients treated over a 22-year time period. Ultimately, 81 metacarpal shaft and neck fractures in 60 patients met inclusion criteria. Among all metacarpal fractures, complications were present in 39 (48.1%) cases. There were no significant associations between complication prevalence and hardware type. Revision surgery was required in 11 (13.6%) patients; there were no significant associations between revision procedures and hardware type. Postoperatively, all patients with imaging data had radiograph follow-up to assess union status. There was no significant association between time to union and hardware type. Conclusions:. Outcomes showed no significant difference between plate and pin fixation for metacarpal shaft and neck fractures. These findings suggest that surgeons may have flexibility to decide on the type of operative intervention while considering patient-specific factors, such as the need for early mobilization