Trauma News

Published results showed greater interobserver and intraobserver reliability when a three-column classification system was used to diagnose acetabular fractures compared with use of the Judet-Letournel classification.

Adoption of robotic systems by orthopedic surgeons has been slow and limited due to lack of improved efficiencies, the requirement of significant capital expenditure and no convincing evidence of changes in outcomes, according to an article in The Journal of Arthroplasty, by Brian S. Parsley, MD, in 2018. However, since these were first introduced in the specialty, robotics have continued to evolve, Parsley noted, which provide greater opportunities for advanced surgical planning, optimization of component placement and improved overall mechanical alignment.

There are two areas in orthopedic surgery where robotics has been employed successfully: joint arthroplasty and pedicle screw instrumentation in spine surgery. In joint arthroplasty, robotics is used to aid the accuracy of bone cuts in total knee arthroplasty and the accurate placement of the acetabular component in total hip arthroplasty. Many cadaveric and retrospective clinical studies have demonstrated high accuracy with bone cuts in arthroplasty leading to improved overall implant alignment and increased accuracy of screw placement in pedicle instrumentation. Despite these advantages, however, it is unclear whether robotic assistance results in improved outcomes that justify its added costs. For example, the advantages gained from robotics must outweigh the added costs of the robotic system itself, the annual service and maintenance fees of the system, as well as the cost of disposables. One also has to factor in the possible increased anesthesia and operative time in the beginning of the learning curve for the surgeon, as well as the cost of preoperative advanced imaging or the use of intraoperative CT/fluoroscopy to register the patient to be tracked by the navigational system. One area where robotic surgery may improve cost-effectiveness is by decreasing the revision rates of joint arthroplasty and spine surgery. Some studies suggest a decreased need for revision surgery with robotic assistance; however, these studies, at present, are generally retrospective studies with implicit bias. Robotics in orthopedic surgery is here to stay and will help surgeons in particularly complex cases; however, more evidence is needed to determine whether outcomes truly outweigh the costs in more routine surgical procedures.

ORLANDO — Data from registries in the United States and United Kingdom show an increase in the number of primary total hip arthroplasty periprosthetic femur fractures, a problem that presents orthopedic surgeons with challenges, including changes they may need to make intraoperatively to prevent these fractures, a presenter said at the Current Concepts in Joint Replacement Winter Meeting.

The American Academy of Orthopaedic Surgeons released a series of new clinical practice guidelines and appropriate use criteria to offer guidance on diagnosis and management decisions for combat and civilian trauma patients. These guidelines and appropriate use criteria were created as part of the Major Extremity Trauma and Rehabilitation Consortium, a volunteer workgroup of musculoskeletal trauma surgery experts, military surgeons and AAOS research staff.

According to study results, the mortality frailty index correlated with 30-day morbidity and mortality in patients who were 50 years old or older with intertrochanteric femur fractures. Investigators found the strongest predictor of increased 30-day morbidity and mortality after surgical treatment of the intertrochanteric femur fractures was a modified frailty index of 0.27 or more.

In recent years, the incidence of natural casualties, such as tsunamis, hurricanes earthquakes, and human disasters, such as industrial accidents, military actions and terrorist acts, has been growing continuously around the world. The resulting casualties affect large populations; most of the injuries are orthopaedic, bringing to the forefront the key role and responsibility of the orthopaedics and traumatology practitioners in delivering an immediate and appropriate medical intervention for wounded patients.

DENVER — In elderly patients with high energy or fragility fractures of the pelvis, use of retrograde transpubic screws may yield good clinical results with lower or similar complication rates to alternative methods of anterior pelvic ring fixation, according to results presented at the Orthopaedic Trauma Association Annual Meeting, here.

Tibial shaft fractures have an incidence of 16.9 per 100,000 people per year. Men aged 10 to 20 years tend to sustain these fractures, whereas women aged 20 to 30 years tend to sustain these injuries. The mechanisms of injury include low-energy twisting injuries or high-energy trauma which portend a high risk of associated soft tissue injury due to the subcutaneous location of the tibia. Treatment options are largely dictated by integrity of the soft tissue envelope and location of the fracture.

Social determinants of health are environmental factors that can be modified to improve a patient’s ability to manage musculoskeletal disease and intervention. Where a person lives, works and accesses health care can affect outcomes of surgical care. While many environmental factors are quickly glossed over in preoperative assessments, often with the thought that not much can be done to change them, overall outcomes can be affected, thus leading to conclusions that costly interventions are not valuable to patients and overall population health.