Author: saqib@orthoclips.com

We cover two recent review papers on the topic: “An Update on Spinal Cord Injury and Current Management” by Carroll et al in the October 2024 JBJS Reviews, and “Updates in the Early Management of Acute Spinal Cord Injury” by Lambrechts et al in the September 1, 2023 issue of JAAOS. Urgency of spinal decompression, controversies with methylprednisolone, emerging neuroprotective and regenerative therapies, and optimizing spinal cord perfusion are covered.

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We review the results of the recent RCT published in the September 4, 2024 JBJS entitled “Low-Intensity Pulsed Ultrasound Versus Sham in the Treatment of Operatively Managed Scaphoid Nonunions: The SNAPU Randomized Controlled Trial” by White and coauthors from the Wrist and Elbow Research Group of Canada (WECAN).

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We review “Integrated Dual Lag Screws Have Higher Reoperation Rates for Fixation Failure Than Single Lag Component Cephalomedullary Nails: A Retrospective Study of 2,130 Patients with Intertrochanteric Femoral Fractures” from the September 18, 2024 JBJS. This compared patients treated with the Trigen InterTAN with DPS TFNA and Stryker Gamma 3. The authors are Christian Gonzalez and the Hip Fracture Nail Study Group.

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Does far cortical locking improve healing for management of distal femur fractures, compared to standard locked plating? We discussed the findings from the randomized control trial entitled “Far Cortical Locking Versus Standard Constructs for Locked Plate Fixation in the Treatment of Acute, Displaced Fractures of the Distal Femur” by Dr. Kelly Lefaivre and colleagues from the Canadian Orthopaedic Trauma Society in the October 2, 2024 edition of the JBJS. This was a multi-center international randomized control trial performed across 16 centers on adult patients with AO type 33A and 33C fractures. This technology has been around for a while, but these are some long-awaited results so tune in to find out more.

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We are discussing three papers from the August 2024 volume of the Journal of Orthopaedic Trauma, all from the Young Femoral Neck Fracture Working Group. This includes 26 North American trauma centers with over 500 young adult patients with femoral neck fractures. The first paper focuses on optimal fixation strategies, the second focuses on isolated femoral necks versus neck/shaft fractures, and the third focuses on how treatment failure appears to increase with age.

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With all the external fixation being done for temporary stability, what is the evidence for best practices for conversion to internal fixation? There are issues regarding timing, whether you can keep the ex fix in the operative field if needed, how to best sterilize it, what to do with the pin sites before and after the pins come out, etc. We review two recent papers: “External fixation before planned conversion to internal fixation in orthopaedic trauma: controversies and current trends” by Wynn et al in the Oct 1, 2024 JAAOS. We also review data from our own group entitled “Evaluating the efficacy of disinfecting agents on external fixator devices” (Horowitz et al) being presented at the OTA 2024 in Montreal this weekend, as well as the paper entitled “Safety of prepping the external fixator in situ during staged internal fixation of pilon fractures: a retrospective comparative cohort study” by Yeramosu et al in the September 2023 issue of JOT.

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In this episode, we review two recent randomized control trials investigating this question. “Skin Antisepsis before Surgical Fixation of Extremity Fractures” is a publication from the PREPARE trial in the February 2024 issue of the New England Journal of Medicine. This was a randomized control trial of over 6000 patients in which day investigated iodine versus chlorhexidine for skin prep of both closed and open extremity fracture surgery.

The second paper is in the August 20, 2024 issue of the Journal of the American American Medical Association entitled “Povidone Iodine vs Chlorhexidine Gluconate in Alcohol for Preoperative Skin Antisepsis
A Randomized Clinical Trial”. This was a multi center trial of over 3000 patients at three sites in Switzerland that looked at prevention of SSI and cardiac or abdominal surgery.

Results from both trials are discussed and in this season, we are introducing some surprisingly engaging, artificial intelligence hosts. Enjoy.

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Conversation with Alexander Neuwirth, M.D., Associate Program Director of the Orthopaedic Surgery Residency and Associate Program Director, Frank E. Stinchfield Adult Reconstruction Fellowship, and Assistant Professor of Orthopaedic Surgery in the Division of Adult Hip and Knee Reconstruction at Columbia University Medical Center and New York-Presbyterian Hospital. We discuss teaching millennials, active learning, flipped classrooms, and didactic curricula for orthopaedic residencies.

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Interview with Dr. Noelle Van Rysselberghe from Harborview Medical Center in Seattle, Washington discussing her paper in the February 2024 Journal of Orthopaedic Trauma entitled “Retrograde Intramedullary Nailing Versus Locked Plating for Extreme Distal Periprosthetic Femur Fractures: A Multicenter Retrospective Cohort Study”.

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Interview with Dustin Greenhill, MD, FAAOS, Associate Program Director of Orthopaedic Surgery at the St. Luke’s University Health Network and Assistant Clinical Professor at Temple University School of Medicine. Dr. Greenhill is a pediatric orthopaedic surgeon and first author of the paper entitled “Treatment of Length-Unstable Pediatric Femur Fractures in Children Aged 5 to 11 years: A Focused Review” in the May 1, 2024 issue of the Journal of the American Academy of Orthopaedic Surgeons.

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