Author: saqib@orthoclips.com

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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Interview with Devon Brameier, BM, BCh, Senior Clinical Research Coordinator, Dept. of Orthopaedic Surgery, Harvard Medical School Orthopaedic Trauma Initiative, Brigham and Women’s Hospital. We discuss their paper entitled “Use of Direct Oral Anticoagulants Among Patients With Hip Fracture Is Not an Indication to Delay Surgical Intervention” from the March 2024 Journal of Orthopaedic Trauma.

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Interview with Dr. Brian Mullis, Professor of Orthopaedic Surgery and Residency Director, Indiana University School of Medicine and Dr. Leilani Mullis, Assistant Professor of Clinical Anesthesia and Chair, Residency Selection Committee, Indiana University School of Medicine. We discuss their paper entitled “Orthopaedic Trauma and Anemia: Conservative versus Liberal Transfusion Strategy: A Prospective Randomized Study” in the January 2024 issue of the Journal of Orthopaedic Trauma.

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An interview with Dr. Scott LaValva, lead author on the April 3, 2024 JBJS publication entitled “Robotics and navigation do not affect the risk of periprosthetic joint infection following primary total hip arthroplasty: A propensity score-matched cohort analysis”. Dr. LaValva is a PGY-4 orthopaedic surgery resident at the Hospital for Special Surgery in New York City, USA.

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