Fracture of pubic rami during hip fracture fixation: a rare case of traction table–related injury

We present a case of an elderly and comorbid patient who was scheduled to undergo a hip fracture fixation using an intramedullary nail. Unfortunately, this was delayed by 3 weeks as the patient was unfit to undergo this procedure. She was placed onto the traction table and intraoperatively sustained a superior and inferior pubic rami fracture while attempting reduction on the traction table. Closed-reduction techniques using traction tables and perineal posts are not without morbidity. Risk factors such as osteoporosis and delayed-fixation should be accounted for when managing this complex and often frail group of patients.

A Web-Based Dynamic Nomogram to Calculate the Risk of Nonhealing after Femoral Neck Fracture Fixation among Young Adults: Bench to bedside Translational Research

Background: The aim of this study was to develop a prognostic model to identify a subgroup of high-risk patients for non-healing after femoral neck fracture fixation among young adults. The model was implemented by presenting graphically as a nomogram that could be easily used in every day clinical cases. Methods: Data on a total of 129 patients were included in the current study. The mean [standard deviation (SD)] age of the participants was 42 (13) years and 28% of the patients were women. Harrell’s C statistic was used as a measure of discrimination predictive power. We calculated the Nam-D’Agostino χ 2 to examine calibration for prediction models. Results: Approximately, 83% of fractures united uneventfully, with avascular necrosis (AVN), fixation nonhealing, non-union, infection, arthroplasty, and death being observed. Body mass index (BMI) and head acetabular trabecular angle (HATA) were inversely associated with the risk of all-cause nonhealing. The final model showed excellent discriminatory power [Harrell’s C statistic: 0.820, 95% confidence interval (CI) (0.680-0.960)] and it was well-calibrated [Nam-D’Agostino χ 2 : 10.1, (P = 0.3456)]. A nomogram developed by incorporating significant predictors modelled without discretizing continuous variables. Conclusion: Using readily available clinical and radiological data, we developed a parsimonious, simple, accurate yardstick to measure the 5-year risk of nonhealing after femoral neck fractures among young adults. In order to add ease-of-use and to promote its integration into clinical practice, the prognostic model was demonstrated visually as a statistic nomogram.

Level of Sagittal Plane Fit of Plates on the Radial Shaft: A Cadaveric Study Comparing Precontoured and Straight Titanium Plates

Background: During radial shaft fracture fixation, it is important to contour the plate appropriately to restore the radial bow in order to maintain normal forearm mechanics and motion. The aim of this study was to investigate the fit of precontoured radial shaft plates versus surgeon-contoured plates. Methods: Six 10-hole Acumed® precontoured volar and dorsolateral radius plates and twelve 10-hole Synthes straight titanium 3.5 mm LC-DCP plates were drilled with arrays of 1.5 mm diameter holes to permit measurement of the plate distance off bone. Plates were applied to 6 cadaver radii and secured with a screw on each end. Three plate conditions were tested: precontoured plates, precontoured plates with further surgeon contouring, and straight plates with surgeon contouring. Surgeon contouring time for each plate was recorded. Each plate was divided into 3 equal regions, and the average distance gaps for each region and the entire plate were calculated. Results: For the volar side, precontoured plates had a larger total gap compared to that plate with additional surgeon contouring (1.4 mm difference) and the straight surgeon-contoured plates (1.2 mm difference). On the dorsal side, there was no difference in fit between the 3 plate conditions at any location. No differences were found in plate contouring times. Conclusions: The precontoured dorsal plate fit was as good as the surgeon-contoured plates indicating this plate could potentially be used in fracture surgery without further bending. The precontoured volar plate was under-contoured, on average, and would likely require further bending to restore the radial bow.