Background and Objectives: Tibial malunions are defined as tibial fractures that have healed in a clinically unacceptable position, resulting in deformity such as shortening, lengthening, abnormal rotation, or angulation. These deformities can have adverse effects on patients, such as pain and gait disturbance, as well as long term development of post-traumatic arthritis. This paper seeks to highlight some of the options for surgical management of malunions and detail the strategies and approaches used to manage these complicated cases. Materials and Methods: An exhaustive search was conducted on PubMed using the key search terms “Tibial” OR “Tibia” AND “Malunion” to be included in the title. Exclusions to the search included any article with patients aged < 18 years, any nonhuman subjects, and any article not published or translated into English. Results: A systematic review of the literature revealed 26 articles encompassing 242 patients who had undergone surgical correction for tibia malunion. A total of 19 patients suffered from complications. Methods of treatment included osteotomies, with plate and screws, external fixator, angled blade plate, intramedullary nails, Ilizarov fixator, Taylor Spatial Frame, Precise nail, and total knee arthroplasty. Restoring alignment and the articular surface led to overwhelmingly positive patient outcomes. Conclusions: Tibial malunions take many forms, and as such, there are many approaches to correcting deformities. The literature supports the following radiological parameters to diagnose tibial malunion: 5–10 degrees angulation, 1–2 cm shortening, 10–15 degrees internal rotation, and 10–20 degrees external rotation. Surgical plans should be customized to each individual patient, as there are many approaches to tibial malunion that have been shown to be successful in delivering excellent clinical outcomes.

Introduction: The purpose of this study is to report on infection with anterior subcutaneous internal pelvic fixation (INFIX) for pelvic ring injuries and the outcomes of treatment. Methods: An IRB-approved retrospective study was performed using trauma databases of a level one and level two trauma center from 2012–2018. Infection after the INFIX procedure was diagnosed in 10 of 179 cases. Treatment included formal irrigation and debridement, removal of the hardware, and culture-specific antibiotics. Patients were followed for a minimum of 12 months. Recorded outcomes include X-rays, Majeed scores, and the presence of any loss of reduction using reduction parameters. Results: Time to detect the infection was 54.2 ± 24.3 days (range 24–90, median 56 days). Staphylococcus aureus was the most common bacteria isolated. The average follow-up was 830 ± 170 days (range 575–1088 days). All patients went on to the radiographic union. There were no recurrent infections or osteomyelitis at the latest follow-up. Patients maintained their reduction after INFIX removal (KI), and Majeed scores ranged from 72 to 96 (seven good, three excellent). Discussion: Infections after using the INFIX procedure were dealt with by irrigating and debriding the wounds, removing the INFIX with culture-specific antibiotics for 2–6 weeks. Implants were maintained for at least 25 days, and there was no loss of reduction. There were no long-term sequelae noted in this small series or the literature review included in this paper.

Introduction: The objective of this study was to (1) construct a pain scale that improves communication between healthcare providers and patients (Interventional Pain Assessment [IPA] tool) and (2) to validate this new pain scale with the numeric rating scale of 0 to 10 Numerical Rating System (NRS). Methods: The IPA uses only three categories: 0 = “I have no pain,” 1 = “My pain is tolerable (no intervention needed),” and 2 = “my pain is intolerable, (intervention needed).” An Institutional Review Board–approved study was done on 322 consecutive patients who were recovering from fracture treatment. We compared ratings of the IPA with NRS. We also asked patients which scale they preferred. Statistical analysis included Kendall rank correlation (Kendall τ) and Spearman rho to determine correlation with the NRS. Results: The IPA exhibited a statistically significant association with the NRS (τ = 0.58, P < 0.0001). Discordant answers were provided by 23.6% patients; 4.7% regarded their mild-to-moderate pain as intolerable (15/322) while 18.9% reported their severe pain as tolerable (61/322). Eighty-two percent of patients preferred the IPA. Conclusion: The IPA is a valid pain scale and has exhibited strong correlation with the NRS 0 to 10, displays simple minimally clinical important difference calculation, and provides meaningful information on the effect of pain control modulation.