BackgroundAnatomic reduction of intra-articular fractures of the tibial plateau and distal radius can be difficult to achieve. Treatment goals are centered on restoring the native anatomy and articular congruency. Several surgeons in the USA have begun using an inflatable bone tamp to reduce these fracture patterns. The concept is built on the success of the tamp in kyphoplasty of the spine, but it has yet to be tested in the lab for use in the extremities. We performed an investigation into the safety and efficacy of using an inflatable bone tamp for intra-articular fracture reduction of the tibial plateau and distal radius.Materials and methodsPaired cadaveric specimens were obtained for a total of six proximal tibias and six distal radii. Intra-articular depression-type fractures were created in all specimens. The inflatable bone tamp was then used to reduce the depression. For comparison, the tibias were fractured on the medial and lateral side and a conventional metal tamp was used on the contralateral side of the balloon. Fine-cut micro-computed tomography (CT) scans were performed on all intact specimens, which were then fractured, and again after fracture reduction. CT data was used to measure the amount of restoration of the normal anatomy and to compare the effectiveness of the balloon to conventional methods.ResultsThe inflatable bone tamp was equivalent to conventional methods in large, minimally displaced fracture fragments and proved superior when comminution was present at the articular surface. No instances of overreduction or penetration into the joint were encountered with the balloon, whereas this was a common occurrence with conventional metal tamps. The inflatable tamp was successful in reducing all distal radius fractures without complication.ConclusionAnatomic reduction of impacted articular fractures should be the goal of any treating surgeon. In our cadaveric models, we have shown the inflatable bone tamp to be safe and effective in reducing depressed articular fractures around the tibial plateau and distal radius. The balloon offers the advantage of being minimally invasive and creating a symmetric, contained defect to hold bone filler for subchondral support.

Due to the known potential for fretting and corrosion at modular junctions in orthopaedic implants, this retrospective study evaluated radiographic and clinical outcomes of 85 primary TKA patients implanted with modular stemmed tibial components and followed up for an average of 82 months. There was low incidence of tibial radiolucent lines, excellent functional outcomes, and no complications associated with stem modularity. The findings were comparable to the historical control study involving 107 TKA with a nonmodular tibial stem design. When using surface cemented tibial components combined with a constrained polyethylene bearing, modular stems appear to be a viable option for primary TKA when adequate fixation and rotational stability are maintained.

PGY-1 intern OITE percentile rank improved significantly with the addition of a specially designed educational curriculum. The stronger USMLE Step I score and PGY-1 intern OITE percentile rank relation observed during the postcurriculum period suggests that interns who participated in the educational curriculum were better prepared to translate general medical and patient care knowledge into orthopedic surgery knowledge.

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