Objective: Examine factors associated with fixation failure in patients treated with superior intramedullary ramus screws. Design: Retrospective. Setting: Single, Level 1 trauma center. Patients: Unstable pelvic ring fractures amenable fixation that included superior intramedullary ramus screws. Intervention: Percutaneously inserted intramedullary superior ramus screw fixation of superior pubic ramus (SPR) fractures. Main Outcome Measurements: Loss of reduction (LOR) of the SPR fracture defined as >2 mm displacement on pelvic radiographs at any time point in follow-up. Results: Two hundred eighty-five fractures in 211 patients (age 44, 95% confidence interval 40.8%–46.4%, 59.3% women, 55.1% retrograde screws) were included in the analysis. 14 (4.9%) of fractures had LOR. Patients were significantly more likely to have LOR as age increased (P = 0.01), body mass index (BMI) increased (P = 0.01), and if they were women (P < 0.01). There was a significantly decreased LOR (P < 0.01) as fractures moved further from the pubis symphysis. Retrograde screws were significantly (P < 0.01) more likely to have LOR. In SPR fractures treated with retrograde screws, failure was significantly associated with increasing BMI (P = 0.02), the presence of an inferior ramus fracture (P = 0.02), and trended toward significance with increasing age (P = 0.06), and decreased distance from the symphysis (P = 0.07). Conclusions: Superior ramus screws are associated with a low failure rate (4.9%), which is lower than previously reported. Retrograde screw insertion, distance from the symphysis, increasing age, increasing BMI, decreased distance from the symphysis, and ipsilateral inferior ramus fractures were predictors of failure. In these patients, alternative modalities should be considered, although low rates of failure can still be expected. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Summary: Supracondylar femur fractures represent a challenging and common injury treated by many orthopedic surgeons. An array of surgical fixation options has been developed to help the treating surgeon restore normal anatomic alignment of these fractures, and lateral precontoured condylar femoral locking plates have become a common implant for most surgeons in treating these fractures. Although these precontoured plates provide significant benefit to the treating physician in regards to gaining appropriate bony fixation, common technical errors that may lead to malalignment when using these plates have been described. Avoiding these errors will help improve patient outcomes. Here, we describe a novel, inexpensive, and universally available technique that may aid the treating surgeon in restoring coronal alignment when treating distal femur fractures.

Level V, Case report.

No abstract

Background: Traditionally, 2-stage exchange arthroplasty is preferred to eradicate chronic periprosthetic joint infections after total knee arthroplasty. However, for cases with significant bone destruction and/or soft tissue damage, the risk of knee instability increases with this technique, leading to a number of complications such as tibiofemoral dislocation, wound healing complications, extensor mechanism rupture, or failure of extensor mechanism repair. Intramedullary fixator rods reinforcing static spacers have been utilized to provide improved stability, but persistent infections were still prevalent. Antibiotic static spacers with intramedullary fixator rods coated with antibiotic cement can lower these reinfection rates.Surgical Technique: The surgical sequence requires removal of the infected prosthesis and placement of a carbon fiber rod and nonarticulating antibiotic spacer. This remains in situ for ~6 to 12 weeks while the patient receives systemic antibiotic treatment. Following confirmation of successful treatment, the antibiotic spacer and carbon fiber rod are removed, and revision arthroplasty is performed in a standard manner.Results: After a minimum of 1-year follow-up, no recurrent infections were diagnosed, 1 patient suffered a complication requiring expedited antibiotic spacer removal, and 1 patient expired in this cohort. Conclusions:This technique represents an effective method of providing stability of the knee and delivering adequate antibiosis in patients with knee periprosthetic joint infections in the setting of extensor mechanism disruption and severe bone loss.