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Objectives: To validate a novel intraoperative method of quantifying femoral head perfusion in adult patients with femoral neck fractures and to determine whether the lack of a perfusion waveform correlates with the development of osteonecrosis, nonunion, or reoperation. Design: Prospective cohort. Setting: Level 1 trauma center. Patients/Participants: Nineteen patients with 20 acute femoral neck fractures treated with hip-preserving surgical fixation. All patients underwent intraoperative quantification of femoral head perfusion. Intervention: Intraoperative quantification of femoral head perfusion pressure and waveform utilizing an intracranial pressure monitor. Main outcome measurements: Radiographic union, avascular necrosis, revision surgery. Results: Nineteen patients (8 male, 11 female, average age 56 ± 21 years) with 20 femoral neck fractures were enrolled. Eight fractures were stable (Garden 1-2/OTA B1.1–1.3) and 12 were unstable (Garden 3-4/OTAB2.1–3.3). A waveform was present in 12 of 20 cases. The average pressures were systolic 36.8 mm Hg, diastolic 30.8 mm Hg, pulse pressure 6.0 mm Hg. A perfusion waveform was significantly associated with advanced age (P = 0.02) and accompanied by trend toward stable fracture patterns. There were 4 deaths during the 1-year follow-up period (20%), and there were 5 conversions to total hip arthroplasty (25%). There was no significant association between revision surgery or death with the absence of a waveform. Conclusions: Our study demonstrated the feasibility of a relatively low cost, minimally invasive, technique to quantify femoral head perfusion. In our limited sample, the absence of perfusion did not correlate with our main outcomes; however, the trend toward correlation with increased fracture displacement was as expected. A larger cohort of patients will be needed to detect a significant difference between those with and without a perfusion waveform with regards to our primary outcomes. Further study is needed to delineate the role such data may play in medical decision making at the time of index surgery. Level of Evidence: Prognostic Level II.

Introduction: The purpose of the study was to quantify the volume of graft that is obtained using sequential upsizing of reamers using the modularity of the second generation Reamer-Irrigator-Aspirator (RIA 2) system and determine any fracture or perforation risk with upsizing. We hypothesize that graft volume may be predicted using radiographic variables that can be measured before reaming. Materials and Methods: Eleven cadaveric specimens were used to evaluate the sequential amount of graft taken using the RIA 2 modular system. Each cadaveric specimen had bone graft harvested from the tibia and femur. Using a radiographic ruler, estimations of the canal size for both the femur and tibia were performed. Average graft volume with SD per incremental increase of reamer was calculated for both the femur and the tibia. Results: There were no perforations of the femur during any reaming. There were 5 perforations or fractures of the tibias during progressive reaming including 3 during the second pass and 2 during the third pass, with a significant increase in perforation in the tibial specimens (P=0.03). There was no significant difference in graft volume after 3 passes from either tibia or femoral harvesting. However, there was a significant decrease in graft volume on the second pass of the femur that was not seen in tibial harvesting (P=0.0013). Discussion: The RIA 2’s reamer head modularity allows multiple passes of the reamer, which gives surgeons the ability to upsize if more autograft is needed. Total autograft volume was similar between the femur and tibia; however, caution should be used in the tibia because of increased perforation risk. Level of Evidence: Level IV—therapeutic study.

Objectives:The objective of this study was to describe the relationship between positive toxicology screens and measures of preinjury mental health and physical function in an orthopaedic trauma populationDesign:This was a cross-sectional study.Setting:Urban Level 1 trauma center.Patients:A total of 125 trauma patients gave written consent for this study.Main Outcome Measurements:Questionnaires such as, Patient Health Questionnaire-9, General Anxiety Disorder-7, PCL-5, and Short Musculoskeletal Function Assessment, were used to survey patients after surgical intervention.Results:Patient Health Questionnaire-9 (P = 0.05) and PCL-5 (P = 0.04) were not found to have significant differences between positive and negative toxicology screens. Both General Anxiety Disorder-7 (P = 0.004) and Short Musculoskeletal Function Assessment function (P = 0.006) were significantly higher in patients with positive toxicology screens.Conclusions:Positive toxicology seems to be associated with preinjury anxiety. Patient reported preinjury function was not adversely affected by the presence of illicit substances or alcohol, nor were levels of post-traumatic stress disorder and depression found to be higher in patients with positive toxicology screens.Level of Evidence:Level IV Cross-Sectional Study.

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