No abstract

Objective: To examine the stability of plate (locking and non–) versus screw constructs in the fixation of these fractures. Methods: An anteromedial coronoid facet fracture (OTA/AO type 21–B1, O'Driscoll type 2, subtype 3) was simulated in 24 synthetic ulna bones that were then assigned to 3 fracture fixation groups: non–locking plate, locking plate (LP), or screw fixation. Each construct was first cycled in tension (through a simulated medial collateral ligament) and then in compression. They were then loaded to failure (displacement >2 mm). Fracture fragment displacement was recorded with an optical tracking system. Results: During tension testing, a mean maximum fragment displacement of 12 ± 13 and 14 ± 9 μm was seen in the locking and non–locking constructs, respectively. There was no difference in fragment motion between the plated constructs. All screw-only fixed constructs failed during the tension protocol. During compression testing, the mean maximum fragment displacement for the screw-only construct (64 ± 79 μm) was significantly greater than locking (9 ± 5 μm) and non–locking constructs (10 ± 9 μm). During load to failure testing, the maximum load to failure in the screw-only group (316 ± 83 N) was significantly lower than locking (650.4 ± 107 N) and non–locking constructs (550 ± 76 N). There was no difference in load to failure between the plated groups. Conclusion: Fixation of anteromedial coronoid fractures (type 2, subtype 3) is best achieved with a plating technique. Although LPs had greater stiffness, they did not offer any advantage over conventional non-LPs with respect to fracture fragment displacement in this study. Clinical Relevance: Isolated screw fixation showed inferior stability when compared with plate constructs for these fractures. This could result in loss of fracture reduction leading to instability and posttraumatic arthrosis.

Suture button constructs must be appropriately tensioned to maintain reduction and re-approximate the degree of physiological motion at the distal tibiofibular joint. These constructs also demonstrate overcompression of the syndesmosis; however, the clinical effect of this remains to be determined.

Objectives: As hospitals seek to control variable expenses, orthopaedic surgeons have come under scrutiny because of relatively high implant costs. We aimed to determine whether feedback to surgeons regarding implant costs results in changes in implant selection. Methods: This study was undertaken at a statewide trauma referral center and included 6 fellowship-trained orthopaedic trauma surgeons. A previously implemented implant stewardship program at our institution using a “red-yellow-green” (RYG) implant selection tool classifies 7 commonly used trauma implant constructs based on cost and categorizes each implant as red (used for patient-specific requirements, most expensive), yellow (midrange), and green (preferred vendor, least expensive). The constructs included were femoral intramedullary nail, tibial intramedullary nail, long and short cephalomedullary nails, distal femoral plate, proximal tibial plate, and lower-limb external fixator. Baseline implant usage from the previous year was obtained and provided to each surgeon. Each surgeon received a monthly feedback report containing individual implant utilization and overall ranking. Results: The overall RYG score increased from 68.7 to 79.1 of 100 (P < 0.001). Three of the 7 implants (tibial and femoral nails and lower-limb external fixation) had significant increases in their RYG scores; implant selections for the other 4 implants were not significantly altered. A decrease of 1.8% (95% confidence interval, 0.4–3.2, P = 0.01) was noted in overall implant costs over the study period. Conclusion: Our intervention resulted in changes in surgeons' implant selections and cost savings. However, surgeons were unwilling to change certain implants despite their being more expensive.