Objective: To evaluate the difference in the quality of fracture reduction between the sinus tarsi approach (STA) and extensile lateral approach (ELA) using postoperative Computed Tomography (CT) scans in displaced intra-articular calcaneal fractures (DIACFs).Design: Retrospective.Setting: Level 1 and level 2 academic centers.Patients: Consecutive patients undergoing operative fixation of DIACFs with postoperative CT scans and standard radiographs.Methods: Patients were identified based on Current Procedural Terminology code and chart review. All operative calcaneal fractures treated between 2012 and 2018 by fellowship-trained orthopaedic trauma surgeons were evaluated. Those with both postoperative CT scans and radiographs were included. Exclusion criteria included extra-articular fractures, malunions, percutaneous fixation, ORIF and primary fusion, and those patients without a postoperative CT scan. The Sanders classification was used. Cases were divided into 2 groups based on ELA versus STA. Bohler angle and Gissane angle were evaluated on plain radiographs. CT reduction quality grading included articular step off/gap within the posterior facet, and varus angulation of the tuberosity:

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Purpose: Empiric antibiotic therapy for hand and upper-extremity infections aims to cover the most common causative organisms, which may change over time. The purpose of this study was to investigate the changes in the bacterial profile of upper-extremity infections over 2 decades at our institution. Methods: We performed a retrospective chart review of patients with upper-extremity infections treated at a single level 1 trauma center between 2001 and 2019. Patients older than 18 years who underwent surgical treatment for infection with operative cultures available were included. Patient demographics, comorbidities, and culture results were reviewed. Then, the distribution of organisms was analyzed for overall prevalence, and the profile of 2001e2010 was compared with that of 2010e2019 using a chisquare test. Results: A total of 237 patients (mean age, 43 years) met the criteria and were included in the study. Over the entire study period, the most isolated organism was Staphylococcus aureus, specifically the methicillin-resistant species. Methicillin-resistant S aureus remained the most common organism in both decades but declined over time from 47% in 2001e2010 to 27% in 2010e2019 (P < .05). There was a significant increase in the proportion of Streptococcus infections (from 6% to 17%; P < .05) and in polymicrobial infections (aerobic 8% to 28%, anaerobic 0% to 14%; P < .05). Enterobacter species were not isolated in 2001e2010 but comprised 13% of infections in the second decade (P < .05). Conclusions: Methicillin-resistant S aureus remains the most common organism isolated from upperextremity infections, though there has been a decline over the last 20 years. Conversely, Streptococcal spp., Enterobacter spp. and polymicrobial infections have increased. This study demonstrates longitudinal shifts in the distribution of bacteria responsible for upper-extremity infections at our institution, and these trends can be considered when choosing future empiric therapy. Type of study/level of evidence: Prognostic IV.

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Purpose: Thrower’s Elbow (TE) is an overuse injury of the medial elbow in pediatric, throwing athletes. The purpose of this study is to report the outcomes of TE in pediatric, throwing athletes. Methods: Between 1996 and 2018, 30 athletes at an average of 12.2 years old (range: 7.9 to 15.4 years old) were treated for TE. Demographic, radiographic, and treatment variables were recorded. Outcome measures included return to original position, inability to return to sport, surgery, premature physeal arrest, and recurrence of elbow pain. Results: Prior to their initial presentation, 25 athletes (25/30, 86%) stated they continued to throw despite arm fatigue/pain. At an average follow-up of 26 months (range: 6 months to 122 months), 22 athletes (22/30, 73%) returned to their original position at an average five months from their initial presentation. Recurrence of elbow pain occurred in 27 athletes (27/30, 90%). No athletes had premature physeal arrest of the medial epicondyle. Conclusions: The majority of athletes with TE returned to their original position or sport after initial treatment, but 90% of those athletes developed recurrent pain. It is important to educate athletes about overuse throwing injuries and prevention by adhering to established guidelines.