Unicondylar tibial plateau fracture (TPF) is a common orthopaedic injury. Although some are treated nonsurgically with excellent results, many are treated operatively to achieve improved patient outcomes. Commonly utilized surgical treatment options include open reduction internal fixation (ORIF) and percutaneous treatment which may include arthroscopic reduction internal fixation (ARIF). The most used classification remains the Schatzker fracture classification. This article presents a review of the epidemiology, relevant anatomy, biomechanics, clinical presentation, diagnosis, and management of tibial plateau fractures.

Lockwood, Winthrop Charles MD; Wuthrich, Zachary R. MD, MS; Silvestri, Lorenzo MD Author Information

Background: There is a clear need for orthopaedic-specific protocols to minimize the risks of prolonged opioid use after surgery. The authors assessed the effect of an opioid-prescribing protocol on new persistent opioid use in patients who were treated surgically for fractures. The hypothesis of this study was that the protocol would reduce the rate of new persistent opioid use. Methods: The study cohort consisted of patients who were treated at a level 1 trauma center before and after implementation of an opioid prescribing protocol. One hundred twenty-two patients prior to protocol implementation and 103 patients after protocol implementation met inclusion criteria. The primary outcome measured was persistent opioid use more than 6 mo postoperatively. Results: There was a significant decrease in the rate of new persistent opioid use in the protocol group from 25% to 12%. The number of patients who needed to be treated to prevent one case of new persistent opioid use was eight. Age was a significant risk factor for new persistent opioid use. For each additional year in age, risk increased by 3%. Conclusions: The authors studied the effect of implementing a protocol for prescribing opioids at a Level 1 trauma center and found a statistically and clinically significant decrease in the rate of new persistent opioid use after implementation of the protocol. Increasing age was identified as an independent risk factor for new persistent opioid use. Level of Evidence: Level III.

Muzammil, Taimur Sohail MBBSa; Muzammil, Sohail MBBS, FRCSEd, FCPSb; Rao, Sajid Ejaz FCPS (Surg), FCPSc Author Information

Artificial turf is used commonly as an alternative to natural grass for athletic playing surfaces, primarily for its ease of maintenance, multi-use capability year-round, and cost. Prior studies have demonstrated increased biomechanical stresses at the shoe-surface interface on artificial turf when compared to natural grass. However, there is debate whether the altered shoe-surface interface confers additional risk for injury to athletes. The purpose of this study was to review the current literature on injury risk associated with artificial turf among various sports played on turf. The present study was a clinical review of the current literature regarding injury risk on artificial and natural turf. While playing surface generally does not appear to impact overall injury risk in soccer and rugby players, data is inconclusive among American football athletes. Lower-extremity injuries, in particular knee and ankle injuries, more commonly occur on artificial turf in comparison to natural grass. Surface and sport-specific shoes, third-generation artificial turf, and routine monitoring and maintenance have all been shown to reduce the risk of injury on artificial turf. When athletes must play on artificial turf, surface-specific strategies may be implemented to reduce their risk of injury. Future studies should be conducted to evaluate further these risk reduction strategies. Level of Evidence: Level V.

Background: This study’s goal was to compare outcomes in cemented and cementless total knee arthroplasty (TKA) in patients with a body mass index of 30 kg/m2 or greater or patients aged 65 yr or younger. Methods: A retrospective matched case-control study was performed on 400 consecutive primary TKAs at the same community-based teaching institution by a single fellowship-trained arthroplasty surgeon. One hundred and eighty-six patients met the inclusion criteria for the obese cohort (93 cementless, 93 cemented). One hundred and seventy-one patients met the inclusion criteria of 65 yr of age or younger cohort (85 cementless, 86 cemented). Charts were reviewed for demographics, TKA revisions, Knee Society Score-Knee (KSS-Knee), Knee Society Score-Function (KSS-Function), Knee Injury and Osteoarthritis Outcomes Scores for Joint Replacement outcome scores, and perioperative complications. Results: The average follow-up was 4 years (range 2.5 to 7 yr). Patients demonstrated improved change for minimal clinically important differences values in both the cementless and cemented TKA groups for KSS-Knee and KSS-Function in each cohort. Substantial clinical benefit had improved change for cementless TKAs in both KSS-Knee and KSS-Function scores; however, only the cementless TKA group achieved an improved change in substantial clinical benefit with KSS-Function. Knee Injury and Osteoarthritis Outcomes Scores for Joint Replacement scores were equivalent between both the cementless and cemented cohorts. Conclusions: This study was clinically significant as outcome data remained positive for longer term follow-up in patients with a body mass index of 30 kg/m2 or greater or those aged 65 yr or younger with cementless total knees. Level of Evidence: Level III.

Patel, Pratik G. FNB, DNB (Orth), DOrth; Bhambhu, Vivek FNB, MS (Orth); Mehendiratta, Dhanish MS (Orth); Dalvie, Samir MS (Orth), DOrth, FCPS, DNBE Author Information

Background: The authors compared two techniques for safe medial pin placement during fixation of supracondylar humeral fractures, namely closed pinning and mini-open pinning of medial wire insertion, and their effectiveness in protection against iatrogenic ulnar nerve injury. Methods: One hundred and nineteen patients with type 2 and 3 Gartland supracondylar humeral fractures (AO Foundation/Orthopaedic Trauma Association [AO/OTA] 13-M/3.1 II, III and IV) were included in this study after applying the exclusion criteria. All patients were managed with cross pinning with identification of two groups. The first group was for percutaneous pinning (N=63), and the second group for patients with medial open incision during medial wire insertion (N=56). All patients were evaluated for the incidence of nerve injury after surgery. Results: Nerve injury occurred in 12 of 119 patients. The estimated duration of follow-up was 43.6±10.2 wk. The results revealed nine patients who had ulnar nerve injury among both groups (group 1, N=8, group 2, N=1), with statistically better results in group 2 (P=0.02). The incidence of nerve injury was not found to be correlated with other variables, which included age, gender, type of fracture, number of Kirschner wires that were inserted, and the level of the surgeon. Conclusions: A medial mini-open incision decreased the risk of ulnar nerve injury during cross pin fixation in the treatment of displaced supracondylar humeral fractures, without additional morbidity. Level of Evidence: Level III.

Background: Internal fixation is the standard choice for treatment of posterior cruciate ligament (PCL) avulsion with a large bony fragment. However, it is not without complication. This study investigated PCL avulsions with large bony fragments to determine if conservative management resulted in acceptable outcomes. Methods: In a prospective cohort study, the outcome of conservative management of PCL avulsion with large bony fragment was evaluated in 40 patients. The inclusion criteria were a fracture size of more than 20 mm and a displacement of less than 2 mm. The outcomes were evaluated after 12 mo and included the evaluation knee range of motion and scoring of the modified Lysholm questionnaire and the International Knee Documentation Committee. Knee instability was checked by the drawer test and confirmed by stress radiography. Results: The mean patient age was 36.9±16.1 yr. The mean final knee range of motion (ROM) was 125.6±8.2 degrees. The mean Lysholm score was 92.3±6.1 points. Accordingly, the excellent, good, and fair results were observed in 29 (72.5%), eight (20%), and three (7.5%) patients, respectively. The mean International Knee Documentation Committee score of the patients was 94.2±5.3 points. Postoperative instability was seen in two patients. Nonunion was observed in two other patients. The size of the bony fragment was 30 and 32 mm in patients with nonunion. Conclusions: Conservative management of the PCL avulsion with a large bony fragment could result in acceptable outcome. However, application of this technique needs further characterization, particularly with respect to the size of bony fragment. Level of Evidence: Level II.

Background: Hip arthroplasty places a large economic burden on the United States healthcare system, and there is a need to better understand influencing factors to help prepare for and limit expenditures. We aimed to assess racial and socioeconomic factors that influence hospital charges and length of stay using the New York State population. Methods: This study used the publicly available New York Statewide Planning and Research Cooperative System (SPARCS) database to identify hip replacement cases from 2013 to 2016 in New York State. Multivariable logistic regression models were used to examine characteristic differences between white and black patients. Multivariable linear models were used to identify predictive variables for hospital charges and length of stay. Results: White patients had lower mean length of stay (3.61 vs. 4.35, P<0.0001) and hospital charges ($55,988 vs. $67,742, P<0.0001). Medicaid patients were more likely to be black compared to the privately insured (OR: 4.37, CI: 4.08 to 4.68). Black race predicted higher hospital charges and length of stay (P<0.0001). Medicaid predicted longer length of stay (P<0.0001). Conclusions: Racial and insurance-based disparities exist among hip replacement patients, and these factors influence length of stay and hospital charges. These tendencies should be noted by healthcare administrators to limit the economic burden of hip arthroplasty. Level of Evidence: Level III