Journal CME
8 Results
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Contains 4 Component(s), Includes CreditsNew!
Management of bicondylar tibial plateau fractures varies widely, and many surgeons may choose to proceed with dual-plate ORIF without clearly understanding when alternative constructs may achieve comparable healed radiographic outcomes. This gap exists because there may not be confidence in the radiographic expectations of suprapatellar intramedullary nailing constructs with supplemental fixation, especially regarding healed depression, widening, and proximal tibial alignment at union. This professional practice gap was identified through review of recent outcomes literature evaluating healed radiographic displacement and alignment after different fixation strategies for OTA/AO 41-C2/C3 injuries. Addressing this need can help surgeons make more evidence-informed construct selections in appropriately selected patients.
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The end stage renal disease patient has a unique risk and complication profile. Previous studies may have under-estimated the overall risk of mortality for distal femur and proximal femur fractures in this patient populations. The large retrospective study from Su et al. provides up to date data on these injuries to allow the orthopedic surgeon to appropriately counsel their patients pre-operatively and set expectations on post-operative risks. This study was also the first published to establish mortality risk of distal femur fractures in the ESRD population.
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Patients with external fixators who need an MRI may experience delayed diagnosis, delayed treatment, or incomplete preoperative evaluation, as many institutions lack evidence-based guidance on MRI policies. This gap reflects deficits in provider knowledge and institutional processes: survey data cited in the article showed that 90% of orthopaedic trauma surgeons reported delays in care related to MRI restrictions and 42% reported cases in which an indicated MRI could not be obtained, whereas this systematic review identified six Level IV studies with 358 MRI instances, no reports of serious patient harm, and only four early terminations without long-term sequelae. This activity will help learners interpret the available evidence and apply evidence-informed precautions and clinical judgment when considering MRI in patients with external fixation.
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While blunt open fractures have been studied extensively, complications after ballistic fractures have been less well reported. The correlation between injury characteristics, patient factors and treatment factors, has not been well delineated. For ballistic femur fractures, which are typically treated operatively, modifiable factors such as operative debridement and administration and timing of antibiotic prophylaxis have not been studied in relation to complications such as nonunion and infection. There is a need to better understand how these factors affect risks of complications to optimize treatment of these injuries.
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The CDC Surgical Wound Classification (SWC) is widely used across hospitals for surveillance and risk stratification of post-surgical infection; however, the application of the SWC has notable limitations when applied to orthopaedic trauma patients and may not adequately predict postoperative infection risk in lower extremity fractures. The lack of language relevant to orthopaedic fracture patients limits the application of the CDC SWC for this patient population. Given these shortcomings, an orthopaedic-specific surgical wound classification may improve risk stratification. This activity aims to enhance provider knowledge by addressing these limitations and exploring more comprehensive approaches to predicting infection in orthopaedic trauma.
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Despite the significant burden that infection and nonunion place on patients with long-bone fractures, many orthopedic providers are unaware of the full extent of their economic and quality-of-life impacts. This knowledge gap limits the ability of providers to appropriately prioritize preventive strategies and advocate for resource allocation. The current literature is sparse and lacks high-quality data, making it difficult for clinicians to base decisions on strong evidence. This CME activity addresses the need for increased provider awareness and understanding of the direct and indirect costs, as well as health utility impacts, of these complications.
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Hip fracture surgery is associated with significant morbidity and mortality in the post-operative period if not addressed expeditiously. Appropriate medical and cardiac optimization prior to surgery helps improve outcomes by preparing the patient for surgery physiologically. Extensive work-up and imaging however can delay definitive care without necessarily changing pre- or post-operative management. This manuscript aims to highlight appropriate indications for pre-operative cardiac imaging and demonstrate the negative outcomes associated with a delay to definitive surgery.
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Evidence may suggest that the risk of nonunion is higher after fixation of a humeral shaft fracture if it was initially treated non operatively. To the author’s knowledge, there has only been 1 other publication specifically looking at patients with humeral shaft fractures treated nonoperatively who went on to nonunion and the outcomes of their nonunion surgery. Nearly all the previously published research on outcomes after humerus nonunion surgery is of low quality, primarily consisting of under-powered case series that have ultimately been combined in systematic reviews. Surgeons and patients need better information to understand the current risk factors for persistent nonunion after fixation of a humeral shaft fracture that was treated non operatively.
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