​​JOT Grand Rounds

JOTCase Reports are a web-based resource. Reference should by formatted according to journal style for the World Wide Web.  A useful tool to help you format your citation: https://www.citethisforme.com/cite/website

 

Upper Extremity​​

Open Reduction and Internal Fixation of a Distal Radius Fracture With a Volar Locking Plate: A Case Report

John Wyrick, MD​

Fracture of the distal radius is the most common fracture of the upper extremity and one of the most common fractures treated by orthopedists. With th​e population continuing to age, the annual incidence of more than 600,000 is expected to increase as well. ​Over the past 10 years, a more aggressive treatment approach has been adopted by the orthopaedic community with a 2-fold increase in the number of patients treated with surgery from 1998 to 2008. This includes an even larger increase in the number of fractures treated with open reduction and internal fixation (ORIF) with volar locking plates. Publication support provided by Stryker Trauma & Extremities​


Precontoured Plate Fixation With Interfragmentary Lag Screw Use in a Middle Third Clavicle Fracture Fixation

Alireza Naderipour, MD and Michael D. McKee, MD, FRCS(C)

Middle third clavicle fractures are common injuries that need surgical fixation in a certain subset of patients. The use of precontoured clavicle plates facilitates intraoperative fixation
and can reduce soft tissue irritation and hardware removal rates.We report a 46-year-old patient with a mid-shaft right clavicle fracture who was treated with this technique, which resulted in an excellent clinical outcome.  
Publication support provided by Stryker Trauma & Extremities

 

Lower Extremity


Erik Lund, MD and Hassan Mir, MD, MBA, FACS

Foot and ankle injuries can present with multiple fractures after high-energy trauma. The goal for complex combined injuries remains anatomic restoration of articular surfaces and overall alignment. Operative fixation may require a variety of plate and screw sizes for an optimal construct. This report demonstrates a case of a combined injury involving fractures of the ankle, talus, and calcaneus, where an assortment of mini-fragment implants were used. Sponsorship provided by Smith & Nephew, Inc           




John A. Scolaro, MD, MA

The concurrent use of plates and intramedullary nails has been described in the treatment of both acute and nonunited long bone fractures. This technique aids in the maintenance of reduction during nailing and if left in place, the plates can also serve to provide adjunctive fixation after nail placement. Read this case which demonstrates the use of mini-fragment plates and revision intramedullary nailing to successfully treat a complex segmental femoral malunion/nonunion. Sponsorship provided by Smith & Nephew, Inc. 

 

Fragment-Specific Pilon Fracture Fixation Using Mini Fragment Plates

Richard A. Lindtner, MD, PhD and Reza Firoozabadi, MD, MA

Surgical stabilization of pilon fractures is challenging and technically demanding. Anatomic reduction of the articular surface is often difficult to obtain and maintain. The objective of this article is to illustrate the successful use of mini fragment plates for fragment-specific pilon fracture fixation. Sponsorship provided by Smith & Nephew, Inc. 


High-Energy Pilon Fractures in the Elderly: A Case Report Highlighting Treatment Options and Strategies​

Michael T. Archdeacon, MD, MSE​

High-energy pilon fractures are complex injuries for which treatment recommendations have changed substantially over the past 4 decades.The appropriate treatment for a high-energy pilon fracture in an elderly patient has not been clearly established.  This report presents an open, complex intra-articular pilon fracture in an elderly patient who ultimately underwent uncomplicated ORIF and subsequent uneventful healing. Publication Support Provided by Stryker Trauma & Extremities​


Suprapatellar Nailing

​This video is narrated and features a surgical procedure completed by Dr. Joshua Langford at Orlando Regional Medical Center demonstrating the suprapatellar technique for tibial nail insertion using an insertion sleeve as part of the T2 Tibia Suprapatellar Instrument System.The demonstration includes patient positioning and incision as well as sleeve insertion and fixation into the tibia plateau, reaming and nail insertion.The video includes pre-nail and post-nail x-ray images demonstrating entry point, fracture reduction and final nail positioning. Publication support provided by Stryker Trauma and Extremities​


The Utility of Semi-Extended Tibial Nailing Utilizing the Suprapatellar Approach in the Treatment of an Open Proximal Tibial Fracture with Vascular Injury 

Daniel N. Segina MD and Ryan M. Wilson PA-C, MPAS

​The case demonstrates the utility of the suprapatellar nailing technique in the semi-extended position, particularly with the avoidance of vascular graft disturbance and prevention of malalignment. Publication Support Provided by Stryker Trauma & Extremities​.




Ginger Bryant MD

Treatment of tibial plateau fractures that involve the medial condyle can be challenging. The surgeon must determine if adequate fixation can be obtained, and more importantly maintained, from the commonly-used “lateral only” plate construct. This case presents a patient who sustained a medial tibial condyle fracture with lateral diaphyseal extension. Medial condyle reduction was obtained and the condylar fracture and the diaphyseal fracture extension were both treated with a medial locking plate only. Publication support provided by Stryker Trauma and Extremities​


A Missed Ipsilateral Femoral Neck Fracture in a Young Patient with a Femoral Shaft Fracture

Anthony V. Florschutz, MD, PhD,* Derek J. Donegan, MD,† George Haidukewych, MD et al.

Ipsilateral femoral neck-shaft fractures are uncommon but significant injuries that can present a diagnostic difficulty with respect to recognition of femoral neck component. Treating surgeons need to be attentive to the potential associated femoral neck fracture when managing femoral shaft fractures and consider its possibility even in the postoperative period. This case report describes a young male who was initially managed for an isolated femoral shaft fracture after a high-energy injury and was postoperatively diagnosed and treated for an ipsilateral femoral neck fracture.  Publication support by Biomet, Inc.


Evaluation and Management of an Unstable Intertrochanteric Fracture of the Femur

Harish Kempegowda, MS; Akhil Tawari, MS; Michael Suk, MD JD MPH FACS; Daniel S. Horwitz, MD

Unstable intertrochanteric fracture of the femur is one of the most commonly encountered orthopaedic injuries in the United States. A 63-year-old female sustained a highly unstable intertrochanteric fracture of the femur (OTA 31-A 3.3) and she was treated with a long cephalomedullary nail. Four months later, a solid union occurred at the fracture site with minimal limb length discrepancy and the patient regained her pre-operative functional status. This case report highlights the important points which must be considered in the treatment of an unstable intertrochanteric fracture with emphasis on preoperative evaluation, intraoperative management and post-operative protocol for a good outcome. Publication support provided by Biomet, Inc. 


Fixator-Assisted Femoral Lengthening Following Intramedullary Exchange Nailing for Subtrochanteric Non-union

Frank A. Liporace, MD and Richard S. Yoon, MD

Non-unions in the femur can be a severely debilitating condition.  Here, we present a 36 year-old male who presented three years following a motor vehicle accident, complaining of severe left thigh pain and a short left lower extremity. Publication support provided by Biomet, Inc.


Intramedullary Nailing of Sequential Bilateral Atypical Subtrochanteric Fractures and the Management of Distal Femoral Intraoperative Fracture: Contemporary Issues on a Case Report

Theodoros H. Tosounidis, MD,  Kalliopi Lampropoulou-Adamidou, MD, Nikolaos K. Kanakaris, MD, 

Long antegrade cephalomedullary nailing is the standard of surgical care of atypical subtrochanteric fractures of the femur. This case discusses the management of sequential bilateral atypical subtrochanteric fractures in an elderly female patient and the technical issues pertaining to nailing of such fractures. Publication support provided by Biomet, Inc. 

 

Pelvis Extremity

Isolated Anterior Intrapelvic Approach for Operative Reduction and Fixation of an Anterior Column Acetabulum Fracture With Superior Impaction

Matthew R. Garner, MD and H. Claude Sagi, MD​

Displaced fractures of the acetabulum in an aging population present unique challenges for the treating surgeon. Traditional extensile exposures and reduction techniques may be ill advised because of patient-related factors. This report presents operative reduction and fixation performed through an isolated anterior intrapelvic approach in an elderly patient with a displaced anterior column acetabulum fracture with superior dome impaction. Publication Support Provided by Stryker Trauma & Extremities​