Various methods and devices are provided for bone screw fixation. In one exemplary embodiment, the methods and devices provide a bone fixation device that includes a receiving head having a recess adapted to seat a spinal rod therein and a shank extending distally from the receiving head. An anti-rotation mechanism can be located distal of a distal end of the receiving head and around a proximal portion of the shank, and it can be configured to interact with bone to prevent rotation of at least a portion of the bone fixation device relative to the bone.

Bone screw fixation

Provided are methods and systems for fabricating multimaterial bodies in a layer-wise fashion, which bodies may be used bone-stabilizing implants. The multimaterial bodies include rigid and flexible portions that are integrally formed with one another. The multimaterial bodies may be softened or stiffened in specific areas to match the biological or anatomical features of a bone.

Intergrated multi-material implants and methods of manufacture

Embodiments provide methods, apparatuses, and systems for fixation of a fractured bone. In various embodiments, the systems and plates may provide elastic suspension of the receiving holes relative to the osteosynthesis plate. This elastic suspension may promote load distribution between the screws that connect a bone segment to the plate, thereby reducing stress risers and load shielding effect. In addition, stress at the screw holes, and within the construct as a whole, is reduced by incorporation of these elastic elements in the plate. Additionally, in some embodiments, for instance if fracture healing by callus formation is desired, elastic suspension of the receiving holes relative to the osteosynthesis plate may enable small, controlled amounts of relative motion between bone fragments connected by the plate, which may promote fracture healing by callus formation.

Flexible plate fixation of bone fractures

Safety riding program and motorcycle-related injuries in Thailand.

Integrated, multidisciplinary team approach to the multiply injured patient can help optimize care, minimize morbidity, and reduce mortality. It also provides a framework for accelerated postinjury rehabilitation course. The characteristics and potential benefits of this approach, including team dynamics and interactions, are discussed in this brief review. Emphasis is placed on synergies provided by specialty teams working together in the framework of care coordination, timing of surgical and nonsurgical interventions, and injury/physiologic considerations. Republished with permission from: Bach JA, Leskovan JJ, Scharschmidt T, Boulger C, Papadimos TJ, Russell S, Bahner DP, Stawicki SPA. Multidisciplinary approach to multi-trauma patient with orthopedic injuries: the right team at the right time. OPUS 12 Scientist 2012;6(1):6-10.

The right team at the right time - Multidisciplinary approach to multi-trauma patient with orthopedic injuries.

An orthopedic fixation device for treating fractures has a body with holes to accept fasteners such as bone screws and pins. Either the fasteners, or the body, or both the fasteners and the body have a layer of bioresorbable material thereon. The bioresorbable material is on the shaft or head of the fasteners and when on the body surrounding one or more holes. Engagement between the fasteners and the body is initially through the bioresorbable material, which engagement rigidly fixes the relative angular orientation between the fastener and the body when the device is applied to a bone. As the bioresrobable material is resorbed the angular relation between the fastener and the body is no longer rigidly fixed, thereby effecting a transformation from rigid osteosynsthesis to flexible osteosynthesis to allow micromotion between the bone fragments which promotes healing.

Orthopedic fixation device with bioresorbable layer

OBJECTIVES To determine the independent risk factors associated with increasing costs and unplanned hospital readmissions in the 90-day episode of care (EOC) for isolated operative ankle fractures at our institution. DESIGN Retrospective cohort study. SETTING Level I Trauma Center. PATIENTS Two hundred ninety-nine patients undergoing open reduction internal fixation for the treatment of an acute, isolated ankle fracture between 2010 and 2015. INTERVENTION None. MAIN OUTCOME MEASURES Independent risk factors for increasing 90-day EOC costs and unplanned hospital readmission rates. RESULTS Orthopaedic (64.9%) and podiatry (35.1%) patients were included. The mean index admission cost was $14,048.65 ± $5,797.48. Outpatient cases were significantly cheaper compared to inpatient cases ($10,164.22 ± $3,899.61 vs. $15,942.55 ± $5,630.85, respectively, P < 0.001). Unplanned readmission rates were 5.4% (16/299) and 6.7% (20/299) at 30 and 90 days, respectively, and were often (13/20, 65.0%) due to surgical site infections. Independent risk factors for unplanned hospital readmissions included treatment by the podiatry service (P = 0.024) and an American Society of Anesthesiologists score of ≥3 (P = 0.017). Risk factors for increasing total postdischarge costs included treatment by the podiatry service (P = 0.011) and male gender (P = 0.046). CONCLUSIONS Isolated operative ankle fractures are a prime target for EOC cost containment strategy protocols. Our institutional cost analysis study suggests that independent financial clinical risk factors in this treatment cohort includes podiatry as the treating surgical service and patients with an American Society of Anesthesiologists score ≥3, with the former also independently increasing total postdischarge costs in the 90-day EOC. Outpatient procedures were associated with about a one-third reduction in total costs compared to the inpatient subgroup.

Cost Determinants in the 90-Day Management of Isolated Ankle Fractures at a Large Urban Academic Hospital.

BACKGROUND:: This study summarizes orthopedic injuries sustained in motorcycle collisions in patients presenting to a Level I trauma center. METHODS:: We performed a retrospective review of orthopedic injuries in motorcycle trauma victims brought into the emergency department. Of 2,634 presenting cases, 151 were identified as involving motorcycle collisions. Variables included age, gender, mechanism of injury, type and location of injury, concomitant injuries, length of hospitalization, number of orthopedic procedures during primary admission, and subsequent readmission. RESULTS:: A total of 71.5% of patients required orthopedic consultation. Average age was 35.0 years, with men injured at a ratio of 8:1. The most common mechanism of injury was motorcycle versus automobile (n = 48). A total of 206 fractures in 108 patients were discovered. The most common site of fracture involved the lower extremities. Open reduction with internal fixation was performed on 110 fractures (69 patients) during primary admission. Fifty-seven patients (52.8%) sustained open fractures requiring emergent orthopedic intervention. Fifty-three patients had various concomitant complications. Two patients died during initial hospitalization. Average hospitalization for patients without orthopedic consultation was 11.9 days versus 13.8 days with orthopedic consultation. The average number of orthopedic procedures performed on patients was 1.6. CONCLUSIONS:: Motorcycle collisions frequently involve patients in their working prime, thus placing substantial burden on the individual and society. Although these patients must continue to receive Level I trauma care, strengthened prevention and improved education efforts are warranted. Language: en

Incidence of orthopedic surgery intervention in a level I urban trauma center with motorcycle trauma.

The authors describe a novel technique of anterograde femoral intramedullary nail fixation for hip fracture using the starting guide pin as a blocking screw. This cost-effective technique uses fluoroscopic radiography to ensure the guidewire is within the posterior aspect of the femur on a lateral view, thereby minimizing the risk of anterior cortical femoral fractures.

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Placing femoral intramedullary nails in severely bowed femurs.

Background: Professional riders demonstrate increased risk factors for such injuries including both extensive time on the bike in addition to a possible underlying osteopenia secondary to the nonimpact nature of the sport. Hypothesis: Nonoperative management of stable, nondisplaced pelvic fractures in professional cyclists offers excellent results. Study Design: Case series. Methods: Three cases of professional cyclists with pelvic fractures were reviewed. Results: All 3 cyclists were able to return to professional competition and remain symptom free. Conclusion: Accurate early diagnosis of pelvic fractures, with the aid of computed tomography, is crucial. Early non-weightbearing with a progression to weightbearing as tolerated and early return to stationary training are appropriate. Accurate diagnosis and careful nonoperative management of stable, nondisplaced pelvic fractures in professional cyclists offers excellent results. Clinical Relevance: Accurate diagnosis of pelvic fractures in high-demand athletes with few complaints and no obvious findings on plain film radiographs. Control of weightbearing and competitive status to prevent injury progression. Gauged return to competition at professional level.

Susan P. Harding

Papers

Orthopedic fixation device with bioresorbable layer

Cost Determinants in the 90-Day Management of Isolated Ankle Fractures at a Large Urban Academic Hospital.

Incidence of orthopedic surgery intervention in a level I urban trauma center with motorcycle trauma.

Placing femoral intramedullary nails in severely bowed femurs.

Pelvic Fractures in Professional Cyclists: A Report of 3 Cases: