Synopsis from October 2016 OTA Conference

Posted by on Oct 25, 2016 | Comments Off on Synopsis from October 2016 OTA Conference

Infection Control – Nasal povidone decreases infection of the hip fracture stabilization in the elderly.

Vancomycin power or fluid placed in open fractures is most effective if used within six hours from injury. Vancomycin only works for 48 hours when placed in the wound.

Stability is necessary to treat infection. If a nail has been used for stabilization and infection occurs, leave the nail in. Studied extensively by Mike McKee at University of Toronto – 92A: 823

Tibia Plateau Fractures – Over reduce the tibia plateau fracture because many subside. Malalignment is the most important.

The posterior approach to treating tibia plateau fractures is becoming used more often because most of the articular malalignment is due to the posterior fractures. Start with a prone position – and then go to supine position.

Tibia Fractures – Immediate weight-bearing does not cause displacement.

Fixation of the fibula is now being questioned in tibia fractures. Some studies show it does not affect the long-term stability but I think this needs to be studied. I wonder if distal tibia fractures that are comminuted need further stability. If the fibula is overlapped, reduction is in valgus.

One study showed that close reduction and mini open reduction do not have differences in infection rate.

Humerus Fractures – Non-operative treatment failed 37% of the time.

Many distal femur fractures are reduced at 5 – 8° of valgus, but this has no clinical significance.

Femoral Neck Fractures – If a valgus hip osteotomy is performed, a 20 – 30° increase in valgus is enough.

Most common displacement of femoral neck fractures is shortening of the femoral neck.

Close reduction of femoral neck fractures results in less avascular necrosis than open reduction. Close reduction resulted in less re-operations than open reduction.

Subtrochanteric Fractures – Immediate weight-bearing as tolerated works best. There is less hospital stay and less re-operations. The HV plate is recommended for SIGN Surgeons.

Fracture Healing – Fractures treated earlier show more callous and faster healing. Fractures treated more than two weeks after injury show less callous and delayed healing. I have always questioned whether the late reduction causes the healing process to start over again.

Vitamin D – We know it plays a role, but the vitamin D level of the average person is not known. Wide difference of opinion regarding optimal doses given after fracture.

Open Fracture – We are developing algorithms for treatment of open fractures. Questions such as when to place immobilization. Which immobilization – plate, external fixator, or early nail fixation.

Role of Traction – Continuous traction to keep the fracture out to length from time of admission until surgery, will decrease operating time – Duane Anderson.

We are studying the time it takes to do surgery on patients who arrive late, compared with those who arrive within two weeks of surgery.

Reaming – We should study if there are lung symptoms after hand reaming. We know that there is lung compromise after power reaming. We also know that power reaming affects increase coagulant ability and therefore possibility of blood clots.

Cerclage – The dangers of nonunion when cerclage wires are placed around a fracture site was emphasized.

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