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Examining Critical Trends in Trauma Surgery

By April C. Bright

Two of the greater challenges that trauma surgeons face today are an increased number of complex fractures and complications from fractures. The Orthopaedic Trauma Association (OTA) convened for its annual meeting in October, and many of the themes that resonated in surgeon voices and research—areas ripe for device company product development—fell in line with those two issues.

For greater context, we spoke with Michael D. McKee, M.D., Chairman of the Department of Orthopaedic Surgery at the University of Arizona College of Medicine and Program Chair of the Annual Meeting. Dr. McKee outlined four areas of opportunity identified at the meeting: periprosthetic fractures, infection prevention, early weight-bearing recommendations and percutaneous pelvic fractures.

Periprosthetic Fractures

Dr. McKee: A number of papers and talks centered on the use of various implants to treat periprosthetic fractures, especially in the lower but also the upper extremities, because these fractures are becoming much more common. The number of patients who have multiple periprosthetic fractures is increasing, so now we’re seeing interprosthetic fractures—meaning a fracture not only below the total hip, for example, but below a total hip and above a total knee in the same leg.

One of the teaching points made by several authors was that if you have a total hip or bipolar hip and you break below it, rather than simply fixing the fracture, perhaps it’s time for orthopaedic surgeons to consider protection of the entire femur. Even if you have success with a fracture union, there is a much-increased rate of another fracture below your implant.

BONEZONE: What is your recommendation for femur protection?

Dr. McKee: In the previous example, you would need an implant that would go all the way down to the condyles, with screws across it, to help protect the entire femur at risk. Companies are designing and manufacturing such implants, or a surgeon may choose to maneuver a regular implant to do the job in that fashion.

Similarly, implants that are amendable to fix a fracture between a total knee and total hip will become more popular as time moves on, and I think a number of other authors thought the same thing.

For periprosthetic fractures, which often occur in older women, making them non-touch or weight-bearing afterward is counterproductive and impractical. We need to make our construct strong enough so that we can allow full weight-bearing after [surgery].

Read Dr. McKee's insight on infection prevention, weight-bearing loads and pelvic devices.  

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