Orthopedic Traumatology. An Evidence-Based Approach

Description

Foreword Preface Contents Contributors Part I: Evidence-Based Medicine in Orthopedic Trauma Surgery 1: Introduction to Evidence-Based Medicine Introduction Hierarchy of Research Studies Study Quality and the Hierarchy of Evidence Randomized Surgical Trials: An Overview of Specific Methodologies The Expertise-Based Design Parallel Trial Design Factorial Design Other Randomized Designs Special Considerations Within the Hierarchy Grades of Recommendation: From the Bench to the Operating Room Evidence-Based Orthopedics: Advances and Misconceptions Closing Comments References Part II: Spine Trauma 2: Cervical Spine Clearance GB: A 25-Year-Old Male with High-­Energy Blunt Trauma Case Presentation Interpretation of Clinical Presentation Interpretation of Radiographic Images Declaration of Specific Diagnosis Brainstorming: What Are the Treatment Goals and Options? Evaluation of the Literature Detailed Review of Pertinent Articles Alert and Asymptomatic Short-Term Cognitive Impairment Symptomatic Long-Term Cognitive Impairment Literature Inconsistencies Evidentiary Table and Selection of Treatment Plan References 3: Cervical Spine Fracture- MJ: A 43-Year-Old Female with Neck Pain and Paralysis Case Presentation Interpretation of Clinical Presentation Declaration of Specific Diagnosis Brainstorming: What Are the Treatment Goals and Options? Evaluation of the Literature Detailed Review of Pertinent Articles Medical Management Conservative Management Closed Reduction and Magnetic Resonance Imaging External Orthosis Surgical Management Intubation Patient Positioning Neuromonitoring Surgical Timing Surgical Approach Literature Inconsistencies Evidentiary Table and Selection of Treatment Method Definitive Treatment Plan References 4: Lumbar Burst Fractures HS: A 21-Year-Old Man with Severe Low Back Pain After a Fall Case Presentation Interpretation of Clinical Presentation Interpretation of Radiographic Imaging Declaration of Specific Diagnosis Brainstorming: What Are the Treatment Goals and Options? Evaluation of the Literature Classification Systems for Thoracolumbar Trauma Non-operative Treatment Operative Treatment Posterior Approach Anterior Approach Literature Inconsistencies Evidentiary Table and Selection of Treatment Method Predicting Outcomes References Part III: Upper Extremity Trauma 5: Scapula Fractures WT: A 19-Year-Old Male with Shoulder Pain Case Presentation Interpretation of Clinical Presentation Declaration of Specific Diagnosis Brainstorming: What Are the Treatment Goals and Options? Evaluation of the Literature Review of Pertinent Articles Conservative/Nonoperative Treatment Surgical Treatment Literature Inconsistencies Evidentiary Table and Selection of Treatment Method Definitive Treatment Plan Predicting Long-Term Outcomes References 6: Clavicle Fractures SW: A 45-Year-Old Male with Shoulder Pain Case Presentation Interpretation of Clinical Presentation Declaration of Specific Diagnosis Brainstorming: What Are the Treatment Goals and Options? Evaluation of the Literature Detailed Review of Pertinent Articles Conservative/Nonoperative Management Operative Management: Plate Fixation Operative Management: Intramedullary Fixation Evidentiary Table and Selection of Treatment Method Definitive Treatment Plan Predicting Long-Term Outcomes References 7: Proximal Humerus Fractures KN: A 67-Year-Old Female with Right Shoulder Pain Case Presentation Interpretation of Clinical Presentation Declaration of Specific Diagnosis Brainstorming: What Are the Treatment Goals and Options? Evaluation of the Literature Detailed Review of Pertinent Articles Part 1: Outcomes of Individual Treatment Methods Nonoperative Treatment Surgical Treatment Closed Reduction and Percutaneous Fixation External Fixation Tension Band Fixation Open Reduction Internal Fixation (ORIF) ORIF: Clinical Outcomes ORIF: Fracture Patterns and Technical Considerations Deltopectoral Versus Deltoid-Splitting Approaches What’s New? Intramedullary Nail Fixation Arthroplasty Hemiarthroplasty (HA) Reverse Total Shoulder Arthroplasty (RSA) Part 2: Comparison of Treatment Methods Nonoperative Versus Operative Treatment External Fixation/Tension Band Versus Nonoperative Treatment ORIF Versus Nonoperative Treatment The PROFHER Trial [104] HA Versus Nonoperative Treatment IMN Versus Nonoperative Treatment Comparison of Surgical Treatment Methods ORIF Versus IMN ORIF Versus HA ORIF Versus RSA HA Versus RSA Summary of Treatment Choice for KN Evidentiary Table and Selection of Treatment Method Definitive Treatment Plan and Prediction of Outcomes References 8: Humeral Shaft Fractures SM: A 34-Year-Old Female with Arm Pain Case Presentation Interpretation of Clinical Presentation Declaration of Specific Diagnosis Brainstorming: What Are the Treatment Goals and Options? Evaluation of the Literature Detailed Review of Pertinent Articles Nonoperative Treatment Operative Treatment External Fixation Minimally Invasive Plate Osteosynthesis Plate Osteosynthesis Versus Intramedullary Nailing Evidentiary Table and Selection of Treatment Method Definitive Treatment Plan Predicting Long-Term Outcomes References 9: Distal Humerus Fractures TR: 65-Year-Old Woman with Elbow Pain Case Presentation Interpretation of Clinical Presentation Declaration of Specific Diagnosis What Are the Treatment Goals and Options? Evaluation of the Literature Detailed Review of the Pertinent Articles Nonoperative Treatment Surgical Approach Plate Osteosynthesis Orthogonal Versus Parallel Plating Total Elbow Arthroplasty Management of the Ulnar Nerve Heterotopic Ossification Other Adverse Events Literature Inconsistencies Evidentiary Table and Selection of Treatment Method Definitive Treatment Plan Long-Term Outcomes References 10: Elbow Fracture Dislocation SL: A 44-Year-Old Male with Arm Pain Case Presentation Interpretation of Clinical Presentation Declaration of Specific Diagnosis Brainstorming: What Are Treatment Goals and Options? Evaluation of the Literature Detailed Review of Pertinent Articles Nonsurgical Treatment Surgical Management Radial Head Olecranon/Proximal Ulna/Coronoid Surgical Incision and Approaches External Fixation Literature Inconsistencies Evidentiary Table and Selection of Treatment Method Predicting Outcomes References 11: Distal Radius Fractures WS: 55-Year-Old Male with Wrist Pain Case Presentation Interpretation of Clinical Presentation Declaration of Specific Diagnosis Brainstorming: What Are the Treatment Goals and Options? Evaluation of the Literature Detailed Review of Pertinent Articles Nonoperative Treatment Operative Treatment Arthroscopic-Assisted Reduction Percutaneous and External Fixation Internal Fixation Evidentiary Table and Selection of Treatment Method Predicting Outcomes References Part IV: Acetabular, Hip, and Pelvic Trauma 12: Acetabular Fractures in the Elderly GV: 76-Year-Old Man with Left Hip Pain Case Presentation Interpretation of Clinical Presentation Declaration of Specific Diagnosis Brainstorming: What Are the Treatment Goals and Options? Evaluation of the Literature Detailed Review of Pertinent Articles Treatment Options Conservative/Nonoperative Treatment Operative Treatment Open Reduction Internal Fixation Limited Open Reduction and Percutaneous Fixation ORIF/Acute Total Hip Arthroplasty Delayed THA Selection of Treatment Method Definitive Treatment Plan Predicting Long-Term Outcomes References 13: Pelvic Ring Injury I DP: A 43-Year-Old Male with Pelvic Ring Injury Case Presentation Interpretation of Clinical Presentation Declaration of Specific Diagnosis Brainstorming: What Are the Treatment Goals and Options? Evaluation of the Literature Detailed Review of Pertinent Articles Conservative/Nonoperative Treatment Surgical Treatment Iliosacral Screw Distraction External Fixation Neural Decompression Low-Energy Traumatic Fractures of the Pelvis Literature Inconsistencies Evidentiary Table and Selection of Treatment Method Definitive Treatment Plan Predicting Long-Term Outcomes References 14: Pelvic Ring Injury II DP: 33-Year-Old Man with Pelvic Ring Injury Case Presentation Interpretation of Clinical Presentation Declaration of Specific Diagnosis Brainstorming: What Are the Treatment Goals and Options? Evaluation of the Literature Detailed Review of Pertinent Articles Conservative/Nonoperative Treatment Surgical Management Symphyseal Plating External Fixation Posterior Iliosacral Screw Fixation Literature Inconsistencies Evidentiary Table and Selection of Treatment Method Definitive Treatment Plan Predicting Outcomes References 15: Femoral Neck Fractures in the Elderly WO: A 65-Year-Old Female with Hip Pain Case Presentation Interpretation of Clinical Presentation Declaration of Specific Diagnosis Brainstorming: What Are the Treatment Goals and Options? Evaluation of the Literature Detailed Review of Pertinent Articles Nonoperative Management Operative Management Internal Fixation Arthroplasty Total Hip Arthroplasty Versus Hemiarthroplasty Unipolar Versus Bipolar Hemiarthroplasty Cemented Versus Uncemented Stem Fixation Evidentiary Tables and Selection of Treatment Method Predicting Outcomes References 16: Intertrochanteric Femur Fractures BB: A 79-Year-Old Male with Hip Pain Case Presentation Interpretation of Clinical Presentation Declaration of Specific Diagnosis Brainstorming: What Are the Treatment Goals and Options? Evaluation of the Literature Detailed Review of Pertinent Articles Conservative/Nonoperative Treatment Surgical Treatment Timing of Surgery Choice of Anesthesia External Fixation Arthroplasty Extramedullary Versus Intramedullary Fixation Literature Inconsistencies Evidentiary Table and Selection of Treatment Method Definitive Treatment Plan Predicting Long-Term Outcomes References 17: Femoral Neck Fractures in the Young Patient MW: A 22-Year-Old Female with a Pauwels’ III Right Femoral Neck Fracture Case Presentation Interpretation of Clinical Presentation Declaration of Specific Diagnosis Brainstorming: What Are the Treatment Goals and Options? Evaluation of the Literature Detailed Review of Pertinent Articles Surgical Management Surgical Timing Reduction Fixation Evidentiary Table and Selection of Treatment Method Definitive Treatment Plan Predicting Long-Term Outcomes References Part V: Lower Extremity Trauma 18: Diaphyseal Femur Fractures JM: 32-Year-Old Male with a Femoral Shaft Fracture Case Presentation Interpretation of Clinical Presentation Declaration of Specific Diagnosis Brainstorming: What Are the Treatment Goals and Options? Evaluation of the Literature Detailed Review of Pertinent Articles Conservative/Nonoperative Treatment Surgical Treatment Plate Fixation External Fixation Intramedullary Nail Fixation Antegrade Intramedullary Fixation Positioning Reduction Starting Point Reaming Rotation Timing of Intramedullary Nailing Outcomes Retrograde Intramedullary Fixation Indications Outcomes Literature Inconsistencies Evidentiary Table and Selection of Treatment Method Definitive Treatment Plan Predicting Long-Term Outcomes References 19: Distal Femur Fractures AC: 71-Year-Old Male with Knee Pain After Fall Case Presentation Interpretation of the Clinical Presentation Declaration of Specific Diagnosis Brainstorming: What Are the Treatment Goals and Options? Evaluation of the Literature Detailed Review of Pertinent Articles Nonoperative Management Operative Management Plate Fixation External Fixation Intramedullary Nail Arthroplasty Literature Inconsistencies Evidentiary Table and Selection of Treatment Method Definitive Treatment Plan Predicting Long-Term Outcomes References 20: Knee Dislocations MS: 33-Year-Old Male with Knee Pain Case Presentation Interpretation of Clinical Presentation Declaration of Specific Diagnosis Brainstorming: What Are the Treatment Goals and Options? Evaluation of the Literature Outcome Measurements Detailed Review of Pertinent Articles Nonoperative Versus Operative Management Early Repair Versus Late Repair Open Versus Arthroscopic Cruciate Repair Repair Versus Reconstruction Hinged External Fixator Literature Inconsistencies Evidentiary Table and Selection of Treatment Method Predicting Long-Term Outcomes References 21: Tibial Plateau Fractures AB: 55-Year-Old Female with Leg Pain Case Presentation Interpretation of Clinical Presentation Declaration of Specific Diagnosis Brainstorming: What Are the Treatment Goals and Options? Evaluation of the Literature Detailed Review of Pertinent Articles Non-operative Treatment Operative Treatment Acute Internal Fixation Hybrid External Fixation with Limited Open Treatment of the Joint Surface Staged Columnar Fixation Spanning External Fixation and Delayed Open Reduction and Internal Fixation Evidentiary Table and Selection of Treatment Method Definitive Treatment Plan Predicting Outcomes References 22: Closed Diaphyseal Tibia Fractures Case Presentation AJ: 31-Year-Old Male with Leg Pain Interpretation of Clinical Presentation Declaration of Specific Diagnosis Brainstorming: What Are the Treatment Goals and Options? Evaluation of the Literature Review of Pertinent Articles and Evidence Non-operative Management Operative Management Plate Osteosynthesis External Fixation Intramedullary Fixation Healing Adjuncts Limitations of the Literature Evidentiary Table and Selection of Treatment Method Definitive Treatment Plan Predicting Outcomes References 23: Open Diaphyseal Tibia Fractures MI: A 24-Year-Old Male with Leg Pain Case Presentation Interpretation of Clinical Presentation Declaration of Specific Diagnosis Brainstorming: What Are the Treatment Goals and Options? Evaluation of the Literature Antibiotics Systemic Antibiotics Local Antibiotics Operative Irrigation and Debridement Predebridement Cultures Timing of Initial Debridement Irrigation Debridement Fracture Treatment Options Casting Unilateral External Fixation Intramedullary Nail Nailing After Provisional Ex-Fix Plate Osteosynthesis Definitive Uniplanar External Fixator Ring External Fixation Soft Tissue Coverage Use of the Wound VAC Timing of Definitive Coverage and Evidentiary Table Definitive Treatment Plan Predicting Outcomes References Part VI: Foot and Ankle Trauma 24: Pilon Fractures JA: 47-Year-Old Male with Ankle Pain Case Presentation Interpretation of Clinical Presentation Declaration of Specific Diagnosis Brainstorming: What Are the Treatment Goals and Options? Evaluation of the Literature Detailed Review of Pertinent Articles Conservative/Non-operative Treatment Operative Treatment Immediate Open Reduction and Internal Fixation Staged Open Reduction and Internal Fixation External Fixation Minimally Invasive Plate Osteosynthesis (“Biologic Fixation”) Comparative Studies Importance of Articular Reduction Literature Inconsistencies Evidentiary Table and Selection of Treatment Method Predicting Outcomes References 25: Trimalleolar Ankle Fractures AG: A 30-Year-Old Female with Ankle Pain Case Presentation Interpretation of Clinical Presentation Declaration of Specific Diagnosis Brainstorming: What Are the Treatment Goals and Options? Evaluation of the Literature Detailed Review of Pertinent Articles Conservative/Non-operative Treatment Operative Treatment Surgical Indications External Fixation Plating vs. Screws Screws Plating Postoperative Care Literature Inconsistencies Definitive Treatment Plan Evidentiary Table and Selection of Treatment Method Predicting Outcomes References 26: Calcaneus Fractures RF: A 22-Year-Old Male with Foot Pain Case Presentation Interpretation of Clinical Presentation Declaration of Specific Diagnosis Brainstorming: What Are the Treatment Goals and Options? Evaluation of the Literature Detailed Review of Pertinent Articles Non-operative Treatment Surgical Options Minimally Invasive Reduction and Fixation Open Reduction and Internal Fixation Subtalar Fusion Recent Review Papers and Literature Inconsistencies [14, 18–21] Evidentiary Table and Selection of Treatment Method Definitive Treatment Plan Predicting Long-Term Outcomes References 27: Talus Fractures EQ: 42-Year-Old Female with Ankle Pain Case Presentation Interpretation of Clinical Presentation Declaration of Specific Diagnosis Brainstorming: What Are the Treatment Goals and Options? Evaluation of the Literature Detailed Review of Pertinent Articles Conservative/Nonoperative Treatment Temporizing Treatment Operative Approaches Timing of Surgery Surgical Approach Fixation Literature Inconsistencies Evidentiary Table and Selection of Treatment Method Definitive Treatment Plan Predicting Long-Term Outcomes References 28: Lisfranc Injuries ST: 28-Year-Old Male with Foot Pain Case Presentation Interpretation of Clinical Presentation Declaration of Specific Diagnosis Brainstorming: What Are the Treatment Goals and Options? Evaluation of the Literature Detailed Review of Pertinent Articles Epidemiology, Anatomy, and Classification Anatomy Conservative Management Operative Management Open Reduction and Internal Fixation and Primary Arthrodesis Closed Reduction and Percutaneous Pinning External Fixation Literature Inconsistencies Evidentiary Table and Selection of Treatment Method Definitive Treatment Plan Predicting Long-Term Outcome References Part VII: Polytrauma, Infection, and Perioperative Management of the Orthopedic Trauma Patient 29: Timing of Treatment in the Multiply Injured Patient RJ: A 19-Year-Old Male with Multiple Injuries Case Presentation Interpretation of Clinical Presentation Declaration of Specific Diagnoses Brainstorming: What Are the Treatment Goals and Options? Evaluation of the Literature Timing of Femoral Fixation, Mortality, and Fat Embolism Syndrome/Adult Respiratory Distress Syndrome Timing of Femoral Fixation in the Multiply Injured Patient with Thoracic Trauma Timing of Femoral Fixation in the Setting of Hypoperfusion Methods of Femoral Stabilization in the Multiply Injured Patient Provisional Stabilization Reamed Nailing Versus Unreamed Nailing RIA Versus Standard Reamer Intramedullary Versus Plate Fixation Literature Inconsistencies Evidentiary Table and Selection of Treatment Method Definitive Treatment Plan Predicting Outcomes References 30: DVT Prophylaxis in Orthopedic Trauma KW: A 45-Year-Old Male with a Transverse Posterior Wall Acetabular Fracture and Femur Fracture Case Presentation Interpretation of the Clinical Presentation Declaration of Specific Diagnosis Brainstorming: What Are the Treatment Goals and Options? Evaluation of the Literature Detailed Review of Pertinent Articles Mechanical VTE Prophylaxis Pharmacologic Chemoprophylaxis Surgical Treatment Literature Inconsistencies Evidentiary Table and Selection of Treatment Method Definitive Treatment Plan Predicting Outcomes References 31: The Infected Tibial Nail GL: Fifty-Four-Year-Old Male with Leg Pain Case Presentation Interpretation of Clinical Presentation Declaration of Specific Diagnosis Brainstorming: What Are the Treatment Goals and Options? Evaluation of the Literature Detailed Review of Pertinent Articles Hardware Removal Versus Retention, Surgical Debridement, and Fracture Stabilization Hardware Removal, Surgical Debridement, and External Fixation Hardware Removal, Surgical Debridement, Temporary Antibiotic Nail, and Revision Intramedullary Nail Placement Evidentiary Table and Selection of Treatment Method Definitive Treatment Plan Predicting Outcomes References 32: Perioperative Optimization in Orthopedic Trauma KN: 81-Year-Old Female with Hip Pain Case Presentation Interpretation of Clinical Presentation Declaration of Specific Diagnosis Brainstorming: What Are the Treatment Goals and Options? Evaluation of the Literature Detailed Review of Pertinent Articles Preoperative Medical Evaluation and Optimization General Anesthesia Regional Anesthesia Neuraxial Anesthesia Peripheral Nerve Blockade Literature Inconsistencies Evidentiary Table and Selection of Treatment Method Definitive Treatment Plan Predicting Long-Term Outcomes References 33: Management of Acute Postoperative Infection AA: A 33-Year-Old Male with Knee Pain Case Presentation Interpretation of Clinical Presentation Declaration of Specific Diagnosis Brainstorming: What Are the Treatment Goals and Options? Evaluation of the Literature Detailed Review of Pertinent Articles Bacterial Pathogenesis/Biofilm Maintenance of Hardware PO Versus IV Antibiotics Antibiotic Choice and Duration Evidentiary Table and Selection of Treatment Method Definitive Treatment Plan Predicting Outcomes References Index