Those of you who are subscribed to the Email discussion list ORT-L know that from time to time cases are submitted to that list with a request for advice. Many of these cases come from outside the US; they often involve complex or neglected injuries, infection or failed previous surgery. Most are great cases, similar to the types of cases that participants bring to fireside discussions at AO courses, and they represent a opportunity to learn and to teach. Potentially, these clinical dilemmas could serve as the starting point for some great discussion on these topics, which would benefit us all. Unfortunately, despite the fact that there are lots of great orthopaedic traumatologists on the list, many of whom are also great educators, the response to these cases has been poor or nonexistent.

I'm not sure why so few respond; I know orthopaedic traumatologists like to discuss difficult cases, because I've seen you at AO courses, OTA meetings, grand rounds and visiting lectures go on (and on and on sometimes) sharing your experience, knowledge, and opinions. I've seen an entire hour-long fireside spent on one case discussion. It may be simply a matter of being too busy, as we all are; or it may be that putting your opinions down in black and white where anyone can see it may inhibit some. I=ve heard some express the concern that they may incur some legal liability by commenting on cases submitted, if the subsequent surgery goes bad and the surgeon blames it on bad advice. This seems pretty far fetched; and it is hard to imagine that an orthopaedic traumatologist would be so timid and gutless as to be deterred from helping colleagues by such fears, so I suspect it is simply a matter of thinking that someone else will respond.

What I'd like to propose is that we develop a cadre of volunteers from the OTA and the list who will commit to responding to cases submitted to the list. Bill Burman has been very helpful in posting these cases to the HWB web server so that the images are easily displayed with a web browser. This electronic consultation unit would simply agree to review the cases and make some comments about options to consider, direct the surgeon to resources in the literature, or share experience with similar situations. With a few committed volunteers to stimulate the interaction, I expect that input and discussion will come from many more all over the world, and hopefully the list will develop into a useful educational avenue for us all. If you are willing to be part of the electronic consultation service, send me an email (anglenj@health.missouri.edu) and we'll start trying to use the list for this activity. You may even want to put together a case of your own to stimulate discussion - consider this a worldwide fireside discussion group.

This issue of the newsletter includes a number of opportunities for members to become active in OTA projects. Like any organization there tends to be a minority who seem to do everything. Now is a good time to expand the number of active, contributing members and increase the effectiveness of the organization.

Jeff Anglen, MD

The OTA Board met in Charlotte on Thursday prior to the opening of the annual meeting. Some of the business conducted:

Received a report from Ken Johnson and Bill Burman several electronic and/or web based educational projects. About 40% of the lectures from our Resident's Basic Fracture course have been captured in digital form - slides, graphics, text. Hopefully, the remaining lectures can be obtained in Charlotte. One problem has been obtaining copyright permission for some of the graphics to be used. They aim to have the whole course available in digital format, either on the web or on a CD, in the year 2000. Specialty Day Debates are now acccesible through the OTA website (www.ota.org). Five of 11 debates are up; 4 of 11 are ready to go, awaiting proof by the debators, 2 of 11 can't be completed because slides haven't been submitted by debators (anybody know Lane or Matta?). These are excellent, high quality educational material, and without any promotion have gotten hundreds of hits since February. They also discussed case based educational projects, options regarding electronic registration for the OTA's meetings and courses, and popular case presentations which are derived from the email discussion list and other lists.

Received officer reports:

Andy Pollack and Brad Henley gave a joint CFO report that showed the operations account doing well enough (despite a projected budget deficit due to increased management fees to AAOS) that we may consider a one time transfer of some funds from operations to research. The goal is to keep 1 year's operating expenses as a balance in the operations account. Both Specialty Day program and the Update course in Seattle finished in the black, somewhat more than expected and it is anticipated that the annual meeting will do well. The Research fund balance stand at $1.3 million, allowing a 15-20% increase in funds awarded this year.

Andy Burgess' president's report focussed on the Specialty Day program for AAOS 2000. This will include panels on managed care and trauma, pediatric trauma, and high energy trauma in the elderly. The guest speaker will be David Viano, MD,Ph.D from Saab discussing basic science and care crashes. Specialty Day last year had a total of 522 registrants, including 120 OTA members. Also discussed was the report of the Orthopaedic Trauma Quality Assurance committee in the form of a letter from Tim Bray. This ad hoc committee was set up a year ago to look at variation in the delivery of orthopaedic trauma care in different hospital settings and the possibilty of OTA guideline development. The Board suggested this issue be referred to the Health Policy and Planning committee for further development.

Old Business:

The Board received the report of Peter Trafton regarding the multispecialty Musculoskeletal Task Force on Documentation Guidelines. The purpose of this task force, which consisted of various orthopaedic specialists, rheumatologists, PM&R docs, podiatrists and chiropractors, was to propose to the AMA and to HCFA guidelines for documenting musculoskeletal physical examination. These guidelines, if adopted, should provide a higher level of credit for the work involved in a detailed musculoskeletal examination. This approach still involves counting elements recorded in the chart.

The Board received an update on the progress of the Bone and Joint Decade project. Efforts are proceeding to have the first decade of the next millenium designated as the Bone and Joint Decade, leading to a worldwide scientific, governmental, and societal emphasis on the problems of the musculoskeletal system. The OTA continues to support these efforts.

The OTA has begun the process of applying to have a seat in the AMA House of Delegates. Andy Pollack is handling that effort and went over the requirements and time frame. There are 4 orthopaedic organizations with seats: AAOS, AOS, NASS and AOFAS. The main benefit involves having a voice in policy decisions, for example with CPT and RVU issues. The process takes several years, and requires certain levels of membership in the AMA. All OTA members are encouraged to join the AMA if not already members so that we can get to the requisite levels.

New Business:

The Board heard a presentation from Chris Born regarding mass casualty preparedness and how systems are positioned to provide orthopaedic trauma care in the mass casualty or natural disaster situation. The Board created an ad hoc committee to study this issue with Dr. Born as chairman. The suggestion was made to have members from various parts of the country in order to get different regional input.

Paul Dougherty discussed liaison between OTA and the military on a variety of issues relating to education and training, and the involvement of orthopaedic traumatologists in training military surgeons. The Board created an ad hoc committee on this issue, with Dr. Dougherty as chairman.

AO North America has proposed funding a lectureship in honor of Hans Willenegger to be given as part of the annual meeting. The Board discussed and approved acceptance of this gift.

Medscape corporation has proposed online daily coverage of content at our annual meeting. They have, by report, 25 million physician users worldwide on their internet based news service, which provides a daily review of meeting content via the web. The Board had questions about the selection and editting process, and some concerns were raised about effects on attendance. The Board requested a formal proposal with details about the mechanics of the process.

Liaison committees:

Barry Riemer gave a report form the AAOS committee on trauma. Mitchel Harris was appointed to replace Hunt, Bruce Ziran was appointed to replace Anglen, and Larry Webb was re-appointed. Members are needed to review Instructional Courses at the AAOS meeting - free ICL tickets are available to any OTA members who will agree to provide evaluation of the course. Discussion of coordination for trauma courses was held, and the Board was generally favorable of joint sponsorship due to the problems of competing courses and conflicting schedules.

Brad Henley requested input of the Board into committee appointments. His desire is to broaden the involvement in the organization, and to focus on early involvement of younger trauma surgeons.

Committee Reports

Coding and Classification - Jim Kellam and Larry Webb discussed the orthopaedic trauma database, which is now complete and available to all members of the organization. They proposed contracting with the IMX corporation for ongoing support and development of the software. The database would still be free to OTA members, others would have to buy it from IMX. IMX would supply technical support, and a support webpage, and continued development. They also discusses the integration of our database with others such as ACS, and state registries.

Education - Jim Kellam discussed the various upcoming programs including the Resident=s course, and the update courses in Kansas City and Calgary for the coming year. Sites of future courses were solicited and the suggestion made that we need to go east for the next update course.

Membership - Mike Baumgaertner gave the report of the membership committee, and discussed the publication requirement, in specific, what is and is not a peer reviewed journal. A few individual issues were discussed. Two members were advanced from associate to active, 8 new active members were recommended, 12 new associate members and 7 new international members.

Research - Mike Bosse reported that the committee recommended awarding over $204,000 for eleven grants. He proposed a special award for a "young investigator". There will be a lunch on Friday at the annual meeting with members of industry to continue building good relationships. The research grants awarded by the OTA will be designated with a company name if that company has donated $20,000. The OTA multicenter studies on closure of open fracture wounds and prevention of DVT have been established - participating centers, protocol and IRB approvals have all been obtained. There are some problems with the costs of data collection and project coordination, in that costs have been higher than expected. If things can not be done cheaper, it may be necessary to proceed with only one of the projects at a time.

Nominations - David Helfet will chair the nominations committee, which has been elected by mail ballot of the OTA members. The slate of officers will be presented at the Specialty Day meeting in Orlando. Ofiices to be elected include President, Secretary, 2 at large positions on the Board of Directors, and 2 members of the membership committee.

Site Selection - Future meeting sites are: 2000 - San Antonio; 2001 - San Diego; 2002 -Toronto; 2003 - considering Salt Lake City, Seattle; 2004 - considering Tampa, Orlando, Palm Beach; 2005 - considering Halifax, Boston; 2006 - considering Milwaukee, Chicago, Minneapolis.

The research department of the television show "ER" is seeking ideas for story lines to be used on the show. They are interested in an orthopaedic trauma surgeon's perspective on what life is really like in the ER ( Lord knows they need it), and are seeking anecdotal real life experiences of a serious or humorous nature. This is one way to increase visibility for orthopaedic trauma surgeons and the issues they deal with. Contact Andy Burgess, Nancy Franzon at OTA headquarters, or Joanne Swanson at AAOS office if you have ideas. I know I have heard you all tell some great stories that I would love to see on TV.

OTA members are needed to review Instructional Course Lectures at the AAOS meeting in Orlando. Free tickets to the ICL are available to members wishing to evaluate the course. Contact Barry Riemer if you want to volunteer.

The International Center for Orthopaedic Education (ICOE) is a central facility for coordination of international exchange in postgraduate orthopaedic education between countries. They are interested in receiving information about postgraduate training opportunities such as: observerships, clinical "hands-on", research, service and teaching. These opportunites will be distributed worldwide and on the web. If you have a training spot or are interested in having one, whatever the degree of formality or time period, contact the ICOE. In addition, the ICOE is developing and worldwide master calendar database for listing upcoming events. Dr. Stuart Weinstein is the Chair of the ICOE; (847)-318-7349, www.aoassn.org

All OTA members are encouraged to support the designation of the next 10 years as the Bone and Joint Decade. Work through your state orthopaedic society to achieve state designation, and call 888-671-4900 to urge President Clinton to designate. More information is available, as well as resources to help spread the word, at: www.boneandjointdecade.org or contact the AAOS liason at: bjd@aaos.org

If you aren't a member of the AMA, join now. The OTA needs 250 members in order to get a seat in the AMA House of Delegates.

The OTA is currently organizing an educational project based on the recently published resident syllabus (J. Orthop. Trauma 13(6):441 - 455, 1999). We will be developing a slide show of each of the categories of the syllabus using a standard powerpoint template. This will eventually be made into a CD-ROM and possibly be available for purchase or distribution by the OTA. Any member who wishes to contribute to this project should contact Paul Tornetta at ptornetta@pol.net and they will be included inthe list of authors. Associate members are encouraged to participate.

If you don't smoke, don't start. Only you can prevent forest fires.

Any members desiring a copy of the Orthopaedic Trauma Database in Windows format and the instruction booklet, contact Nancy Franzon at headquarters.

The OTA HQ staff is pleased to announce that Michele L. Garrett has been hired to take over as meetings coordinator for Julie Van Selow who is not the director for the Knee society and for the AAHKS. Welcome aboard to Michele, thanks and best wishes to Julie!

Mark your calandars:

• OTA business meeting: Noon ­ 1:00 pm, Saturday 3/18/00, Orlando conventions Center, Rm. 311 A-D
• OTA members dinner, 6:00 pm, Saturday 3/18/00, Orlando Omni Rosen Hotel, Signature Room
• OTA annual meeting (jointly with the AAST), 10/13-10/15/00, San Antonio TX
• OTA resident's basic fracture course, 10/12-10/14/00, San Antonio TX
• OTA regional trauma update courses: Kansas City 4/14-4/16/00; Calgary 7/14-7/16/00
• Faculty: make your travel reservations early!

The research committee has awarded the following grants for the 1999 cycle:

• $20,000 ­ OTA/AONA: Grant Study to Prospectively Evaluated Reamed Intramedullary Nails in Tibial Fractures: A Multi-Centered Randomized Trial of Reamed Versus Non-Reamed Intramedullary Nailing.
  Gordon H. Guyatt, MD - McMaster University Health Sciences Ctr
• $19,552 ­ OTA/AONA Grant : Pharmacokinetic Properties, Toxicity & Antibacterial Efficacy of Polycaprolactone Tobramycin Rods in a Rabbit Osteomyelitis Model
  Jeffrey O. Anglen, MD ­ University of Missouri-Columbia
• $19,984 ­ OTA/Smith & Nephew Grant: The Effect of Tourniquet Control on Intramedullary Reaming
  Madhav A. Karunakar, MD ­ University of Michigan
• $19,984 ­ OTA/AONA Grant : Percutaneous Treatment of an Experimental Tibial Atrophic Non-Union: A Gene Therapy Approach in a Rabbit Model.
  Christian Latterman, MD - University of Pittsburgh, Ferguson Laboratory
• $26,774 - OTA/Zimmer Grant: Can Topical Antiseptics or Antibiotics Normalize the Bacterial Count of Superficial Dermal Abrasions, Effectively Extending the Safe Surgical Window for Closed Fractures?
  Laura S. Phieffer, MD - Carolinas Medical Center
• $20,000 ­ OTA Grant: A Comparison Between Dressing Changes and the Application of Subatmospheric Pressure in the Managemnet of Traumatic Wounds
  Lawrence X. Webb, MD - Wake Forest University School of Medicine
• $6,000 - OTA Grant: BMP Function in the Presence of Local Antibiotics
  Steven A. Olson, MD - UCDMC-Dept of Orthopaedics
• $14,825- OTA Grant: Characterization of Callus Mineralization and Collagen Using FT-IRI in the Rabbit Ulnar Model: The Effects of Rigid Fixation
  Joseph M. Lane, MD ­ Hospital for Special Surgery
• $19,581 - OTA/DePuy Ace Grant: Apoptosis in Articular Cartilage Injury
  Joseph Borrelli, Jr., MD ­ Washington University, School of Medicine
• $19,233 ­ OTA/AONA Grant: Expression of Indian Hedgehog and Bone Morphogenetic Proteins in Rats at 6 and 32 Weeks of Age.
  Ralph A. Meyer, Jr., PhD - Carolinas Medical Center
• $18,263 ­ OTA/Synthes Grant:Bone Morphogenetic Protein Treatment of the Infected Bone Defect.
  Andrew Schmidt, MD - Hennepin County Medical Ceter

Do you ever need access to orthopaedic trauma health policy and planning information? How about the ACS Optimal Resources, as well as ACS, AAST, AMA, and AAOS position papers on trauma care, and trauma systems. How about the basics of trauma prevention, or links to where it can be obtained? How about protocols, like those of EAST (Eastern Association for Surgery of Trauma), etc.? How about Trauma Care education resources, schedules, etc.? Please send us your thoughts and wishes. Would you like to volunteer to help organize, edit and maintain our OTA website? Contact Peter Trafton: Peter_Trafton@Brown.edu or Jeff Anglen: anglenj@health.missouri.edu

Criteria for initial appointment to and continuing participation on an orthopaedic trauma service are not universally agreed upon, and are potentially contentious. Some OTA members have expressed concern about this and have requested guidance from the Orthopaedic Trauma Association. The OTA Board felt that this was most often an issue in Community hospitals, which might be Level II or III Trauma Centers. The Committee seeks input from all OTA members who have experience and opinions regarding qualifications for membership on an orthopaedic trauma service. We would be most grateful for a copy of any established policy that your hospital might be using, together with your comments about how well that policy is working.

Additionally, we need input about what a Trauma Center hospital should provide for support of an orthopaedic trauma service. Attention should be paid to OR access, availability of support staff, equipment, and supplies, and to provisions for continuing care of orthopaedic trauma patients, particularly patients with limited insurance coverage who might need outpatient care which the attending orthopaedic surgeon may ultimately provide in his / her office. Should on-call orthopaedic surgeons be compensated for their on-call shifts? Should support be provided for their expenses related to the care of unfunded patients whom they treat incident to their on-call assignments?

Please email your thoughts to Peter_Trafton@brown.edu, or share and discuss them through the Electronic Forum (ORT-List)

Can OTA members participate in the policy decisions that significantly affect our professional lives -- government laws and regulations, organized medicine's positions, trauma system and trauma center policies and regulations, insurance company practices, etc.? How can a few hundred orthopaedic traumatologists change an often uninformed world that seems to set more and more limits upon what we hope to accomplish for our patients?

We offer no easy answers. But shouldn't we stay informed about public policies, try to affect them in their formative stages, and to educate policy-makers about the size and consequences of trauma as a public health problem, one that often requires good surgery for optimal treatment?

Your Health Policy & Planning Committee exists to help OTA members address these concerns. We stay in touch with the national political scene through the reports and surveillance of the Coalition for American Trauma Care, of which the OTA is a supporting member. You can view their reports, as well as participate in discussion of health policy and other issues by joining the OTA's Electronic Forum (e-mail list server). To subscribe, send an e-mail message to listproc@lists.missouri.edu. Leave the subject line blank. The message should read "subscribe ORT-L <your name>".

President Andy Burgess presented to our membership the reasons why OTA members should join two venerable medical organizations - the American College of Surgeons, the most effective representative of some 56,000 surgeons, and the American Medical Association, which represents over 300,000 US physicians and surgeons. (There were almost 621,000 practicing physicians in the US in 1998, expected to grow to 1.1 million by 2010.)

The Health Policy and Planning Committee strongly supports President Burgess's recommendations. By joining the ACS, we can become active, and hopefully influential in its Committee on Trauma (COT). As you know, the COT, through its Resources for the Optimal Care of the Injured Patient, just updated again this year, defines what a trauma center is. The COT also evaluates our trauma centers to verify whether or not they meet the standards. You should become a fellow of the ACS, and then join your State or Provincial Committee on Trauma. You can teach ATLS courses and participate in local trauma committee activities.

By joining the AMA, we help the OTA meet the percentage membership requirement that will gain us a seat on the AMA's CPT Update Committee. This offers influence like that of other orthopaedic subspecialties. (Just check out the CPT codes and RVUs the arthroscopists and spine surgeons have obtained for their procedures.) The alternative is to request other orthopaedic subspecialists to apportion for us the shrinking pie of third party reimbursement.. This decision is easy! Join the AMA. Also, become informed and active if you can with your local and state medical societies as well. Grass roots close politics can affect national policies as well as what goes on near home.

Assignment to the Health Policy and Planning Committee is made by the OTA Board of Directors. The Committee's activities are not closed, however. Expressions of interest and involvement are welcome. We need your input and participation. For example, the Board has asked that we consider what the OTA should expect from its support of the above-mentioned Coalition for American Trauma Care. What do you think.? Should we raise our support for this unique effort. (Our current $5000 per year is the minimum contribution expected of a sponsor.)

The Orthopaedic Trauma Fellowship Guidelines and the Curriculum for Orthopaedic Trauma Residence Training is currently posted on the OTA website. All are welcome to review and download them for educational purposes. These will probably be used as models by the RRC for other orthopaedic subspecialties and non-orthopaedic specialties. The committee is considering development of a CD-ROM program to go with the residency educational curriculum which would contain lectures, images, cases to teach orthopaedic trauma. The Committee invites constructive criticism and hopes to periodically update and refine both documents.

The Fellowship guide has been updated and is also available on the website. There are approximately 25 American programs and 5 Canadian programs with a combined total of about 50 trauma fellowship positions. Six of these programs are ACGME accredited. It is suggested that program directors review the material on the website for accuracy and contact either the Committee chair, or Nancy Franzon to make corrections.

Future initiatives for the Committee include mentoring programs and the marketing of trauma as a desirable subspecialty to pursue. In addition, the Committee will be looking at the possibility of setting up a common time at the San Antonio meeting in the form of a AJob Fair@ to allow an opportunity for potential candidates to interview with the programs rather than having to make multiple trips around the country.

As Chairman of the Orthopaedic Trauma Association's Annual Program Committee, I would like to thank all of you who were involved in the recent Annual Meeting in Charlotte, North Carolina. This was an extremely successful meeting. Over 600 people registered and attended the Scientific Meetings, over 400 which were non-members. In addition to this, there were 122 registrants involved with the Resident's Basic Course and over 250 people involved as company reps or exhibitors. The main meeting room and all the break out sessions remained full from the beginning to the end of the program. New things this year included 2 moderators per session, and designated discussors in one session on polytrauma/ fracture healing, which consisted of complex papers, difficult to discuss from the floor. Seventy two scientific papers and 120 posters were selected out of nearly 400 submissions. The quality of the resultant program is a direct reflection of the efforts involved.

This makes a very difficult act to follow though that is our task at hand. I once again come to you for your assistance. Please mark on your calendar two important dates. March 6, 2000 is the abstract application deadline. Please support us once again by submitting your work. The second date is October 12-14, 2000, the date for the next OTA Annual Meeting in San Antonio, Texas. This will be a combined meeting with AAST, which I am sure will provide for some extremely interesting and stimulating discussion and debate. If you have any suggestions or recommendations regarding this meeting, we would greatly look forward to hearing from you. I would like to thank everyone once again for your support in the past and ongoing support in the future. Please mark your dates, submit your abstracts and we look forward to seeing everyone on October 12, 2000 in San Antonio, Texas.

The following presentations have been selected as the highlight papers from the Annual Meeting to be presented during the Specialty Day program in Orlando.

• Open Reduction and Plating vs. Intramedullary Nailing for Diaphyseal Forearm Fractures: A Prospective Randomized Study
  Cory A. Collinge, MD; Dolfi Herscovici, Jr., DO, Florida Orthopaedic Institute, Tampa, FL
• Fluoroscopic Evaluation of the Cervical Spine in the Polytrauma Patient
  Mitchel B. Harris, MD; Steven C. Kronlage, MD; Phyllis Carboni, RN; Norman B. Chutkan, MD, Louisiana State University School of Medicine, New Orleans
• The Effect of Femoral Nailing on the Inflammatory System: Is There a Second Hit?
  Peter V. Giannoudis, MD; R. Malcolm Smith, MD; Mark C. Bellamy, MA; Robert A. Dickson, MA; Pierre J. Guillou, MD; St. James' University Hospital, Leeds, United Kingdom
• Feasibility of a Gene Therapy Approach for the Treatment of an Atrophic Non-union: An Experimental Study in Rabbits
  Christian Lattermann, MD; Janey D. Whalen, PhD; Axel Baltzer, MD; Kurt R. Weiss; Christopher H. Evans, PhD, DSc; Paul D. Robbins, PhD; Gary S. Gruen, MD, University of Pittsburgh, Orthopaedic Department, Pittsburgh, PA
• A Prospective Randomized Trial Comparing Reamed and Unreamed Intramedullary Nailing: An Analysis of Rates of Union
  James N. Powell, MD; Russell DeGroote, MD; Hans J. Kreder, MD; Ross K. Leighton, MD; Michael D. McKee, MD; Robert G. McCormack, MD: Robert J. Feibel, MD, Foothills Hospital, Calgary, Alberta, Canada
• Prospective Clinical Trial of the Less Invasive Stabilization (L.I.S.S.) for Supracondylar Femur Fractures
  Philip J. Kregor, MD; James P. Stannard, MD; Peter A. Cole, MD; Michael Zlowodski, MD; Jorge A. Alonzo, MD, University of Mississippi Medical Center, Jackson, MS
• Crush Syndrome after Proximal Femoral Fracture
  Ashima Garg, MD; O. Quaba, MA; Carol Hajducka, RGN; Margaret M. McQueen, MD, Edinburgh Orthopaedic Trauma Unit, Edinburgh, Scotland
• Overtightening of the Syndesmosis: Is It Really Possible?
  Paul Tornetta, III, MD; Fletcher Reynolds, MD; Jeffery Spoo, MD; Cassandra Lee, MD, Boston Medical Center, Boston, MA
• The Effect of Sacral Malreduction on the Safe Placement of Iliosacral Screws
  Mark Cameron Reilly, MD; Christopher M. Bono, MD; Behrang Litkouhi, BS; Michael S. Sirkin, MD; Fred F. Behrens, MD, Orthopaedic Trauma Service, New Jersey Medical School, Newark, NJ

There was an excellent response from the readership from the July issue of Fractoids. Here are the results of the last questionnaire:

Floating Shoulder Survey Results

1. How times in your career have you seen a floating shoulder injury (combined middle third clavicle fracture and glenoid neck fracture)?

Never (11%) 1-5 (33%) 6-10 (33%) 10-15 (0%) >15 (22%)

2. Do you believe that a combined middle third clavicle fracture and glenoid fracture

automically represents an unstable injury to the superior, suspensory mechanism of the shoulder?

Yes (50%) No (50%)

3. Do you use a CAT scan to evaluate the displacement of a floating shoulder injury?

Yes (60%) No (40%)

4. If both the clavicle and the glenoid neck fractures are nondisplaced, do you treat these injuries operatively?

Yes (10%) No (90%)

5. Do you think that stabilizing the clavicle fracture, stabilizes the glenoid fracture?

Yes (60%) No (40%)

6. If both the clavicle and the glenoid neck fractures are displaced, which fracture(s) do you operate on?

Clavicle (60%) Glenoid (10%) Both (30%) Neither (0%)

The next topic that has been selected is: The use of irrigation in compound fracture wounds

1. Do you routinely use irrigation fluid for grade 2 or 3 compound fracture wounds?

Yes No

2. What volume of irrigation fluid do you generally use for these wounds?

1 liter 3 liters 5 7 9 10 >10 liters

Other_________

3. What do you irrigate with?

Normal Saline______

Antibiotic solution______ Antibiotic in some bags only (which ones ?)___________

Antiseptic solution______

Detergent solution_______

Holy water______

Other___________________________________________

4. How do you irrigate the wound?

Bulb syringe Pulsatile irrigator Nonpulsatile irrigator Other________

5. Are you aware of any complications related to the use of orthopaedic irrigation?

Yes (please describe)_________ No

6. Do you redrape the extremity after irrigation of an open fracture wound, prior to internal fixation?

Yes No

7. Do you change any part(s) of your surgical attire after irrigating open fracture wounds, prior to internal fixation?

Gown and gloves Just gloves Nothing

We look forward to hearing your comments and presenting them in future issues of Fractoids. Please send all completed questionnaires by mail or e-mail to:

Craig S. Roberts, M.D.
Department of Orthopaedic Surgery
University of Louisville School of Medicine
3rd Floor ACB Bridge
Louisville, KY 40292
E-mail: craig.roberts@louisville.edu

The OTA does not endorse these technical points and formally disclaims any responsibility for their use.