Table Of ContentOrthopedic 
Traumatology
An Evidence-Based Approach
Second Edition
Manish K. Sethi
William T. Obremskey
A. Alex Jahangir
Editors 
123
Orthopedic Traumatology
Manish K. Sethi  •  William T. Obremskey 
A. Alex Jahangir
Editors
Thomas J. Iorio  •  Michelle S. Shen 
Basem Attum
Associate Editors
Orthopedic 
Traumatology
An Evidence-Based Approach
Second Edition
Editors
Manish K. Sethi, MD William T. Obremskey, MD, MPH, MMHC
Department of Orthopedics Department of Orthopedics
Vanderbilt University Medical Center Vanderbilt University Medical Center
Nashville, TN, USA Nashville, TN, USA
A. Alex Jahangir, MD, MMHC
Department of Orthopedics
Vanderbilt University Medical Center
Nashville, TN, USA
Associate Editors
Thomas J. Iorio, BS Michelle S. Shen, BA
Department of Orthopedic Surgery   Department of Orthopedic Surgery  
and Rehabilitation and Rehabilitation
Vanderbilt University Medical Center Vanderbilt University Medical Center
Nashville, TN, USA Nashville, TN, USA
Basem Attum, MD, MS
Department of Orthopedic Surgery  
and Rehabilitation
Vanderbilt University Medical Center
Nashville, TN, USA
Section Editors
Mohit Bhandari, MD, PhD, FRCSC Mitchel B. Harris, MD, FACS
Division of Orthopedic Surgery Department of Orthopedic Surgery
McMaster University Brigham and Women’s Hospital
Hamilton, ON, Canada Harvard Medical School
Boston, MA, USA
Michael David McKee, MD, FRCS(C)
Division of Orthopedics, Department of Surgery   Cory A. Collinge, MD
St. Michael’s Hospital, University of Toronto Department of Orthopedic Surgery  
Toronto, ON, Canada and Rehabilitation
Vanderbilt University Medical Center
Paul Tornetta III, MD
Nashville, TN, USA
Department of Orthopedic Surgery
Boston Medical Center Roy Sanders, MD
Boston, MA, USA University of South Florida  
Department of Orthopedics 
Andrew H. Schmidt, MD
Florida Orthopedic Institute  
Department of Orthopedic Surgery
Tampa General Hospital 
Hennepin County Medical Center
Journal of Orthopedic Trauma
Department of Orthopedic Surgery Tampa, FL, USA
Unviersity of Minnesota
Minneapolis, MN, USA
ISBN 978-3-319-73391-3        ISBN 978-3-319-73392-0  (eBook)
https://doi.org/10.1007/978-3-319-73392-0
Library of Congress Control Number: 2018932331
© Springer International Publishing AG, part of Springer Nature 2013, 2018
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or 
part of the material is concerned, specifically the rights of translation, reprinting, reuse of 
illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, 
and transmission or information storage and retrieval, electronic adaptation, computer software, 
or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this 
publication does not imply, even in the absence of a specific statement, that such names are 
exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in 
this book are believed to be true and accurate at the date of publication. Neither the publisher nor 
the authors or the editors give a warranty, express or implied, with respect to the material 
contained herein or for any errors or omissions that may have been made. The publisher remains 
neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Printed on acid-free paper
This Springer imprint is published by the registered company Springer International Publishing 
AG part of Springer Nature.
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Foreword
When I wrote the foreword to the first edition of Orthopedic Traumatology: 
An Evidence-Based Approach in late 2011, I emphasized the progress in the 
orthopedic trauma community toward using, on a routine basis, the highest 
levels of evidence on which to base treatment decisions. The first edition of 
Orthopedic Traumatology has proven to fulfill that need as our community 
moves away from expert opinion in the form of standard textbook writing and 
toward aggregation of the highest levels of evidence. Not everything in ortho-
pedic trauma surgery is able to be studied with randomized trials, as many 
injuries are of low incidence such that well-done cohort studies are going to 
be the highest level of evidence available on which to base our treatment deci-
sions in the long run. However, the editors of the first edition – Drs. Sethi, 
Jahangir, and Obremskey – and the chapter authors provided the roadmap of 
level 1 and level 2 evidence for the most common conditions in orthopedic 
traumatology. This approach has proven to be extremely useful, with over 
17,000 downloads of this compilation.
In this second edition, the editors – now Drs. Sethi, Obremskey, and 
Jahangir – decided to add chapters on four new conditions that are relatively 
common. This includes chapters on elbow fracture dislocation, hip-pelvis- 
femoral neck fracture combination in younger patients, mid-foot fractures, 
and acute infection. These chapters all represent useful additions to the com-
pendium. All chapter authors have performed extensive and broad-reaching 
literature reviews to identify any high-level evidence that has been published 
since the first edition.
The result is a book which is very useful for teaching and, more impor-
tantly, for making individual treatment decisions and for developing proto-
cols for use in trauma centers. These highly committed and compulsive 
editors and authors have done a yeoman’s work in providing these collections 
of the highest level of evidence. I recommend this second edition with great 
enthusiasm,  as  it  is  the  continued  fulfillment  of  our  migration  toward 
evidence-b ased orthopedic trauma surgery for patient care.
Minneapolis, MN, USA  Marc Swiontkowski
v
Preface
As medicine makes a transition from volume to value, the need for evidence- 
based practice is of even greater importance. We undertook the process of 
creating this book to help residents, fellows, and practicing orthopedic sur-
geons understand the principles on which medical decisions are made and to 
provide them with a reference that explains the data and thought processes of 
leaders in orthopedic trauma patient care. Many “HOW” books are available 
on surgical technique. This book was designed and intended to be a “WHY” 
book that would help clinicians understand and make evidence-based deci-
sions on patient care.
We thank our many chapter authors – who are thought leaders and excel-
lent clinicians – for their astute evaluation of the literature and clear commu-
nication of treatment options.
The response and distribution of the first edition of this evidence-based 
book were so great that we felt compelled to provide a second edition. We 
hope this second edition continues the work started by the first edition to 
improve the knowledge depth of clinicians and the quality of care for patients.
Nashville, TN, USA  Manish K. Sethi, MD 
   William T. Obremskey, MD, MMHC, MPH 
   A. Alex Jahangir, MD, MMHC 
vii
Contents
Part I  Evidence-Based Medicine in Orthopedic Trauma Surgery
Mohit Bhandari
 1   Introduction to Evidence-Based Medicine . . . . . . . . . . . . . . . . .    3
Clary J. Foote, Mark Phillips, and Mohit Bhandari
Part II  Spine Trauma
Mitchel B. Harris
 2   Cervical Spine Clearance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   21
Daniel G. Tobert and Mitchel B. Harris
 3   Cervical Spine Fracture- Dislocation . . . . . . . . . . . . . . . . . . . . . .   31
Kevin R. O’Neill, Michelle S. Shen, Jesse E. Bible,  
and Clinton J. Devin
 4   Lumbar Burst Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   43
Daniel G. Tobert and Mitchel B. Harris
Part III  Upper Extremity Trauma
Michael David McKee
 5   Scapula Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   57
Peter A. Cole and Lisa K. Schroder
 6   Clavicle Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   71
Brian L. Seeto and Michael David McKee
 7   Proximal Humerus Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . .   83
Erik A. Lund and Paul S. Whiting
 8   Humeral Shaft Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  109
Basem Attum, Diana G. Douleh, William T. Obremskey, Bill 
Ristevski, and Jeremy A. Hall
 9   Distal Humerus Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  119
Lee M. Reichel, Andrew Jawa, and David Ring
ix
x Contents
 10   Elbow Fracture Dislocation . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  127
Chad M. Corrigan, Clay A. Spitler, and Basem Attum
 11   Distal Radius Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  139
Cameron T. Atkinson, Michelle S. Shen, Samuel A. Trenner, 
Philipp N. Streubel, and Jeffry T. Watson
Part IV  Acetabular, Hip, and Pelvic Trauma
Cory A. Collinge
 12   Acetabular Fractures in the Elderly . . . . . . . . . . . . . . . . . . . . . .  155
John C. Weinlein, Edward A. Perez, Matthew I. Rudloff,  
and James L. Guyton
 13   Pelvic Ring Injury I. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  171
Rita E. Baumgartner, Damien G. Billow, and Steven A. Olson
 14   Pelvic Ring Injury II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  181
Matthew D. Karam, Adam Keith Lee, and David C. 
Templeman
 15   Femoral Neck Fractures in the Elderly . . . . . . . . . . . . . . . . . . . .  191
David Polga and Robert T. Trousdale
 16   Intertrochanteric Femur Fractures . . . . . . . . . . . . . . . . . . . . . . .  201
Hassan R. Mir
 17   Femoral Neck Fractures in the Young Patient . . . . . . . . . . . . . .  211
Cory A. Collinge
Part V  Lower Extremity Trauma
Paul Tornetta III
 18   Diaphyseal Femur Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . .  223
Paul S. Whiting, Obioma V. Amajoyi, and Manish K. Sethi
 19   Distal Femur Fractures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  237
William M. Ricci, A. Alex Jahangir, and Christopher D. Parks
 20   Knee Dislocations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  249
Mahesh Kumar Yarlagadda, Frank R. Avilucea,  
Samuel Neil Crosby Jr, Manish K. Sethi,  
and William T. Obremskey
 21   Tibial Plateau Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  263
Jodi Siegel and Paul Tornetta III
 22   Closed Diaphyseal Tibia Fractures . . . . . . . . . . . . . . . . . . . . . . .  275
Michel A. Taylor, Marlis T. Sabo, and David W. Sanders
 23   Open Diaphyseal Tibia Fractures . . . . . . . . . . . . . . . . . . . . . . . .  287
Scott P. Ryan, Christina L. Boulton, and Robert V. O’Toole
Contents xi
Part VI  Foot and Ankle Trauma
Roy Sanders
 24   Pilon Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  305
Basem Attum, Vamshi Gajari, David P. Barei,  
and A. Alex Jahangir
 25   Trimalleolar Ankle Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . .  323
Conor Kleweno and Edward K. Rodriguez
 26   Calcaneus Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  335
Richard Buckley and Theodoros H. Tosounidis
 27   Talus Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  345
Hassan R. Mir and Roy Sanders
 28   Lisfranc Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  355
Basem Attum, Moses Adebayo, and A. Alex Jahangir
Part VII   Polytrauma, Infection, and Perioperative Management  
of the Orthopedic Trauma Patient
Andrew H. Schmidt
 29   Timing of Treatment in the Multiply Injured Patient . . . . . . . .  367
Kevin D. Phelps, Laurence B. Kempton, and Michael J. Bosse
 30   DVT Prophylaxis in Orthopedic Trauma . . . . . . . . . . . . . . . . . .  385
Keith D. Baldwin, Surena Namdari, Jeffrey Zhao,  
and Samir Mehta
 31   The Infected Tibial Nail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  395
Megan A. Brady, Seth A. Cooper, and Brendan M. Patterson
 32   Perioperative Optimization in Orthopedic Trauma . . . . . . . . .  405
Jesse M. Ehrenfeld and Michael C. Lubrano
 33   Management of Acute Postoperative Infection . . . . . . . . . . . . .  419
Frank R. Avilucea
 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  429
Contributors
Moses  Adebayo,  MD Department  of  Orthopedic  Surgery,  Howard 
University, Washington, DC, USA
Obioma V. Amajoyi, MD Department of Orthopedics and Rehabilitation, 
University of Wisconsin-Madison, University of Wisconsin Hospital and 
Clinics, Madison, WI, USA
Cameron T. Atkinson, MD Arlington Orthopedic Associates, Arlington, 
TX, USA
Basem Attum, MD, MS Department of Orthopedic Surgery, Vanderbilt 
University Medical Center, Nashville, TN, USA
Frank R. Avilucea, MD Department of Orthopedic Surgery, Division of 
Orthopedic Trauma, University of Cincinnati Medical Center, Cincinnati, 
OH, USA
Keith D. Baldwin, MD Children’s Hospital of Philadelphia, Department of 
Orthopedics, University of Pennsylvania, Philadelphia, PA, USA
David P. Barei, MD, FRCSC Harborview Medical Center, University of 
Washington, Department of Orthopedics, Seattle, WA, USA
Rita E. Baumgartner, MD Department of Orthopaedic Surgery, Duke 
University Medical Center, Durham, NC, USA
Mohit Bhandari, MD, PhD, FRCSC Division of Orthopedic Surgery, 
McMaster University, Hamilton, ON, Canada
Jesse E. Bible, MD, MHS Department of Orthopedics, Penn State Milton 
S. Hershey Medical Center, Hershey, PA, USA
Damien G. Billow, MD Department of Orthopedics, Cleveland Clinic, 
Cleveland, OH, USA
Michael  J.  Bosse,  MD Department  of  Orthopedic  Surgery,  Carolinas 
Medical Center, Charlotte, NC, USA
Christina L. Boulton, MD Department of Orthopedic Surgery, University 
of Arizona – Banner University Medical Center, Tucson, AZ, USA
Megan  A.  Brady,  MD Iowa  Methodist  Medical  Center,  Des  Moines 
Orthopedic Surgeons, West Des Moines, IA, USA
xiii