Importance Previous research has suggested that intrawound vancomycin powder reduces deep surgical site infections among patients with periarticular tibial fractures at high risk of infection. It is unknown whether the addition of tobramycin powder further decreases infection rates. Objective To compare whether the combination of tobramycin plus vancomycin vs vancomycin alone delivered as intrawound powder at the time of definitive fixation reduces deep surgical site infections. Design, Setting, and Participants Open-label, assessor-masked, randomized clinical trial conducted at 39 US trauma centers. Eligible patients were adults with an operatively treated periarticular tibial fracture (either tibial plateau or pilon) who met 1 of 3 criteria for elevated infection risk. Enrollment occurred between June 18, 2021, and December 12, 2024 (final follow-up, July 15, 2025). Interventions Intrawound tobramycin (1.2 g) plus vancomycin (1.0 g) powder vs intrawound vancomycin (1.0 g) powder delivered at the time of definitive fixation. Main Outcomes and Measures The primary outcome was a deep surgical site infection requiring surgical management within 182 days of definitive fracture fixation. Secondary outcomes included deep surgical site infections with pathogens that were gram-negative only, deep surgical site infections with at least 1 pathogen that was gram-positive, deep surgical site infections with polymicrobial cultures, deep surgical site infections with negative culture results, and cellulitis or skin infections treated only with antibiotics. Results Among the 1660 participants randomized, 1528 (mean age, 47.0 [SD, 14.3] years; 603 female [39.5%]; 925 male [60.5%]) were included in the primary analysis. Deep surgical site infections occurred in 51 of 753 participants (182-day probability, 7.4%) in the tobramycin plus vancomycin group and 47 of 775 participants (182-day probability, 6.6%) in the vancomycin alone group (hazard ratio, 1.11; 95% bayesian credible interval, 0.75-1.66; posterior probability of superiority, 29.7%). The threshold required for superiority was not reached for any secondary outcome. Conclusions and Relevance Among patients with operatively treated periarticular tibial fractures at high risk of infection, adding intrawound tobramycin powder to vancomycin powder at the time of definitive fixation did not reduce deep surgical site infections compared with vancomycin powder alone. Trial Registration ClinicalTrials.gov Identifier: NCT02227446

BACKGROUND:Midfoot osteoarthritis (OA) is commonly treated with intraarticular corticosteroid injections before surgical fusion. However, the impact of preoperative injection timing on postoperative outcomes remains unclear. This study evaluates the association between the timing of corticosteroid injections and postoperative 90-day complications and 1-year revision following midfoot arthrodesis. METHODS:We conducted a retrospective cohort study using the PearlDiver Mariner database (2015-2024), identifying 82 144 patients who underwent midfoot arthrodesis. Patients were stratified into 5 groups based on the timing of corticosteroid injection before surgery: ≤1 month, >1-2 months, >2-3 months, ≥3 months (reference), and no preoperative injection (control). Outcomes included 90-day postoperative complications and revision surgery within 1 year of the procedure. Multivariable logistic regression and Cox proportional hazards models were used to evaluate adjusted odds and time-to-event outcomes, respectively. RESULTS:Unadjusted 90-day complication rates were higher among injection cohorts than controls; however, in adjusted logistic models, odds of complications did not differ significantly vs the ≥3-months reference (unmatched and propensity-matched). In time-to-event analyses, preoperative injections administered within 3 months of surgery were associated with a significantly higher hazard of 1-year revision vs ≥3 months (HRs ~1.25-1.49). Older age, male sex, and greater comorbidity burden were also associated with higher risk. CONCLUSION:Preoperative corticosteroid injections administered within 3 months of midfoot arthrodesis were associated with increased rates of 1-year revision compared with injections given ≥3 months preoperatively, whereas adjusted odds of 90-day complications were similar across timing groups. These timing-related risks may inform preoperative planning for elective midfoot fusion but should be interpreted cautiously given the limitations of administrative claims data and residual confounding by indication. LEVEL OF EVIDENCE:Level III, retrospective cohort study.

CASE:Three patients aged 29, 30, and 38 with diabetes mellitus presented with medial tibial plateau fractures after the insidious onset of knee pain. All were treated with open reduction and internal fixation that failed early and required revision surgery. None were initially diagnosed with a neuropathic knee. In retrospect, the clinical scenario and fracture patterns were similar and should raise suspicion for charcot arthropathy. CONCLUSION:Atraumatic pain with a progressive deformity and fragmentation of the medial plateau are concerning for Charcot knee. Correct diagnosis is crucial to develop an appropriate treatment plan.

Case: Three patients aged 29, 30, and 38 with diabetes mellitus presented with medial tibial plateau fractures after the insidious onset of knee pain. All were treated with open reduction and internal fixation that failed early and required revision surgery. None were initially diagnosed with a neuropathic knee. In retrospect, the clinical scenario and fracture patterns were similar and should raise suspicion for charcot arthropathy. Conclusion: Atraumatic pain with a progressive deformity and fragmentation of the medial plateau are concerning for Charcot knee. Correct diagnosis is crucial to develop an appropriate treatment plan.

Importance:Previous research has suggested that intrawound vancomycin powder reduces deep surgical site infections among patients with periarticular tibial fractures at high risk of infection. It is unknown whether the addition of tobramycin powder further decreases infection rates. Objective:To compare whether the combination of tobramycin plus vancomycin vs vancomycin alone delivered as intrawound powder at the time of definitive fixation reduces deep surgical site infections. Design, Setting, and Participants:Open-label, assessor-masked, randomized clinical trial conducted at 39 US trauma centers. Eligible patients were adults with an operatively treated periarticular tibial fracture (either tibial plateau or pilon) who met 1 of 3 criteria for elevated infection risk. Enrollment occurred between June 18, 2021, and December 12, 2024 (final follow-up, July 15, 2025). Interventions:Intrawound tobramycin (1.2 g) plus vancomycin (1.0 g) powder vs intrawound vancomycin (1.0 g) powder delivered at the time of definitive fixation. Main Outcomes and Measures:The primary outcome was a deep surgical site infection requiring surgical management within 182 days of definitive fracture fixation. Secondary outcomes included deep surgical site infections with pathogens that were gram-negative only, deep surgical site infections with at least 1 pathogen that was gram-positive, deep surgical site infections with polymicrobial cultures, deep surgical site infections with negative culture results, and cellulitis or skin infections treated only with antibiotics. Results:Among the 1660 participants randomized, 1528 (mean age, 47.0 [SD, 14.3] years; 603 female [39.5%]; 925 male [60.5%]) were included in the primary analysis. Deep surgical site infections occurred in 51 of 753 participants (182-day probability, 7.4%) in the tobramycin plus vancomycin group and 47 of 775 participants (182-day probability, 6.6%) in the vancomycin alone group (hazard ratio, 1.11; 95% bayesian credible interval, 0.75-1.66; posterior probability of superiority, 29.7%). The threshold required for superiority was not reached for any secondary outcome. Conclusions and Relevance:Among patients with operatively treated periarticular tibial fractures at high risk of infection, adding intrawound tobramycin powder to vancomycin powder at the time of definitive fixation did not reduce deep surgical site infections compared with vancomycin powder alone. Trial Registration:ClinicalTrials.gov Identifier: NCT02227446.

Appropriate management of acute postoperative pain is critical for patient care and practice management. The purpose of this study was to determine whether postoperative pain score correlates with injury severity in tibial plateau fractures. A retrospective review of prospectively collected data was completed at a single academic level one trauma center. All adult patients treated operatively for tibial plateau fractures who did not have concomitant injuries, previous injury to the ipsilateral tibia or knee joint, compartment syndrome, inadequate follow-up, or perioperative regional anesthesia were included (n = 88). The patients were split into groups based on the AO/OTA fracture classification (B-type vs C-type), energy mechanism, number of surgical approaches, need for temporizing external fixation, and operative time as a proxy for injury severity. The primary outcome measure was the visual analog scale (VAS) pain score (average in the first 24 h, highest in the first 24 h, two- and six-week postoperative appointments). Psychosocial and comorbid factors that may affect pain were studied and controlled for (history of diabetes, neuropathy, anxiety, depression, PTSD, and previous opioid prescription). Additionally, opioid use in the postoperative period was studied and controlled for (morphine milligram equivalents (MME) administered in the first 24 h, discharge MME/day, total discharge MME, and opioid refills). VAS scores were similar between groups at each time point except the two-week postoperative time point. At the two-week postoperative time point, the absolute difference between the groups was 1.3. The groups were significantly different in several injury and surgical variables as expected, but were similar in all demographic, comorbid, and postoperative opioid factors. There was no clinical difference in postoperative pain between AO/OTA 41B and 41C tibial plateau fractures. This supports the idea of providers uncoupling nociception and pain in postoperative patients. Providers should consider minimizing extended opioid use, even in more severe injuries.

The incidence of hip fractures has continued to increase as life expectancy increases. Hip fracture is one of the leading causes of increased morbidity and mortality in the geriatric population. Early surgical treatment (<48 h) is often recommended to reduce morbidity/mortality. In addition, adequate pain management is crucial to optimize functional recovery and early mobilization. Pain management often consists of multimodal therapy which includes non-opioids, opioids, and regional anesthesia techniques. In this review, we describe the anatomical innervation of the hip joint and summarize the commonly used peripheral nerve blocks to provide pain relief for hip fractures. We also outline literature evidence that shows each block’s efficacy in providing adequate pain relief. The recent discovery of a nerve block that may provide adequate sensory blockade of the posterior capsule of the hip is also described. Finally, we report a surgeon’s perspective on nerve blocks for hip fractures.

This study aims to explore the prevalence of dysphagia, as well as mortality associated with dysphagia in the elderly population receiving surgical treatment for a hip fracture. A retrospective cohort study was completed at an academic level 1 tertiary care center. Patients older than or equal to 65 admitted with a hip fracture diagnosis from January 2015 to December 2020 (n = 617) were included. The main outcome was the prevalence of dysphagia and association with mortality. Secondary analysis included timing of dysphagia and contributions to mortality. Fifty-six percent of patients had dysphagia, and the mortality rates were higher in patients with dysphagia (8.9

Introduction Traumatic brain injuries (TBIs) can be difficult to diagnose and are often marginalized when compared to more obvious physical injuries. Despite this, recognition and early treatment can lead to improved outcomes. Even mild TBIs have the potential to cause significant long-term consequences for patients, which may affect their physical recovery from orthopaedic injuries. The objective of this study was to examine the incidence and treatment of TBI within the orthopaedic trauma population. Methods Inclusion criteria were all patients presenting after an acute trauma with an orthopaedic surgery consult over a continuous 3 month timeframe (n = 187). A retrospective review was completed at an academic tertiary referral trauma center. The primary outcome was the rate of TBI. Secondary outcomes included rate of TBI listed as a discharge diagnosis and rate of follow up plan. Several secondary variables were noted and their associations with TBI evaluated. Results 27 % of the 187 patients had an acute TBI. 61 % of TBI patients had the diagnosis listed in their discharge summary. 6 % had a follow up plan. The positive TBI group was associated with more high energy injuries (p = 0.032), average limbs involved (p = 0.007), upper extremity injury (p < 0.001), bilateral lower extremity injury (p = 0.004), and Injury Severity Score (p < 0.001). 82 % of patients with an acute TBI had an occupational therapy consult and 39 % had a neurosurgery consult. 24 % of patients with a TBI were admitted to the orthopaedic primary service. Conclusions Patients presenting after an acute trauma with orthopaedic injuries have high rates of TBI, but low rates of diagnosis and treatment. This lack of diagnosis and treatment can negatively impact recovery from orthopaedic injuries. Orthopaedic providers should be aware of the diagnostic criteria and initial treatment steps for TBI to ensure prompt and effective treatment, which has been shown to improve outcomes.

Objective: To identify reasons for nonmedical delays in femur, pelvis, and acetabular fracture fixation at an institution with a dedicated orthopaedic trauma room (DOTR) and an early appropriate care practice model. Design: Retrospective review of a prospective registry. Setting: Urban Level 1 trauma center. Patients/Participants: Two hundred ninety-four patients undergoing 313 procedures for 226 femur, 63 pelvis, and 42 acetabular fractures. Intervention: Definitive fixation. Main Outcome Measurements: Reasons for delays in fixation after hospital day 2. Results: Delays occurred in 12.5% of procedures (39/313), with 7.7% (24/313) having medical delays and 4.8% (15/313) having nonmedical delays. Nonmedical delays were most commonly due to the operating room being at-capacity (n = 6) and nonpelvic trauma specialists taking weekend call (n = 5). Procedures with nonmedical delays were associated with younger age (median difference −16.0 years, 95% confidence interval [CI], −28 to −5.0; P = 0.006), high-energy mechanisms (proportional difference [PD] 58.5%, 95% CI, 37.0–69.7; P < 0.0001), Thursday through Saturday hospital admission (PD 30.3%, 95% CI, 5.0–50.0; P < 0.0001), pelvis/acetabular fractures (PD 51.8%, 95% CI, 26.7–71.0%; P < 0.0001), and external fixation (PD 33.0%, 95% CI, 11.8–57.3; P < 0.0001). Conclusion: Only 4.8% of procedures experienced nonmedical delays using an early appropriate care model and a DOTR. Nonmedical delays were most commonly due to 2 modifiable factors—the DOTR being at-capacity and nonpelvis trauma specialists taking weekend call. Patients with nonmedical delays were more likely to be younger, with pelvis/acetabular fractures, high-energy mechanisms, external fixation, and to be admitted between Thursday and Saturday. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Objective: To evaluate S1 transsacral (TS) corridors on reformatted and nonreformatted computed tomography (CT) images to determine which most reliably identifies narrow corridors. Design: Retrospective cohort. Setting: Level 1 trauma center. Patients: Two hundred forty-five patients with operative pelvic ring injuries. Intervention: CT scan review. Main Outcome Measurements: Preoperative CT scans were evaluated to determine the width of the S1 TS corridor on standard axial nonreformatted (ANR), axial reformatted (AR), and coronal reformatted images. Sensitivity and specificity of each format to detect a narrow corridor (<10 mm on AR or coronal reformatted) were calculated. Patients with S1 TS screws were evaluated to determine the rate of screw breach with narrow corridors. Results: The axial width of the S1 TS corridor was consistently smaller on ANR versus AR images (mean difference 1.4mm, 95% confidence interval 1.1–1.5). The corridor width on ANR images was on average 86% of the AR measurement. ANR images had the highest sensitivity and specificity (100% and 98%) for detecting S1 TS corridors <10 mm. Fifty-three S1 TS screws were placed in corridors ranging 10–23 mm on AR images and 7–19 mm on ANR images. Four (57%) of the 7 screws placed in corridors less than 10 mm in width on ANR images breached the sacral cortex. Conclusion: Using ANR images to measure the S1 TS corridor consistently measured smaller widths than AR images and identified all narrow corridors. A high rate of screw breach was noted with screw placement in narrow corridors. Level of Evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Objectives: To determine the association of pelvic fracture displacement on lateral stress radiographs (LSRs) with the hospital course of patients with minimally displaced lateral compression type 1 (LC1) pelvic injuries. Design: Retrospective review. Setting: Level 1 trauma center. Patients/Participants: Twenty-eight adult patients with minimally displaced (<1 cm) LC1 injuries. Intervention: Nonoperative management. Main Outcome Measurements: Delayed operative fixation, days to clear physical therapy, mobilization, hospital length of stay, and total hospital opioid morphine equivalent dose. Results: LSR displacement was correlated with delayed operative fixation [r = 0.23, 95% confidence interval (CI) 0.05–1.11; P = 0.01], days to clear PT (r = 0.13, CI 0.01–0.28; P = 0.02), length of stay (r = 0.13, CI 0.006–0.26; P = 0.02), and opioid morphine equivalent dose (r = 19.4, CI 1.5–38.1; P = 0.03). A receiver operating characteristic curve for delayed operative fixation over LSR displacement had an area under the curve of 0.87. The LSR displacement threshold that maximized sensitivity and specificity for detecting patients who required delayed fixation was 10 mm (100% sensitivity and 78% specificity). Ten of the 15 patients with ≥10 mm of displacement on LSRs underwent delayed operative fixation for pain with mobilization at a median of 6 days (interquartile range 3.7–7.5). Patients with ≥10 mm of displacement on LSRs took longer to clear PT, took longer to walk 15 feet, had longer hospital stays, and used more opioids. Conclusions: LC1 fracture displacement on LSRs is associated with delayed operative fixation, difficulty mobilizing secondary to pain, longer hospital stays, and opioid use. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Summary: Small posterior wall rim fractures are typically stable; however, if incarcerated in the joint, they must be removed. It is possible to reduce the morbidity associated with open approaches by addressing these incarcerated fragments in a percutaneous manner. This allows the restoration of joint congruity and removal of the osteochondral fragment from the joint space. The following report details the surgical technique to accomplish this, and the results of a case series of patients who underwent this technique. The advantages include limiting the morbidity of an open approach. However, the surgeon must be prepared to convert to an open approach if percutaneous removal does not accomplish the goals of surgery—a concentric, stable hip joint.

Objectives: To determine whether displacement on lateral stress radiographs (LSRs) in patients with minimally displaced lateral compression type 1 pelvic ring injuries is associated with any demographic and/or injury characteristics. Design: Retrospective comparative cohort. Setting: Urban level 1 trauma center. Patients/Participants: Ninety-three consecutive patients with minimally displaced lateral compression type 1 injuries. Intervention: Displacement of pelvic ring injury on LSR (≥10 mm vs. <10 mm). Main Outcome Measurements: Demographic and injury characteristics (mechanism of injury, Nakatani rami classification, rami comminution, Denis zone, complete/incomplete sacral fracture, sacral comminution). Results: 65.6% of patients (n = 61) had ≥10 mm of displacement on LSR. On univariate analysis, displacement was associated with increased age [median difference 11: confidence interval (CI), 2–23], female sex [proportional difference (PD): 25.1%, CI, 3.9%–44.4%], Nakatani classification (type I PD: 27.9%, type II PD: −19.5%), and rami comminution (PD: 55.6%, CI, 35.4%–71.3%). On multivariate analysis, displacement was only associated with rami comminution (odds ratio: 16.48, CI, 4.67–58.17). Displacement was not associated with energy of injury mechanism, sacral fracture Denis zone, complete sacral fracture, sacral comminution, or bilateral rami fractures. Conclusions: Although rami comminution was the only variable found to be independently associated with displacement ≥10 mm on LSR, no single variable perfectly predicted displacement. Future studies are needed to determine whether displacement on stress radiographs should change the management of these injuries. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

To evaluate the value of three-dimensional (3D) computed tomography (CT) scans on the interobserver and intraobserver reliability of AO/Orthopaedic Trauma Association (OTA) and Young and Burgess (YB) classifications for pelvic ring injuries. Seven reviewers (four fellowship-trained orthopaedic trauma surgeons and three fellows) independently classified 36 pelvic ring injuries using radiographs and axial two-dimensional (2D) CT scan images and then repeated this process 2 months later with the addition of 3D CT images. Interobserver and intraobserver reliability was assessed. The interobserver reliability of the AO/OTA classification using 2D vs. 3D CT scans was considered fair (k 0.23, CI 0.17–0.29) vs. slight (k 0.16, CI 0.09–0.22), with no observed difference [mean difference (MD) − 0.07, CI 0.16–0.01]. The interobserver reliability of the YB classification using 2D vs. 3D CT scans was considered fair for both (k 0.37, CI 0.32–0.42, vs. 0.37, CI 0.30–0.45), with no observed difference (MD − 0.0005, CI − 0.08 to 0.08). The intraobserver reliability of the AO/OTA vs. YB classifications was considered fair (k 0.35, CI 0.26–0.44) vs. moderate (k 0.49, CI 0.40–0.57), with the YB classification having higher kappa value (MD 0.13, CI 0.01–0.26, p = 0.03). The addition of 3D CT scan reconstructions to radiographs and 2D CT did not improve the interobserver reliability of AO/OTA and YB classifications for pelvic ring injuries.

Background:Percutaneous screw fixation of the posterior pelvic ring is technically demanding and can result in cortical breach. The purpose of this study was to examine risk factors for screw breach and iatrogenic nerve injury.Methods:A retrospective review at a single level-one trauma center identified 245 patients treated with 249 screws for pelvic ring injuries with postoperative computed tomography (CT) scans. Cortical screw breach, iatrogenic nerve injury, and associated risk factors were evaluated.Results:There were 86 (35%) breached screws. The breach rate was similar between screw types (33% S1-iliosacral (S1-IS), 44% S1-transsacral (S1-TS), 31% S2-IS, and 30% S2-TS) and was not associated with patient characteristics, Tile C injuries, or corridor size or angle. The overall rate of screw revision for screw malpositioning was 1.2% (3/249). Iatrogenic nerve injuries occurred in 8 (3.2%) of the 249 screws. Screws that caused iatrogenic nerve injuries had greater screw breach distances (5.4 vs. 0 mm, MD 5, CI 2.3 to 8.7, p < 0.0001), were more likely to be S1-IS screws (88% vs. 47%, PD 40%, CI 7 to 58%, p = 0.006), more likely to be placed in Tile C injuries (75% vs. 44%, PD 31%, CI -3 to 55%, p = 0.04), and there was a trend for having a screw corridor size <10 mm (75% vs. 47%, PD 28, CI -6 to 52%, p = 0.06). Of the 7 iatrogenic nerve injuries adjacent to screw breaches, two nerve injuries recovered after screw removal, three recovered with screw retention, and two did not recover with screw retention.Conclusion:Screw breaches were common and iatrogenic nerve injuries were more likely with S1-IS screws. Surgeons should maintain a high degree of caution when placing these screws and consider removal of any breached screw associated with nerve injury.

Objectives: To evaluate the interobserver reliability of measured displacement and occult instability of minimally displaced lateral compression type 1 (LC1) fractures on lateral stress radiographs (LSRs) and to compare differences in displacement between LSR with the injured side down (ID) and up (IU). Design: Retrospective review. Setting: Urban Level 1 trauma center. Patients/Participants: Twenty-three adult patients with minimally displaced (<1 cm) LC1 injuries. Intervention: None. Main Outcome Measurements: Three orthopaedic surgeons measured the distance between the radiographic teardrops on LSR and supine anteroposterior pelvic radiographs to calculate dynamic fracture displacement. The interobserver reliability of the measured displacement, a continuous variable, was assessed by calculating the intraclass correlation coefficient. The interobserver reliability of occult instability (≥10 mm of displacement on LSR), a categorical variable, was assessed by calculating the kappa value. Matched-pairs analysis was performed to calculate the mean difference of measurements between observers and between ID and IU LSR. Results: The interobserver reliability of the measured displacement was excellent (intraclass correlation coefficient 0.93). The mean difference in measurements between observers ranged from −1.8 to 0.96 mm. The mean difference in the measured displacement between ID and IU LSRs for each observer ranged from −0.6 to 0.3 mm. There was 83% (19/23 cases) agreement on the presence of occult instability (≥10 mm of displacement on LSR) on both ID and IU LSRs. The interobserver reliability of occult instability was moderate (kappa 0.76). Conclusions: Measured fracture displacement and occult instability of minimally displaced LC1 injuries were reliably measured and identified on LSR, regardless of the laterality.

To assess the reliability of a standardized measurement of screw breach on postoperative computed tomography (CT) scans following percutaneous fixation of the posterior pelvic ring. Three orthopedic trauma surgeons independently utilized a standardized method of measuring posterior pelvic ring screw breaches on post-operative CT scan images. Breaches were measured as a continuous variable on sagittal images reformatted to be perpendicular to the screw on axial images. The inter-rater and intra-rater reliability of screw breach distance measurements was assessed. Measurements were performed on 42 screws in 20 patients. Screw types included S1-iliosacral (IS) (n = 16), S1-transsacral (TS) (n = 8), S2-IS (n = 2), and S2-TS (n = 16). Patients with varying degrees of screw breaches were chosen to test measurements across breach severities, including 0 mm (n = 10), ≤ 2 mm (n = 12), > 2 to 4 mm (n = 11), and > 4 mm (n = 9). The mean difference and 95

Summary: The use of antibiotic-impregnated cement as a local antibiotic delivery system is well-established as an adjunctive treatment for chronic osteomyelitis. Because the elution of antibiotics is a surface area phenomenon, the geometry of the cement is an important consideration. The antibiotic cement bead rouleaux technique is a simple and efficient method of bead fabrication that requires only 10 minutes of preparation time and readily available operating room supplies. The discoid structure of the beads provides 3 times the surface-area-to-volume ratio of a spherical bead, which facilitates antibiotic elution. Given the speed and ease of fabrication, along with optimized geometry, the antibiotic cement bead rouleaux is a useful addition to the surgeon's repertoire.

Objective: To determine what size S1-transsacral (TS) corridor is amenable to TS screw placement, as this is commonly used to identify sacral dysmorphism, and to determine if gender, ethnicity, or screw breach is associated with narrow corridors. Design: Retrospective review. Setting: Urban level-1 trauma center. Patients: Two hundred ninety patients with pelvic ring injuries and preoperative computed tomography (CT) scans. Intervention: Percutaneous posterior pelvic ring fixation. Main Outcome Measurements: The width of the S1-TS corridor was measured on the axial (inlet) and coronal (outlet) reformatted CT images. Patients with S1-TS screw fixation and postoperative CT scans were identified. Corridor size, gender, ethnicity, and screw breach were documented. Results: S1-TS screws were placed in 55 of the 290 patients. No S1-TS screws were placed in corridors less than 8 mm. Corridors of <8 mm were present in 114 (39%) of the 290 patients and were not associated with gender or ethnicity. S1-TS screws placed in small (<10 mm) versus large (>= 10 mm) corridors did not have a detectable difference in screw breaches (5 of 8, 62% versus 19 of 47 40%; difference, 22%, 95% confidence interval -14% to 52%) or median (interquartile range) screw breach distance [3 mm (2.5-4.8) versus 3 mm (1.2-4.8); difference, 0.9 mm; confidence interval -1.6 to 2.2]. Conclusion: These data are useful for the standardization of sacral dysmorphism reporting based on corridor size. Screw breaches were common irrespective of TS corridor size, emphasizing the small degree of error allowed by this procedure.