Although fractures are the most frequently treated orthopedic injuries, and have been for centuries, some aspects of their care remain controversial and other areas become controversial as newer information comes to light. This issue of Orthopedic Clinics of North America highlights a few of these areas.
The first three articles, although they deal with total joint arthroplasty rather than fractures, highlight the importance of patellofemoral offset in total knee arthroplasty, controversies in deep vein thrombosis prophylaxis with warfarin, and inpatient compared with outpatient arthroplasty.
In the next section, Rozell, Connolly, and Mehta challenge the long-standing dictum that open fractures should be debrided within 6 hours of injury by describing a myriad of other factors that affect the frequency of infection and complicate identification of an optimal time to debridement.
One area in which new knowledge may change treatment methods is that of posttraumatic heterotopic ossification (HO). Historically, radiation therapy and medications such as indomethacin have been used for prophylaxis, but Barfield, Holmes, and Hartsock provide information about the biology of HO and suggest that a better understanding of molecular signaling and proteomics variability may lead to individualized prophylactic protocols to suppress the formation of HO.
Although most fractures in children and adolescents heal without difficulty, midshaft clavicular fractures in adolescents have come under scrutiny because of less than optimal results with nonoperative treatment. Yang and Andras review the current controversy in the management of these fractures. Foot and ankle fractures are other entities that may seem benign in children but can have long-term adverse effects. Denning discusses a variety of complications associated with these fractures in children. Hopkins, Calandruccio, and Mauck then discuss controversies in fractures of the proximal ulna. Tenenbaum, Shazar, Bruck, and Bariteau, and Gotha and Zide discuss the treatment of posterior malleolar and calcaneal fractures in adults.
Overall, this issue provides much up-to-date information and highlights a number of controversies in the treatment of fractures. The authors and I hope this information will be beneficial to our readers as they determine the optimal care for their patients.