The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · May 2005
Intermediate to long-term results of a treatment protocol for calcaneal fracture malunions.
Nonoperative management of displaced intra-articular calcaneal fractures may result in malunion affecting the function of both the ankle and the subtalar joint. The purpose of this study was to report the intermediate to long-term results of a treatment protocol for calcaneal fracture malunions. ⋯ This treatment protocol proved to be effective in relieving pain, reestablishing a plantigrade foot, and improving patient function. Because of the difficulty we encountered in restoring the calcaneal height and the talocalcaneal relationship in this group of patients with a symptomatic calcaneal fracture malunion, we believe that patients with a displaced intra-articular calcaneal fracture may benefit from acute operative treatment.
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Despite a trend toward the use of regional anesthesia for orthopaedic procedures, there has been resistance to the use of interscalene regional block for shoulder surgery because of concerns about failed blocks and potential complications. ⋯ Interscalene regional block provides effective anesthesia for most types of shoulder surgery, including arthroplasty and fracture fixation. When administered by an anesthesiologist committed to and skilled in the technique, the block has an excellent rate of success and is associated with a relatively low complication rate.
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J Bone Joint Surg Am · May 2005
Complications of fluoroscopically guided extraforaminal cervical nerve blocks. An analysis of 1036 injections.
A number of serious complications associated with fluoroscopically guided extraforaminal cervical nerve blocks have been reported in the literature. The purpose of the present study was to determine the rate of complications associated with these blocks and to determine whether needle positioning during the procedure affected the prevalence of complications at one institution. ⋯ No catastrophic complications occurred in this series of 1036 nerve blocks. We found that the medial-lateral needle depth as seen on frontal-view radiographs was not associated with complications, although the anterior positioning of the needle as seen on lateral-view radiographs was associated with minor complications. Our results suggest that, with our technique, cervical nerve blocks are relatively safe procedures.
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J Bone Joint Surg Am · May 2005
Use of a distraction plate for distal radial fractures with metaphyseal and diaphyseal comminution.
Distal radial fractures with extensive comminution involving the metaphyseal-diaphyseal junction present a major treatment dilemma. Of particular difficulty are those fractures involving the articular surface. One approach is to apply a dorsal 3.5-mm plate extra-articularly from the radius to the third metacarpal, stabilizing the diaphysis and maintaining distraction across the radiocarpal joint. ⋯ The use of a distraction plate combined with reduction of the articular surface and bone-grafting when needed can be an effective technique for treatment of fractures of the distal end of the radius with extensive metaphyseal and diaphyseal comminution. A functional range of motion with minimal disability can be achieved despite a prolonged period of fixation with a distraction plate across the wrist joint.