The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Jan 2006
Randomized Controlled Trial Comparative StudyComparison of short and long arm plaster casts for displaced fractures in the distal third of the forearm in children.
Various methods of cast immobilization have been recommended for the treatment of distal forearm fractures in children. The purpose of this study was to determine if short arm casts are as effective as long arm casts in the treatment of displaced fractures of the distal third of the forearm in these patients. ⋯ A well-molded short arm cast can be used as effectively as a long arm cast to treat fractures of the distal third of the forearm in children four years of age and older, and they interfere less with daily activities.
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J Bone Joint Surg Am · Jan 2006
Comparative StudyDeficits following nonoperative treatment of displaced midshaft clavicular fractures.
Displaced fractures of the midpart of the clavicular shaft are generally treated nonoperatively, and few functional deficits have been reported. Whereas prior investigators have presented radiographic and surgeon-based outcomes, we used a patient-based outcome questionnaire and objective muscle-strength testing to evaluate a series of patients who had received nonoperative care for a displaced midshaft fracture of the clavicle. ⋯ Traditionally, good results with minimal functional deficits have been reported following nonoperative treatment of clavicular fractures. However, surgeon-based methods of evaluation may be insensitive to loss of muscle strength. We detected residual deficits in shoulder strength and endurance in this patient population, which may be related to the significant level of dysfunction detected by the patient-based outcome measures.
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J Bone Joint Surg Am · Jan 2006
Randomized Controlled Trial Comparative StudyAbove and below-the-elbow plaster casts for distal forearm fractures in children. A randomized controlled trial.
Closed fractures of the distal third of the forearm are the most common fractures of childhood, but the method of immobilization after closed reduction is controversial. This study was undertaken to determine whether below-the-elbow casts are as effective as above-the-elbow casts in immobilizing these types of fractures and to identify patient and treatment considerations that are related to loss of reduction. ⋯ Below-the-elbow casts perform as well as above-the-elbow casts in maintaining reduction of fractures in the distal third of the forearm in children, and the complication rates are similar. Factors that are associated with a higher risk of loss of reduction include combined radial and ulnar fractures and residual angulation of the fracture after the initial reduction.
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Previous recommendations for treatment of Morel-Lavallee soft-tissue degloving lesions have included open débridement with packing or delayed closure. The purpose of this study was to review the use of percutaneous drainage for the initial management of these lesions. ⋯ Early percutaneous drainage with débridement, irrigation, and suction drainage for the treatment of Morel-Lavallee lesions appears to be safe and effective. Percutaneous procedures for pelvic fixation were well tolerated by the small number of patients in this series, and open procedures appeared to be safe when performed in a delayed fashion.