The Journal of bone and joint surgery. American volume
-
J Bone Joint Surg Am · Mar 2008
Extraperiosteal plating of pronation-abduction ankle fractures. Surgical technique.
Pronation-abduction ankle fractures frequently are associated with substantial lateral comminution and have been reported to be associated with the highest rates of nonunion among indirect ankle fractures. The purpose of the present study was to report the technique for and outcomes of extraperiosteal plating in a series of patients with pronation-abduction ankle fractures. ⋯ Extraperiosteal plating of pronation-abduction ankle fractures is an effective method of stabilization that leads to predictable union of the fibular fracture. The results of this procedure are at least as good as those of other techniques of open reduction and internal fixation of the ankle, although specific results for pronation-abduction injuries have not been previously reported, to our knowledge.
-
J Bone Joint Surg Am · Mar 2008
Radial head arthroplasty with a modular metal spacer to treat acute traumatic elbow instability. Surgical technique.
The use of a metal radial head prosthesis to help stabilize an elbow with traumatic instability is appealing because internal fixation of multifragment, displaced fractures of the radial head is susceptible to either early or late failure. The newer modular prostheses are easier to size and implant, but their effectiveness has not been investigated, to our knowledge. ⋯ An intentionally loosely placed modular metal radial head prosthesis can help to restore stability in conjunction with repair of other fractures and reattachment of the lateral collateral ligament to the epicondyle in the setting of traumatic elbow instability with a comminuted fracture of the radial head. While a prosthesis that is too large can cause problems, lucencies around the stem of the intentionally loose prosthesis and most changes in the capitellum do not appear to cause problems, at least in the short term.
-
J Bone Joint Surg Am · Feb 2008
Fracture displacement and screw cutout after open reduction and locked plate fixation of proximal humeral fractures [corrected].
Fixation of proximal humeral fractures is challenging. Locking plate technology offers mechanical advantages for treating unstable fractures in weak bone. In this study, we assessed the radiographic and clinical results of a single surgeon's experience treating proximal humeral fractures with a locked proximal humeral plate. ⋯ The use of locking plates in the surgical treatment of proximal humeral fractures is associated with an unexpectedly high rate of screw cutout and revision surgery, especially in patients older than sixty years who have a three or four-part fracture. The indications for open reduction and internal fixation in these patients require continued analysis.
-
Delivery of intravenous antibiotic prophylaxis within one hour prior to surgical incision is considered important in helping to decrease the incidence of surgical site infections, but methods to ensure compliance have not been established. ⋯ Piggybacking of verification of prophylactic antibiotic administration onto the wrong-site-surgery time-out protocol is an effective, cost-free, and easy-to-adopt method to ensure compliance with appropriate timing of prophylactic antibiotics.
-
When performing total hip arthroplasty without computer navigation, surgeons align the acetabular component with landmarks such as the plane of the operating table and the presumed position of the pelvis. In contrast, first-generation computer navigation systems rely on the pelvic anterior plane, defined by the anterior superior iliac spines and the pubic tubercle. We sought to study the effect of patient positioning on the tilt of the pelvis as measured in the pelvic anterior plane and its effect on cup alignment angle values. ⋯ For navigation systems that rely on the pelvic anterior plane, cup alignment values can be converted to familiar target values with our nomogram with good accuracy and reproducibility. The next generation of navigation systems should be able to measure the pelvic tilt for each individual patient and automatically adjust alignment values.