The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Jan 1983
Complications of Ender-pin fixation in basicervical, intertrochanteric, and subtrochanteric fractures of the hip.
Two hundred patients with a basicervical, intertrochanteric, or subtrochanteric fracture were treated by Ender-pin fixation during a three-year period. Their median age was 73.5 years and there was a 10 per cent mortality rate. Early partial weight-bearing with some external support was allowed for most patients. ⋯ Distal pin migration of more than two centimeters occurred in 50 per cent of the unstable intertrochanteric fractures. Seventy-six per cent of the forty-two patients who were personally examined at follow-up had pain in the knee and 36 per cent had external malrotation. The incidence of pin migration increased in the more unstable fractures.
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The value of an osteotomy of the fusion mass in attaining realignment of the spine when a lateral shift of the trunk over the pelvis has developed in the frontal plane was studied in fifty-five patients. All had had a previously fused but progressive spinal deformity. The indications for osteotomy were progression of the curve, imbalance of the trunk, pain, deteriorating cardiopulmonary function, or pseudarthrosis, or a combination of these conditions. ⋯ Most had a two-stage procedure which consisted of a posterior osteotomy, halo-femoral traction, and a posterior re-fusion with Harrington instrumentation two weeks later. At an average follow-up of thirty-two months, it was found that osteotomy of the fusion mass enabled the surgeon to realign the trunk over the pelvis and to correct pelvis obliquity, but correction of the angular deformity was only secondary. Although the rate of complications was high (51 per cent, including one postoperative death), osteotomy of the fusion mass and re-fusion may be indicated in a patient with a previously fused but progressively unbalanced, painful deformity of the spine.
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Forty-five patients with an unstable fracture of the pelvic ring, for whom the conventional treatment would have been bed rest with skeletal traction or with a pelvic sling, were treated with the Hoffmann external-fixation apparatus. In eighteen fractures of the lateral compression type and fourteen fractures of the anteroposterior compression type, the treatment was successful. Proximal migration of the hemipelvis occurred in four of the eleven patients with a fracture of the unilateral shear type. There were two deaths from associated injuries.
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J Bone Joint Surg Am · Jul 1982
Unstable fracture-dislocations of the forearm (Monteggia and Galeazzi lesions).
Forty-nine Monteggia and forty-seven Galeazzi lesions were treated over a twenty-five-year period. I used Bado's criteria to evaluate the results in the Monteggia lesions. In all of the children in the series either closed or open reduction yielded good results, while the results of treatment of the Monteggia fractures in the adults in the study varied. ⋯ In the Type-II, III, and IV lesions in this series, fair results were the rule. The results of closed reduction of the classic Galeazzi fractures in the adults in this series were not good, due to malunion of the radius and persistent derangement of the distal radio-ulnar joint. The seventeen patients who were treated with accurate reduction and internal fixation of the fractured radius and immobilization of the forearm in full supination for six to eight weeks obtained good results.