Injury
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Positioning of the implanted cannulated screw is paramount for stable femoral neck fracture fixation. To avoid overdrilling, the aim of this study is to determine the optimum configuration of three cannulated screws employed in femoral neck fracture fixation. ⋯ Results of this study had supported the use of the inverted isosceles triangle as the best screw configuration for femoral neck fracture fixation. Screw position, Pauwels angle, and drilling frequency can all affect the mechanical strength of femoral neck fracture fixation.
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In patients with severe traumatic brain injury, increased intracranial pressure (ICP) is associated with poor functional outcome or death. Hypertonic saline (HTS) is a hyperosmolar therapy commonly used to treat increased ICP; this study aimed to measure initial patient response to HTS and look for association with patient outcome. Patients >17 years old, admitted and requiring ICP monitoring between 2008 and 2010 at a large urban tertiary care facility were retrospectively enrolled. ⋯ In patients treated with HTS for intracranial hypertension, those who survived or had good neurological outcome, when compared to those who died or had poor outcomes, showed a significantly larger sustained decrease in ICP 2h after administration. This suggests that even early in a patient's treatment, treatment responsiveness is associated with mortality or poor functional outcome. While this work is preliminary, it suggests that early failure to obtain a sustainable response to hyperosmolar therapy may warrant greater treatment intensity or therapy escalation.
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The objective of this study was to evaluate the effectiveness of the treatment of infected forearm nonunion by bone transport. ⋯ Our study suggested that bone transport in the treatment of infected forearm nonunion acquired satisfied functional results. Radical debridement is the key step to control bone infection.
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Surgical treatment options for distal femur fractures include intramedullary nailing or plating using a lateral or lateral parapatellar approach. However, medial plating is required for additional stability in some fractures such as severely comminuted fractures and periprosthetic fractures, and in those for which use of a lateral plate or nail is not appropriate. This study aimed to explore the safe zone for medial minimally invasive plate osteosynthesis of the distal femur with computed tomography angiography. ⋯ The anteromedial aspect of the distal half of the femur is the safe zone, and a long plate can be positioned safely in this zone at the anterior aspect up to the level of 8 cm below the LT.
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Case Reports
Management of infected non-union of the proximal femur: A combination of therapeutic techniques.
A challenging case of a nonunion of the proximal femur complicated by infection attributed to microbial and fungal pathogens requiring a combination of novel surgical techniques to achieve eradication of infection, preservation of the native hip joint, and restoration of function.