Injury
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Case Reports
The medial femoral condyle free osteocutaneous flap for osteomyelitis in pilon fractures.
High energy tibial plafond (pilon) fractures are known to have a high rate of complication, particularly wound dehiscence and infection. Wound infection, requiring debridement of both soft tissue and bone can be especially challenging to reconstruct due to the combination of high load-bearing requirements within a thin soft tissue envelope. ⋯ Level IV, retrospective case study.
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Although the gold standard in open book pelvic fractures remains the pubic symphysis (PS) plate fixation, the clinical outcomes are not satisfactory, despite the excellent anatomical reduction assessed radiologically. Some authors suggest that residual instability of the posterior pelvic elements may be responsible for the chronic pain and the early osteoarthritic changes in the sacroiliac joint (SIJ). ⋯ The posterior fixation with ISS can represent an alternative option for treatment of pelvic injuries associated with rotational instability. Further prospective clinical studies are necessary to determine, the influence of the residual pubic symphysis mobility in the every day life, when the above-mentioned technique is applied.
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No simple clinical technique with which to measure the volume of bone gaps in the treatment of open fractures or nonunions of the tibia is currently available. It is difficult to compare the three-dimensional magnitude of bone defects in research studies on bone grafting without such a tool, and clinicians have no way of determining the magnitude of defects in clinical practice. The purposes of this study were to develop and to validate a technique with which to accurately measure bone gap volumes of the tibial shaft by using only simple measurements on already available clinical radiographs and a simple equation. We hypothesized that a technique could be developed using anteroposterior- and lateral-view radiographs of the tibia to accurately determine the volume of a tibial shaft fracture. ⋯ The equation provides a simple technique with which to calculate three-dimensional gap volumes based on standard radiographs. The simplicity of the equation and availability of standard radiographs make this a practical research and perhaps clinical tool that might be useful in quantifying volumes of the tibial shaft defect.
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There is no consensus among surgeons on the treatment for humeral fractures: the best it is still a matter of some debate. The aim of our work was to demonstrate that external fixation may be considered a valid method not only in emergencies but also for the definitive treatment of such fractures. We perform a retrospective case study review on 85 humeral fractures, 62 shaft fractures, and 23 extrarticular distal third fractures treated with external fixation. ⋯ One case of delayed union and one case of refracture were encountered. Eighty-one patients demonstrated SF-36 scores at or above the national average and an average DASH score of 8.9. External fixation of humeral shaft fractures is considered a valid treatment method as it provides good results in terms of stability of reduction, tolerability, healing times, and functional recovery.
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Osteosynthesis of femoral neck fractures is related to 20-46% complication rate. Filipov's novel method for biplane double-supported screw fixation (BDSF), using three cannulated screws, has demonstrated excellent clinical results since 2007. Its two calcar-buttressed screws are oriented in different coronal inclinations with steeper angles to the diaphyseal axis and intended to provide constant fixation strength under different loading situations. The aim of this study was to biomechanically evaluate BDSF fixation strength and compare it with the conventional fixation (CFIX) using three parallel cannulated screws. ⋯ Femoral neck fracture stability can be substantially increased applying BDSF due to better cortical screw support and screw orientation. Having two calcar-buttressed screws oriented in different inclinations, BDSF can enhance constant stability during various patient activities. The more unstable the situation, the better BDSF stability is in comparison to CFIX.