Injury
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Review Multicenter Study
Minimally-invasive treatment of calcaneal fractures: A review of the literature and our experience.
The optimal treatment of calcaneal fractures (CF) is currently controversial and is still under debate. It is well established that conservative treatment of these fractures is associated with poor results. ⋯ ORIF is the most popular technique for these fractures, but it is associated with high rates of wound complications, hardware failure and infections. Several minimally-invasive techniques have been developed recently for the treatment of CF, with the common aim to be as simple, effective and inexpensive as possible and to reduce surgical times, complications and length of hospital stay.
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We present the case of a 39-year-old sportswoman who was involved in a motorcycle accident in 2012. She sustained a complex proximal femoral fracture that involved the neck and trochanteric region. We decided to preserve the natural bone stock and repair the fractures, adopting skeletal traction in the first stage and then implanting an intramedullary nail. Twenty months later the fracture was healed clinically and radiologically and the patient was able to walk and run without pain.
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With an incidence of less than 0.2% of all pediatric fractures, pelvic ring injuries are rare. Historically they were conservatively treated, but because malunion and long-term morbidity are associated with unstable injuries, a trend towards operative treatment can be observed. The purpose was to determine clinical and radiographic outcomes following these complex pediatric pelvic ring injuries. ⋯ In pediatric patients with pelvic ring injuries, radiographic deformity persisted and did not remodel. Pelvic ring deformity occurred more commonly with complex unstable ring injuries. The complex displaced injuries have higher rates of operative intervention, residual deformity, and low back and SI joint pain.
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Anterior humeral line (AHL) location is commonly used to evaluate sagittal alignment after fracture reduction in children with supracondylar humeral fractures. However, the position of the AHL for acceptable fracture reduction has not been validated by clinical outcome. The purpose of this study was to investigate the relationship between the location of AHL and range of elbow motion. ⋯ These findings demonstrate that children with AHL crossing the middle and posterior thirds of the capitellum appear to have slightly better early elbow flexion and total range of elbow motion. AHL crossing the anterior third of the capitellum can be an underreduction that has similar elbow motion as AHL anterior to the capitellum. AHL posterior to the capitellum is a warning sign of overreduction and should be avoided.
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Comparative Study
Is softcast (3M) strong enough for potentially unstable paediatric forearm fractures?
The majority of paediatric forearm fractures are treated using a circumferential splint, with prior manipulation as necessary. Plaster of Paris is often chosen for its ease of application, cost and proven reliability. Softcast is an alternative, providing a comfortable and water-resistant splint that can be removed without a plaster saw, and is in widespread use for immobilising buckle fractures. Softcast has not been recommended for acute unstable fractures. We established whether a Softcast splint could provide sufficient mechanical stability to control an unstable paediatric forearm fracture. ⋯ A 6-wrap Softcast splint provides adequate mechanical stability and protection for paediatric patients up to approximately 20kg, avoiding high-risk activities. The primary risk is not of fracture angulation and loss of position, but temporary indentation of the splint, causing discomfort or pain. Considering its ease of removal, Softcast may be preferable for younger paediatric patients. Its cost may be offset by reducing the number and duration of hospital visits.