Injury
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The aim of this study was to evaluate the Latin American orthopaedic trauma surgeons preference regarding knee positioning and entry portals for IM nailing and identify the reasons of these preferences. ⋯ Even with the potential benefits of the semi-extended knee positioning for tibial nailing, the Latin American orthopaedic community remains using the transpatellar tendon approach with the knee in flexion as the standard technique. Lack of surgical training for suprapatellar and parapatellar approaches with the knee in semi-extension, added by the unavailability of suprapatellar jigs and soft outer protection sleeves contribute to counter the trend towards the semi-extended techniques.
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Dysesthesia, electrical and burning sensations, in addition to allodynia are frequent symptoms of neuropathic pain. Despite the high frequency, scientific data on the development of neuropathic pain after surgery for fracture fixation are scarce. The goal of the present study was to determine the prevalence, risk factors, and evaluate potential associations among neuropathic pain, pain intensity, sociodemographic, and clinical variables after wrist, hip, and ankle fracture fixation. ⋯ In our study, neuropathic pain after wrist, hip, and ankle fracture fixation was prevalent and associated with higher BMI values and amount of medication, in addition to higher proportions of female sex, absence from work, DM, limitation for daily activities, postoperative complications, and use of pain modulating medications.
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Local muscle flaps are especially advantageous when treating soft tissue defects, but one disadvantage is the potential functional deficits associated with the muscle transfer. In this study, we evaluated ankle function among patients (cases) who underwent reconstruction of soft tissue defects in the leg using local flaps of the gastrocnemius and/or soleus muscle. Function was compared between the affected and contralateral non-affected limb and against patients (controls) with open tibial fractures who required no soft tissue reconstruction. ⋯ However, no deficit in plantar flexion strength was detected; nor any significant difference in AOFAS ankle-hindfoot scores in cases versus controls. Local muscle flaps are useful for reconstructing post-traumatic soft tissue defects in the leg. Some loss of ankle ROM should be expected, but likely no clinically-measurable deficit in overall ankle strength and function.
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Type I Young and Burgess anterior posterior compression (APC) pelvic injuries have been classically managed non operatively due to theoretical integrity of sacroiliac joint ligaments (SIJL), though examination under anesthesia (EUA) has been proven occult mechanical instability in up to 50% of these injuries. We sought to determine the diagnostic accuracy of magnetic resonance (MRI) for detection of occult instability on APC-I injuries when compared to EUA. ⋯ Injury to SIJL on MRI presented an accuracy of 77% (58.29% - 89.64%) for the detection of occult pelvic instability on EUA.
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We have read the paper "Important tips and numbers on using the cortical step and diameter difference sign in assessing femoral rotation - Should we abandon the technique?" [1] with great interest. Restoring femoral rotation during intramedullary nailing can pose challenges to many experienced surgeons. ⋯ This technique also improves the ergonomics of the surgery and can be used simultaneously with other femoral rotation evaluation techniques. LEVEL OF EVIDENCE: V.