The Orthopedic clinics of North America
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A midshaft femoral fracture in a high-energy trauma victim should prompt the orthopedist to search carefully for an ipsilateral fracture of the femoral neck. This fracture will be present in 5 per cent of patients, and the incidence may be increasing. ⋯ Successful methods of management of the femoral shaft fracture have included compression plating, retrograde Kuntscher nailing, and interlocking nails. Approaches to the treatment of concomitant intertrochanteric and femoral shaft fractures should be selected according to the skill and experience of the surgeon and the availability of equipment.
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The complications of knee dislocations may be disastrous and must be anticipated. In most series, a 25 to 30 per cent incidence of arterial damage is reported. If the artery is not repaired, the incidence of amputation can be up to 72.5 per cent. ⋯ After all problems affecting limb survival are solved, open repair of all ligamentous injuries is recommended to provide ligamentous stability and congruity of the joint. Prior to performing the procedure, a surgeon must have a thorough knowledge of the anatomy of the knee. Rehabilitation techniques and early postoperative motion are important for guiding the injured patient through the immediate and late postoperative period.