The Orthopedic clinics of North America
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Orthop. Clin. North Am. · Oct 2004
Review Comparative StudyTrochanteric osteotomy for acetabular fractures and proximal femur fractures.
Anatomic reconstruction of the articular surface is a primary goal of internal fixation of fractures of the hip joint. The quality of the reduction correlates with long-term outcomes. ⋯ Ganz et al described a technique of trochanteric osteotomy combined with a Kocher-Langenbeck approach that allows direct visualization of the joint without the risk for avascular necrosis of the femoral head. This article reviews the indications of this approach in the treatment of fractures around the hip joint.
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Orthop. Clin. North Am. · Oct 2004
Review Comparative StudyThe role of pelvic angiography in evaluation and management of pelvic trauma.
Controversy exists about the indications and optimal timing of angiography in hemodynamically unstable patients with severe pelvic fractures. Recommendations from published studies are limited by small numbers of patients. In this article the recommended indications, timing, and drawbacks to angiography are reviewed.
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Orthop. Clin. North Am. · Oct 2004
Review Comparative StudySoft tissue injuries associated with pelvic fractures.
Significant soft tissue injuries often occur as part of high-energy injuries to the pelvis. These soft tissue injuries must be recognized and considered when implementing a treatment plan if complications are to be minimized. ⋯ Closed pelvic and acetabular fractures also may include soft tissue injury that requires special consideration. Careful evaluation and management of the soft tissues aids in determining appropriate techniques for reduction and fixation of the associated fractures.
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Subtrochanteric femur fractures have demanded special consideration in orthopaedic traumatology, given the high rate of complications associated with their management. The intense concentration of compression, tensile, and torsional stresses and decreased vascularity of the region has challenged orthopaedists with problems of malunion, delayed union, and nonunion resulting from loss of fixation, implant failure, and iatrogenic devascularization of the operative exposure. Only recently has a better understanding of fracture biology, reduction techniques, and biomechanically improved implants allowed for subtrochanteric fractures to be addressed with consistent success.