Journal of orthopaedic trauma
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Scapulothoracic (ST) dissociation is a closed complete traumatic forequarter amputation manifested by a flail pulseless arm and well-defined roentgenographic findings. These roentgenographic findings were previously reported to be lateral displacement of the scapula and either acromioclavicular separation (17) or displaced clavicular fracture (20). ⋯ We present one patient, however, in whom ST dissociation is an isolated finding. A review of the literature, and a review of treatment options that includes some combination of amputation, shoulder arthrodesis, prosthetic fitting, and reconstructive tendon transfers, are presented.
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Randomized Controlled Trial Comparative Study Clinical Trial
Neurological complications of dynamic reduction of Colles' fractures without anesthesia compared with traditional manipulation after local infiltration anesthesia.
To investigate whether or not injection of local anesthetic into the fracture hematoma on reduction of a Colles' fracture increases the risk of neurological complications, a prospective randomized trial was conducted. The outcome in 62 patients whose Colles' fractures were reduced in a new bone-alignment device without anesthesia was compared with that in 54 patients with Colles' fractures that were reduced manually after injection of local anesthetic. At follow-up, any symptoms and signs of nerve damage were recorded. ⋯ The difference is significant (p less than 0.01). The authors have previously shown that injection of local anesthetic into the hematoma of Colles' fractures increases the carpal tunnel pressure. Neurological complications after the use of local anesthesia in reducing Colles' fractures is considered to be secondary to the scarring and fibrosis caused by this increase in pressure.
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Case Reports
Compartment syndrome of the thigh complicating surgical treatment of ipsilateral femur and ankle fractures.
A 26-year-old man presented with ipsilateral femur and ankle fractures. The patient was treated with interlocking nail of his femur fracture, followed by open reduction and internal fixation of his ankle fracture under tourniquet control. ⋯ This case illustrates the possible complication of treating a femur fracture with intramedullary nailing and then immediately applying a tourniquet to treat an ipsilateral extremity fracture. Because of the complication with this patient, we feel the procedure should be staged, or a tourniquet should be avoided if possible.
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Case Reports
Treatment of unstable femoral shaft fractures with closed interlocking intramedullary nailing.
From 1979 to 1982, 64 femoral shaft fractures in 62 patients were treated by closed interlocking nailing at Harborview Medical Center, Seattle, WA, U. S. A., and Parkland Memorial Hospital, Dallas, TX, U. ⋯ The delayed unions and nonunions healed after one additional procedure. This study shows that closed interlocking nailing is a safe, effective technique that provides stable fixation in most unstable femoral shaft fractures. This technique represents a major advance in the treatment of difficult femoral shaft fractures that would be poorly suited for standard closed nailing.