Journal of orthopaedic trauma
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Screw placement at the posterior margin of the acetabulum during open reduction and internal fixation of posterior acetabular wall fractures must avoid intraarticular penetration of the hip joint. Analysis of the preoperative computed tomography (CT) scan, operative positioning of the patient in a secure reference plane, and placement of the screws in the coronal plane perpendicular to the long axis of the body will help avoid this surgical complication.
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Thirteen patients with segmental fractures involving the distal femur and femoral shaft were treated with internal fixation. Nine of the distal femur fractures were intraarticular. Priority was given to restoration of the articular surface and the alignment of the distal femur. ⋯ One patient was treated with Ender nails. All the fractures eventually healed, but the recovery time was long. Although no patient was asymptomatic, 10 have resumed their preinjury level of function.
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Between 1980 and 1988, 127 patients with 131 low-velocity gunshot wounds to the forearm were treated. In 71 extremities there was no bony injury; 60 extremities sustained fractures. The diagnosis of a compartment syndrome was based on tissue pressure measurements and/or clinical examination. ⋯ Low-velocity gunshot injuries to the forearm are at definite risk for the occurrence of a compartment syndrome. A high index of suspicion is necessary to prevent untoward sequelae. Patients with this injury, especially those with a proximal one-third fracture who constitute an extremely high-risk group, should be monitored closely.
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A Weber type C ankle fracture was sequentially reproduced in 12 cadaver lower extremities and an external rotation torque was applied at each interval. The fractures were then repaired in staged fashion and the rotational stability of the mortise evaluated. Maximum external rotation of the talus within the mortise averaged 7.7 degrees in the intact ankle and increased by 311% to 31.8 degrees after creation of a Weber C injury. ⋯ Fibular fixation combined with a syndesmotic screw restored 51% of original stability, and the addition of medial malleolar fixation improved stability to 101%. Bimalleolar fixation without a syndesmotic screw yielded 73% of the original rotational stability. The results of this study suggest that when rigid medial and lateral osteosynthesis can be achieved, syndesmotic fixation may not be necessary.
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Of 36 patients who presented over a 3-year period with nailgun injuries, nine of these injuries were found to have penetrated into the knee joint. Six of these injuries were treated by operative nail removal, curettage of the nail tract, and examination of the joint. The remaining three patients had nail removal, followed by irrigation of the joint in the emergency room. ⋯ In three of six patients treated by operative irrigation and debridement, a piece of clothing or nailgun resin was discovered in the nail tract or floating within the knee joint. None of the patients in the group treated by operative nail removal, joint visualization, irrigation, and nail tract curettage experienced any complications, whereas one patient treated nonoperatively developed a septic knee. Due to the unique nature of these nailgun puncture wounds, we strongly advocate operative nail removal, curettage of the nail tract, visualization of the joint, and use of prophylactic antibiotics in the treatment of nailgun arthrotomies.