Journal of orthopaedic trauma
-
Comparative Study
Biomechanical effects of internal fixation of the distal tibiofibular syndesmotic joint: comparison of two fixation techniques.
This biomechanical study compares two methods of internal fixation of the tibiofibular syndesmosis used in Weber type C malleolar fractures of the ankle. The transverse syndesmotic 3.5-mm screw was compared with two 1.5-mm Kirschner wires introduced obliquely across the distal tibiofibular syndesmosis. The influence of implants on distal tibiofibular joint motion and contact characteristics of the intact ankle joint were determined. ⋯ Both techniques stabilized the injured syndesmotic joint and limited its normal motion during flexion and extension of the ankle. Pressure distribution displaced laterally in internally stabilized ankles compared with intact specimens, regardless of the type of fixation used. Therefore, both techniques alter joint biomechanics equivalently compared with the intact ankle.
-
We report three cases of tibial compartment syndrome after closed intramedullary nailing of the tibia. In no case was there any obvious other predisposing factor for the development of the syndrome apart from the surgery and the fracture potential itself. It is recommended that tibial compartment syndrome be regarded as a rare, but significant complication of tibial nailing.
-
Transcarpal fractures in children are rare in the orthopaedic literature. This is a case report of a 10-year-old boy who sustained fractures across the distal radius, scaphoid, lunate, and triquetrum with gross displacement. ⋯ The injury healed with good wrist function but abnormal carpal development. This unusual pattern of injury is described so that it may be more readily appreciated in the future.
-
Forty-seven tibial nonunions were treated with a reamed intramedullary nail. Initially, there were 14 (30%) closed and 33 (70%) open tibial fractures. The initial fracture management consisted of casts in 12 (26%) patients, Ender or Lottes nails in nine (19%), and external fixation in 26 (55%). ⋯ After one or more procedures, these nonunions consolidated without apparent infection. Reamed intramedullary nailing is a safe and effective method of treatment for tibial nonunions of previously closed fractures and prior open fractures that have been treated with Ender or Lottes nails. Because of the risk of infection, we do not recommend its use after external fixation of open fractures.
-
Closed degloving injuries of the toes are rare due to their short length, protection in shoes, and general lack of adornment. When these injuries occur, neurovascular compromise can lead to a loss of viability of the toe. Prompt recognition and successful reduction are necessary to maintain normal structure and function.