Journal of orthopaedic trauma
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Our purpose was to determine the incidence of deep-vein thrombosis (DVT) in patients who have had early operative fixation of fractures of the lower extremity distal to the hip. There is a high incidence of distal thrombosis in patients who have undergone early operative fixation of lower-extremity fractures. The incidence of DVT is higher with proximal extremity fractures than with distal extremity fractures. ⋯ This study suggests a higher DVT incidence in more proximal fractures, but little risk of embolization. Thrombus formation proximal to the popliteal fossa is rare. Older age, longer operating times, and longer times before fracture fixation all correlate with an increased incidence of DVT.
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Seven children (3-10 years of age) were treated for a type III supracondylar fracture of the humerus. All fractures were reduced and pinned. Closed reduction was performed in four patients; three required open reduction. ⋯ At an average follow-up of 30 months, all seven patients had normal circulatory status, including a radial pulse. All fractures had healed, and all extremities had a normal carrying angle and normal elbow motion. Immediate exploration of the antecubital fossa should be considered if an extremity remains pulseless (to palpation and Doppler) after reduction and stabilization of significantly displaced supracondylar fractures of the humerus.
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Thirty dry adult bony specimens and eight embalmed cadavers were used to report on the morphological data of the ischial tuberosity and to determine the most optimal technique for ischial tuberosity screw placement for open reduction and internal fixation of posterior acetabular fractures. The average width, height, and depth of the ischial tuberosity were 27.0 mm, 32.2 mm, and 32.4 mm, respectively. The average angles between the posterior and medial aspects and between the posterior and lateral aspects of the ischial tuberosities were 79.5 degrees, and 111.5 degrees, respectively. ⋯ The tendinous origin of the hamstrings becomes quite substantial (7-10 mm thick) at a point 2 cm distal to the inferior acetabular margin. The exposure of the ischial tuberosity should therefore be restricted to this level. The entry point of the screws should be 5 mm or 10 mm medial to the lateral margin of the ischial tuberosity, and the screws should be directed 35-40 degrees, 45-50 degrees, and 50-55 degrees caudally at the level of the inferior acetabular margin and 1 cm and 2 cm below it, respectively, to obtain the most favorable bony purchase.
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Comparative Study
Biomechanical comparison of posterior internal fixation techniques for unstable pelvic fractures.
Early reduction and rigid fixation of unstable vertical shear pelvic fractures has been shown to decrease the incidence of late sequelae and facilitate early mobilization. The results of fixation of the posterior pelvic ring without anterior fixation are unknown. The purpose of this study was to perform a biomechanical comparison of the most frequently used techniques of posterior fixation for unstable pelvic sacroiliac dislocations in conjunction with ipsilateral rami fractures, i.e., an unstable vertical shear injury. ⋯ Compared to the intact pelvis, single posterior methods of fixation provided approximately 70-85% resistance to axial and torsional loading. By combining SI screws with transiliac bars, approximately 90% of intact pelvic stability was achieved. Our results suggest that rigid posterior fixation of sacroiliac dislocations alone may obviate the need for additional complex anterior surgical procedures to fix rami fractures.
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A retrospective evaluation of 138 patients requiring operative decompression, reduction and fixation of spinal injuries between January 1986 and April 1989 was conducted. The variables of timing and method of operative intervention, level and classification of fracture, associated injuries, injury severity score (ISS), associated neurologic deficits, length of intensive care unit and hospital stays, and projected costs were analyzed for correlation with postoperative complications (pulmonary, skin, urinary, other). Four subgroups were identified: group IA patients underwent surgery within 72 h of injury and had an ISS of < 18; group IB patients underwent surgery after 72 h and had an ISS of < 18; group IIA patients underwent surgery within 72 h and had an ISS of > or = 18; and group IIB underwent surgery after 72 h and had an ISS of > or = 18. ⋯ Irrespective of associated injuries, all had fewer complications if they underwent surgery within 72 h. Morbidity was higher in patients with a neurological deficit compared with neurologically intact patients. Surgical decompression, reduction, and/or fixation of spinal fractures within the first 72 h is indicated in patients with multiple trauma (ISS > or = 18) and cervical injuries with a neurological deficit.