Journal of orthopaedic trauma
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Thoracolumbar burst fractures are a major cause of disability; however, there are few studies on the functional outcome of patients with this injury. The purpose of this study is to evaluate the functional outcome of patients with thoracolumbar burst fractures using a generic and a condition-specific health status survey. The SF-36 survey (generic) and the Roland scale (condition-specific) were administered to 24 patients who had a minimum of 2 years follow-up after a thoracolumbar burst fracture without neurologic deficit. ⋯ There was a strong correlation (r = 0.71) between the Roland scale and the SF-36 pain scale. There were poor correlations between the Roland scale and residual kyphosis (r = 0.003), and between the SF-36 pain scale and residual kyphosis (r = 0.10). There was no significant difference in the functional outcome of those patients treated operatively versus nonoperatively.
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This case describes the successful treatment of a child with a vascular injury and two ipsilateral grade IIIB open lower leg fractures using two local-advancement soft-tissue techniques. Multiple relaxing skin incisions were used for closure of the wound associated with the patient's midshaft tibial fracture, whereas a randomly patterned rotational fasciocutaneous flap was used for coverage of the wound associated with the patient's medial malleolar fracture. These straightforward local-advancement soft-tissue coverage techniques allowed for treatment of a child with vascular injuries, ensuring the viability of the foot, while preventing distant donor site morbidity and functional sacrifice. Additionally, no special microsurgical or specialty training is necessary to achieve a similar result.
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Fifteen fresh-frozen adult cadaver feet were dissected to investigate areas in the hindfoot where external fixation pins could be safely inserted with the least risk to underlying nerves, vessels, and tendons. Using palpable anatomic landmarks, four relative "safe zones" on the calcaneus and talus were delineated. These included an area on the medial calcaneus, the medial talus, the lateral calcaneus, and the lateral talus. ⋯ The structures most at risk for injury during pin insertion in the zones described were the medial and lateral calcaneal nerve branches, which inconsistently crossed the medial and lateral calcaneal safe zones, respectively. In these areas overlying the tuberosity, however, the subcutaneous tissues were thin, and iatrogenic nerve injury during pin insertion appeared avoidable if blunt dissection was used to reach the calcaneal cortex. The data presented here provide information to assist selection of pin sites that minimize risk to underlying soft tissues during external fixation of the talus and calcaneus.