Journal of orthopaedic trauma
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Fifteen cadaveric adult bony hemipelvis specimens and 30 adult dry bone specimens were obtained to evaluate the configuration of the anterior column of the acetabulum and to develop a safe path for screw placement into it. Each cadaveric specimen was sectioned at 1-cm intervals, beginning at the level of the inferior border of the acetabulum (junction between the anteroinferior edge of the acetabulum and the most anterolateral edge of the superior ramus of the pubic bone). The plane of the cross-section was perpendicular to the anterior column. ⋯ At 3.0 cm superior to the inferior acetabular margin, these angles were found to be 20.7 +/- 4.3 degrees, 29.4 +/- 6.0 degrees, and 39.3 +/- 5.9 degrees, respectively. All of the above mentioned angles are with respect to the perpendicular of the longitudinal axis of the anterior column without violation of the hip joint. Screws placed 1.0 cm lateral to the pelvic brim at the levels of 1.0, 2.0, 3.0, and 4.0 cm superior to the inferior acetabular margin and directed perpendicular to the anterior column penetrated the hip joint.
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Case Reports
Recalcitrant femoral pseudarthrosis healed with a torsionally stiff intramedullary nail.
A case of long-standing femoral pseudarthrosis was successfully treated by replacement of a torsionally less rigid intramedullary nail by one approximately 20 times more rigid. Complete union occurred 6 months after nail exchange.
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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.