Journal of orthopaedic trauma
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A proposed extensile medial approach to the medial surface of the shaft of the femur was studied on 30 cadaver thighs. The incision is made along a line extending from the mid inguinal point to a point one-third the distance from the adductor tubercle to the medial side of the patella. After mobilizing the sartorius muscle posteromedially, the medial femur is exposed by a three-step technique. ⋯ Distal extension can be made to expose the knee joint. The approach can be extended proximally to the lesser trochanter between the vastus medialis and both the adductor brevis and pectineus muscles. Anatomic measurements in relation to the adductor tubercle and cross-sections of the thigh were made to better describe anatomic constants and variables in this rather unfamiliar medial thigh area.
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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.