Journal of orthopaedic trauma
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Because of their complexity, war injuries inflicted by a blast mechanism often require tailoring of treatment to attain a more individualized solution. We report two cases of bilateral, severely mangled lower limbs with open tibial fractures and crush injuries to the feet. In each case, one limb had to be amputated below the knee, but the other limb was saved by immediate stabilization in a tubular external fixation frame crossing the knee; the frame was later replaced by a hybrid ring fixation frame with a freely moving knee. Such incidences are rare, and the particular management detailed here has not previously been reported in the literature.
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Comparative Study Clinical Trial
Comparison of the Nebraska collar, a new prototype cervical immobilization collar, with three standard models.
To determine whether a novel immobilization collar called the Nebraska collar would restrict motion of the cervical spine better than three traditional designs: the Philadelphia collar, the sterno occipital mandibular immobilizer (S.O.M.I.), and the Lehrman-Minerva cervical orthosis. ⋯ The new Nebraska collar provides stabilization that is significantly more rigid than the other models tested, with no difference in patient comfort.
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Comparative Study
Experimental study of distal interlocking of a solid tibial nail: radiation-independent distal aiming device (DAD) versus freehand technique (FHT).
Recently, radiation-independent aiming devices for the tibia that compensate for insertion-related implant deformation have been developed, but the benefits of such systems have not been determined. This study prospectively evaluated the duration of the nailing procedure, the length of radiation time, and the accuracy of interlocking screw placement when using a radiation-independent distal aiming device (DAD) versus the freehand technique (FHT). ⋯ These results suggest that the DAD can eliminate the need for radiation during placement of distal interlocking screws.
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Comparative Study
Effect of limited and standard reaming on cortical bone blood flow and early strength of union following segmental fracture.
To quantitatively determine the extent to which limited and standard intramedullary reaming disrupts cortical circulation and to evaluate the effect on the biomechanical properties of the united fracture. ⋯ Both limited reaming and standard reaming negatively affect diaphyseal cortical circulation. Limited reaming spares cortical perfusion compared with standard reaming at the time of nail insertion. No long-term advantage for limited reaming was demonstrated. Limited reaming may be advantageous acutely for the stabilization of tibial fractures in which the circulation is already compromised.
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To evaluate whether the implantation of the modular trochanter stabilizing plate (TSP) in addition to the dynamic hip screw (DHS) prevents excessive telescoping and limb shortening in four-part and selected three-part trochanteric fractures. ⋯ In unstable pertrochanteric fractures with small or missing lateral cortical buttress, the addition of a TSP to the DHS effectively supports the unstable greater trochanter fragment and can prevent rotation of the head-neck fragment. Excessive fracture impaction and consecutive limb shortening was prevented by this additional implant in 90 percent of these patients.