Journal of orthopaedic trauma
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Comparative Study Clinical Trial
Blood flow changes to the femoral head after acetabular fracture or dislocation in the acute injury and perioperative periods.
Acute blood flow to the femoral head has been postulated to be affected negatively by traumatic acetabular fracture or dislocation. To the best of our knowledge, a prospective study that has examined acute changes in blood flow to the femoral head with respect to the timing of reduction and the effect of open reduction and internal fixation after acetabular fracture or dislocations has not been performed. ⋯ A global loss of scintillation in the femoral head as determined by SPECT scanning occurs in some patients with hip dislocations and fractures or dislocations of the acetabulum in the early injury period. Changes in blood flow occurred in patients with short (one hour) and long (twenty-four hours) dislocation times. However, the development of avascular necrosis could not be predicted by early SPECT scanning. Until further multicenter studies are performed, SPECT scanning cannot be recommended on an acute or routine basis to predict those patients who will develop avascular necrosis. Operative approaches for open reduction of the hip and internal fixation of acetabular fractures do not appear to affect blood flow to the femoral head. Although a golden time to relocation cannot be fully established from this study, early relocation is advised to decrease the potential risk of vascular spasm, scarring, and subsequent avascular necrosis.
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To evaluate the effect of calcium phosphate bone cement on stability and strength of the fracture repair in a central depressed tibial plateau fracture cadaveric model. ⋯ This study suggests that the non-weight-bearing postoperative period may be significantly reduced without clinically significant articular collapse.
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Comparative Study
Surgical options for the treatment of severe tibial pilon fractures: a study of three techniques.
To determine whether long-term results of one of three different management protocols for severe tibial pilon fractures offer advantages over the other two. ⋯ On the basis of our results, we now prefer a two-step procedure for the treatment of severe tibial pilon fractures with extensive soft tissue damage. In the first stage, primary reduction and internal fixation of the articular surface is performed using stab incisions, screws, and K-wires. Temporary external fixation is applied across the ankle joint. After recovery of the soft tissues, the second stage entails internal fixation with a medial plate using a reduced invasive technique.
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Comparative Study
Retrograde versus antegrade nailing of femoral shaft fractures.
To compare union rates and complications of retrograde intramedullary nailing of femoral shaft fractures with those of antegrade intramedullary nailing. ⋯ Retrograde and antegrade nailing techniques provided similar results in union and malunion rates. There were more complications related to the knee after retrograde nailing and more complications related to the hip after antegrade nailing.
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The authors report a rare case of palmar lunate transscaphoid fracture-dislocation resulting from a palmar flexion injury. After performing an open reduction of the lunate, they used a dorsal approach to fix the fractured scaphoid with a Herbert screw. A Kirschner wire fixation was also performed to stabilize the lunotriquetral joint.