Journal of orthopaedic trauma
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To evaluate the outcome of an uncommon variant of the anterior-posterior compression pelvic injury, in which the posterior ring injury is a midline sagittal sacral fracture extending into the spinal canal. ⋯ Patients who sustain sagittally oriented midline fractures of the sacrum that extend into the spinal canal (Denis zone III) as part of displaced, vertically stable anterior-posterior compression pelvic injuries, have a low incidence of neurologic deficit attributable to sacral root or plexus injury. This is in contrast to the high rate of neurologic deficit (>50%) otherwise reported in zone III sacral fractures, particularly in those associated with a displaced transverse component. In the midline sagittal fracture variant, simultaneous lateral displacement of both bony and neural elements through the midline may protect the sacral roots and plexi from significant traction or shear injury by maintaining the spatial orientation between the sacral foramina and sciatic notch. Long-term sequelae were related to urogenital complaints rather than to musculoskeletal problems, as 4 of the 10 patients in this series had either sexual or urologic dysfunction.
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Randomized Controlled Trial Clinical Trial
Triangular osteosynthesis and iliosacral screw fixation for unstable sacral fractures: a cadaveric and biomechanical evaluation under cyclic loads.
To conduct a biomechanical comparison of a new triangular osteosynthesis and the standard iliosacral screw osteosynthesis for unstable transforaminal sacral fractures in the immediate postoperative situation as well as in the early postoperative weight-bearing period. ⋯ Triangular osteosynthesis for unstable transforaminal sacral fractures provides significantly greater stability than iliosacral screw fixation under in vitro cyclic loading conditions. In vitro cyclic loading, as a limited simulation of early stages of patient mobilization in the postoperative period, allows for a time-dependent evaluation of any fracture fixation system.
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To determine the mortality risk following hip fracture and identify factors predictive of increased mortality. ⋯ The data demonstrate that hip fracture is not associated with significant excess mortality amongst patients older than age 85. Amongst younger patients, however, those with ASA classifications of 3 or 4 have significant excess mortality following hip fracture that persists up to 2 years after injury.
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To document the locations of injury, frequency of associated injuries, and need for operative intervention in patients presenting to a tertiary medical center after sustaining an orthopedic injury related to snowmobile use. ⋯ Snowmobile accidents represent a frequent cause of orthopedic injuries in northern regions. An understanding of these injuries may help emergency departments prepare for patients injured on these machines. Recognition of the most common orthopedic injuries may help in the design of safer snowmobiles.
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Evaluate the effects of axial motion and transforming growth factor beta (TGF-beta) on callus formation and fracture healing.DESIGN Prospective experimental design with a 39-day postfracture recovery. ⋯ Injection of rhTGF-beta1 during the first postfracture week does not provide a biologic boost that improves fracture healing. Injection of TGF-beta1 may be detrimental to healing under conditions when fracture motion is present. The results suggest that there is a tendency for exposure to TGF-beta1 to inhibit the normal development of peripheral callus in response to axial interfragmentary motion.