Journal of orthopaedic trauma
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Multicenter Study
Outcome of open reduction and internal fixation of surgical neck nonunions of the humerus.
The purpose of this study was to evaluate the results of open reduction and internal fixation of nonunions of the surgical neck of the humerus. ⋯ Open reduction and internal fixation with autogenous bone graft results in excellent outcomes even in patients >65 years old and patients with significant medical problems. This treatment method offers predictable fracture healing and has a low complication rate.
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To correlate interosseous membrane (IOM) tears of the ankle to the height of fibular fractures in operative ankle fractures. ⋯ The level of the fibular fracture does not correlate reliably with the integrity or extent of the interosseous membrane tears identified on MRI in operative ankle fractures. One cannot consistently estimate the integrity of the IOM and subsequent need for transsyndesmotic fixation based solely on the level of the fibular fracture. An intraoperative syndesmotic stress test is recommended to establish the presence or absence of syndesmotic instability.
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To determine the prevalence and patterns of foot injuries following motorcycle trauma. ⋯ Motorcycle accidents continue to be a source of severe injury, especially to the foot. The most common foot injury is a metatarsal fracture; however, there must be a high index of suspicion for associated injuries. Although these injuries are associated with a low mortality rate, they require prompt assessment and treatment to limit long-term morbidity and disability. The difference in foot injury pattern and mortality between the parent population and our series, among other factors, potentially may be influenced by the actual mechanism of contact with the road surface and the modifying action of the foot during the accident.
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The application of the pelvic clamp as a tool for emergency stabilization of unstable pelvic ring fractures has proved to be a life-saving procedure. Using correct technique, the pelvic clamp can be applied within a few minutes after the patient's admission. To avoid severe complications (eg, pin perforation into the pelvis) during the application, anatomic landmarks for the correct pin placement have to be defined. ⋯ The ideal insertion point of the pins is an anatomic region on the lateral cortex of the ileum, where an easily palpable "groove" is formed by angulations of the lateral cortex of the iliac wing. Being increasingly used as an entry point for percutaneous transiliosacral screw fixations of sacroiliac joint injuries and sacral fractures, this region, which is close to the sacroiliac joint, represents an ideal point for maximum compression of the posterior pelvic ring. With the described technique, this "groove" can be identified easily even in emergency situations by blunt palpation with an instrument, avoiding the time-consuming use of a fluoroscope in most cases.
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Percutaneous internal fixation of pelvic fractures has gained popularity allowing rapid mobilization with reduced surgical related morbidity; however, this method depends on conventional fluoroscopy, which exposes the patient and the surgeon to a significant amount of radiation. The use of computerized fluoroscopic navigation systems enables the simultaneous use of several radiographic projections. These preliminary fluoroscopic views are taken when the operating team stands at a distance from the radiation source. ⋯ Fluoroscopic verification of screw placement demonstrated a deviation