Journal of orthopaedic trauma
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To present a case series of patients with posterior bicondylar tibial plateau fractures treated by direct fracture exposure and fixation through dual incisions. ⋯ Posterior bicondylar tibial plateau fractures have a high association with lateral meniscal pathology and can be associated with anterior cruciate ligament injury. Reduction of the posterior plateau condyles is easiest with the knee in full extension. Flexion contractures can be a problem, and patients should be encouraged to regain/maintain knee extension. The dual-incision approach to these challenging fractures can result in good to excellent knee function for these patients.
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Multicenter Study
Predictors of functional outcome following transsyndesmotic screw fixation of ankle fractures.
Given the continued debate regarding syndesmotic screw fixation, we reviewed our institution's series of ankle syndesmotic screw insertions: 1) to examine technical aspects of syndesmotic screw fixation; and 2) to identify predictors of function and quality of life utilizing validated instruments. ⋯ Our findings suggest: 1) technical aspects of syndesmotic screw fixation vary between surgeons; 2) 16% of syndesmotic screws may have been unnecessary; and 3) despite variability in technique and indications, anatomic reduction of syndesmosis was significantly associated with improved Short Musculoskeletal Functional Assessment Index functional outcome. Larger, prospective studies are needed to further explore our findings.
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Iliosacral screws are a popular technique used to treat complicated injuries of the pelvis. It is well recognized that this technique entails some potentially disabling complications, including damage to vessels and lumbosacral nerves. The recommended insertion site for iliosacral screws into the S1 body lies along the posterior ilium between the greater sciatic notch and the iliac crest. The anatomy and course of the superior gluteal nerve and vessels have been described along the outer aspect of the posterior ilium. Injury to the superior gluteal nerve and vessels has been reported during pelvic surgery, including the insertion of iliosacral screws. The purpose of this study is to assess the risks of injury and proximity of percutaneously inserted iliosacral screws to the superior gluteal nerve and vessels using a cadaver model. ⋯ The deep superior branch of the superior gluteal nerve and vessels, which provides major blood and nerve supply to the G. medius and G. minimus, is at significant risk during the percutaneous placement of iliosacral screws even when "well placed" and soft tissue protecting cannulas are used. The clinical effects of these injuries remain poorly understood.
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We present the case of an intraforaminal iliosacral screw placed percutaneously with aid of C-arm using inlet, outlet, and lateral views of the pelvis. The iliosacral screw was placed above the S1 foramen on the outlet view, into the middle of S1 via the ala on the inlet view, and below the cortical shadow of the ala on the lateral view. ⋯ Postoperative computed tomography scan showed that the iliosacral screw was within the S1 foramen. Because of the tangential nature of the S1 foramen, slight posterior placement of the screw into the S1 body and not into the promontory resulted in violation of the foramen despite it being above the cortical shadow on the outlet view.