Journal of orthopaedic trauma
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In the treatment of tibia fractures, is the intraoperative diastolic blood pressure (DBP) less than pre- and postoperative DBP, and how does this relate to the diagnosis of compartment syndrome using DeltaP (diastolic blood pressure [DBP] - intracompartmental pressure)? ⋯ There is a predictable response of DBP in patients with tibia fractures treated with intramedullary (IM) nailing under general anesthesia. The preoperative DBP is a good indicator of the postoperative DBP, and the intraoperative DBP is significantly lower (average 18 mm Hg; P < 0.05). The surgeon should recognize that intraoperative DeltaP may be lower than DeltaP once the patient is awakened in deciding whether to perform a fasciotomy or awaken the patient and perform serial examinations and or compartment pressure measurements. Intraoperative DeltaP may be spuriously low compared with that after the patient is awakened.
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Review Case Reports
Transverse divergent dislocation of the elbow with ipsilateral distal radius fracture in a child.
We report a rare case of an irreducible transverse divergent dislocation of the elbow with an ipsilateral distal radius torus fracture and a fracture of the coronoid process in a 9-year-old male. Closed reduction of the elbow was attempted, but the humeroulnar joint remained dislocated. At surgery, the avulsed anterior band of the medial collateral ligament complex of the elbow was found to be interposed between the medial condyle of the humerus and the olecranon. ⋯ He was able to use his upper extremity for all activities in his daily life and had returned to sports. No radiographic abnormalities were found at this follow-up, particularly premature epiphyseal closure of the radial head. Closed reduction has been successful in a majority of reported cases of transverse divergent dislocation of the elbow, yet the presence of an incomplete reduction of the ulnohumeral joint should alert the physician to the possible interposition of soft tissues or bony fragments necessitating an open reduction.
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To describe the clinical features and outcome of a series of patients with complete motor and sensory ulnar nerve palsy associated with a fracture of the distal radius. ⋯ Acute ulnar nerve palsy may occur in association with high-energy, widely displaced fractures of the distal radius. These are usually neurapraxic injuries that recover to normal or near-normal strength and sensation. We recommend exploration and release of a complete ulnar nerve palsy associated with a fracture of the distal radius fracture when there is an open wound or an acute carpal tunnel syndrome, and observation without exploration otherwise.
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To evaluate the radiographic and clinical outcome, including the incidence of recurrence, in patients with displaced greater tuberosity (GT) fractures associated with a traumatic anterior shoulder dislocation. ⋯ Displaced fractures of the GT after traumatic anterior shoulder dislocation may result in limitation of motion and functional disability if they are not treated promptly by surgery. Open reduction and stable fixation of the GT along with rotator cuff repair when present, allows for early passive motion of the joint, and yields excellent final results in approximately three quarters of the patients and restores their ability to return to full activities of daily living. A compliant patient is also necessary for a successful result.
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The purpose of this study was to examine the effects of resorbable bone cement on screw and plate-screw fracture fixation in a porous osteoporotic bone model. ⋯ : In fracture situations in which osteoporotic bone makes screw and screw-plate fixation tenuous, screw augmentation with TCP cement should be considered as adjunct treatment.