Journal of orthopaedic trauma
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Extremity wounds and fractures traditionally comprise the majority of traumatic injuries in US armed conflicts. Little has been published regarding the extremity wounding patterns and fracture distribution in the current conflicts in Iraq and Afghanistan. The intent of this study was to describe the distribution of extremity fractures during this current conflict. ⋯ The burden of wounds sustained in OIF/OEF is extremity injuries, specifically soft-tissue wounds and fractures. These results are similar to the reported casualties from previous wars.
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To evaluate the role of a modified Pauwels' intertrochanteric osteotomy (MPIO) in neglected femoral neck fractures in children. ⋯ An MPIO creates a biomechanical environment conducive to healing of a neglected femoral neck nonunion in a child while simultaneously correcting an associated coxa vara. The procedure also seems to have a biological role in helping restore viability to a noncollapsed femoral head with avascular necrosis.
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Case Reports
Extended (16-hour) tourniquet application after combat wounds: a case report and review of the current literature.
We present a case of emergency tourniquet use of unusually long duration. The patient was wounded during combat operations, and the subsequent battle and evacuation caused a significant delay in surgical treatment of his wounds. Emergency tourniquets can be lifesaving, but are not benign interventions. ⋯ We conducted a search of the published literature including the Medline database, and present a review of the relevant articles concerning emergency tourniquet use, tourniquet injury, and mitigating treatments. Given the widespread use of tourniquets in ongoing military operations, it seems likely that tourniquets will transition to civilian use. Thus it is important for physicians to understand tourniquet injury and appreciate that even extended tourniquet application times does not necessarily doom the affected limb.
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External fixation for pelvic stabilization is an important component of the overall treatment of patients with high-energy pelvic fractures. Traditional constructs include single and multiple pin placements in several locations in each iliac crest. ⋯ Pins in this location are more stable biomechanically, allow for pelvic reduction in the transverse plane of deformity, facilitate concurrent or subsequent laparotomy procedures, and may allow improved reduction of the posterior elements with a femoral distractor as a compressor. We describe the technique for placement of supraacetabular external fixation pins, pelvic reduction, and compression using a femoral distractor.