Journal of orthopaedic trauma
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To identify whether medial tenderness is a predictor of deep deltoid ligament incompetence in supination-external rotation ankle fractures. ⋯ There was no statistical significance between the presence of medial tenderness and deep deltoid ligament incompetence. There is a 25% chance of the fracture in question with medial tenderness having a positive external rotation stress and a 25% chance the fracture with no medial tenderness having a positive stress test. Medial tenderness in a Weber B lateral ankle fracture with a normal clear space on standard plain radiographs does not ensure the presence of a positive external rotation stress test.
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Chronic infection of bone with nonunion and/or bone defects is traditionally treated by a 2-stage procedure involving initial debridement and antibiotic delivery and then definitive internal fixation. Alternatively, external fixators are used to provide stability. A technique with which antibiotic cement-coated interlocking intramedullary nails are prepared in the operating room with the use of nails and materials that generally are available is herein described. ⋯ One patient experienced partial debonding at insertion, coinciding with the site of segmental defect, which was treated with an antibiotic cement spacer. In summary, control of infection and stability to promote union has traditionally been provided by 2 separate procedures, which have proved to be efficacious in the past. However, both these goals can be achieved in half the patients with 1 surgical procedure in a variety of scenarios using the technique of an antibiotic cement-coated intramedullary nail.
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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.