Journal of orthopaedic trauma
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To evaluate the outcomes of patients with atrophic humeral shaft nonunion (HSNU) treated by Ilizarov frame fixation without the use of bone graft. ⋯ Ilizarov circular frame fixation without bone graft is a reliable method for the treatment of atrophic nonunion of the humerus, even after failed previous surgery.
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Multicenter Study Comparative Study Clinical Trial
Results of femoral intramedullary nailing in patients who are obese versus those who are not obese: a prospective multicenter comparison study.
Antegrade femoral nailing through a piriformis fossa starting point in patients who are obese has been demonstrated to be problematic. Retrograde femoral nailing therefore has been advocated in this patient population, but little data exist to support such a recommendation. The purpose of this study was to evaluate and compare antegrade and retrograde femoral nailing technique in both patients who are and are not obese. ⋯ This study provides evidence, in the form of decreased operative and radiation exposure times, to support the use of retrograde nailing technique for the treatment of femoral shaft fractures in patients who are obese. Also, antegrade nailing was found to require significantly more operative and radiation exposure time in the patient who is obese as opposed to the patients who is not obese. Although having similar baseline functional scores, patients who are obese recovered at a slower rate and more incompletely than patients who are not obese.
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Multicenter Study
Open reduction and internal fixation of tibial pilon fractures using a lateral approach.
To assess the wound complications and reductions achieved in a cohort of patients with pilon fractures who were treated using a novel lateral approach. ⋯ When applied in a staged fashion, the lateral surgical approach for pilon fractures provides excellent protection of the soft-tissue envelopes by creating thick flaps while allowing excellent visualization for reconstruction of the anterior and lateral distal tibia.
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Case Reports
Use of a 30-degree external rotation view for posteromedial tubercle fractures of the talus.
A fracture of the posteromedial talar tubercle is also referred to as the Cedell fracture and is an infrequently described injury. Failure to recognize this injury may lead to posteromedial ankle pain and tarsal tunnel syndrome. It is therefore important to diagnose these fractures at the time of the initial presentation to avoid future morbidity. ⋯ On the 30-degree external rotation view of the ankle, all fractures of the posteromedial tubercle of the talus were revealed. In contrast, the fracture was visualized in only 2 cases using the standard lateral radiograph of the ankle, and not once in the anteroposterior or mortise views. In conclusion, a 30-degree external rotation view is likely to show a fracture of the posteromedial tubercle of the talus in contrast to the 3 routine trauma views of the ankle, aiding in diagnosis and treatment strategy at time of initial presentation.
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To determine the prognostic reliability, sensitivity, and specificity of the Hawkins sign. The Hawkins sign is a subchondral radiolucent band in the talar dome that is indicative of viability at 6 to 8 weeks after a talus fracture. It is visible in the anterior-posterior view, but seldom appears on lateral radiographs. ⋯ The Hawkins sign is a good indicator of talus vascularity following fracture. If a full or partial positive Hawkins sign is detected, it is unlikely that AVN will develop at a later stage after injury.