Journal of orthopaedic trauma
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This introduction summarizes historical aspects regarding improvements in the treatment of open fractures and complicated wounds. Before the development of standardized surgical wound treatment and antisepsis, amputations were frequently required to prevent sepsis and death. Nowadays, the use of modern sealing techniques has caused a further dramatic reduction in the infection rates and an improvement of the healing response, thus enabling orthopaedic surgeons to perform skin graft coverage, where previously plastic surgeons had to perform skin flaps.
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To define the unique clinical and radiographic features, operative treatment, and complications of irreducible femoral head fracture-dislocation without associated posterior wall fracture. ⋯ Irreducible femoral head fracture-dislocations without associated posterior wall fractures occur rarely, but are heralded by unique clinical and radiographic features. These patients warrant special consideration in terms of recognition and management. The physical examination findings and specific radiographic markers should alert the surgeon to this injury pattern and its related complications. Closed reduction of this fracture-dislocation should not be attempted. Delayed operative management may be related to femoral head aseptic necrosis. Accurate reduction and stable fixation can successfully be performed through a Smith-Petersen surgical exposure using small or miniature fragment cortical screws alone.
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External fixation is frequently used for provisional and/or definitive stabilization of open and closed fractures and dislocations involving the lower extremity. There is some concern, however, that application of an external fixator with subsequent reduction of the fractures with distraction may precipitate the development of compartment syndrome. The hypothesis of this study was that application of external fixation and restoration of limb length would have no effect on the compartment pressures. ⋯ Application of knee-spanning external fixation as a temporary measure for stabilization of high-energy proximal tibial fractures and dislocations may result in transient elevation of intracompartmental pressure of the leg. Although DeltaP may fall below the threshold of 30 mm Hg, this does not appear to lead to compartment syndrome.
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To investigate whether locking screws offer any advantage over nonlocking screws for plate fixation of humeral shaft fractures for weight-bearing applications. ⋯ Synthetic and cadaveric bone testing showed that locking screws offer no obvious biomechanical benefit in this application.
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The primary aim was to describe the epidemiology of the Holstein-Lewis humeral shaft fracture, its association with radial nerve palsy, and the outcome regarding recovery from the radial nerve palsy and fracture healing. The secondary aim was to analyze the long-term functional outcome. ⋯ The Holstein-Lewis humeral shaft fracture was associated with a significantly increased risk of acute radial nerve palsy. The overall outcome regarding fracture healing, radial nerve recovery, and function was very good regardless of the primary treatment modality, that is, operative or nonoperative treatment. The indication for primary operative intervention in this fracture type appears to be relative.