Journal of orthopaedic trauma
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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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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.
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Insertion of rigid uniplane bent femoral nails through the piriform fossa has been reported to cause neurovascular complications. New nails were designed for more lateral entry points. However, these may be associated with a higher risk of iatrogenic fractures. This study investigated if two differently bent nails with more lateral entry points induce higher cortical bone strains than a uniplane bent nail introduced through the piriform fossa. ⋯ Bone strains at the medial impingement location were low for all nails. Entry portals with thin cortical walls due to, for example, larger reamer diameters and a small greater trochanter seem to be more susceptible to insertion accuracy, which may influence strain and fissure or fracture occurrence. Furthermore, we do not recommend determination of the entry point of laterally inserted nails based solely on anatomic landmarks of the greater trochanter because this may influence insertion accuracy. This implies that biplanar imaging is important for accurate and safe insertion of laterally started nails.
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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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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.