Journal of orthopaedic trauma
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The objective of this study was to test the stiffness and ultimate load to failure of new intramedullary (IM) nail proximal screw configurations as compared to a trochanteric reconstruction nail. ⋯ The proximal 3-screw configuration provided more stiffness than either the 2-screw configuration or trochanteric reconstruction nail. The 2-screw configuration performed equally to a standard trochanteric reconstruction nail in stiffness testing. The ultimate loads to failure for the 3 tested constructs were not significantly different.
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Comparative Study
Radiographic and clinical comparisons of distal tibia shaft fractures (4 to 11 cm proximal to the plafond): plating versus intramedullary nailing.
The purposes of this study were to review distal tibia shaft fractures treated with a plate or a nail and to assess the clinical and radiographic results, complication rates, and the need for secondary procedures. ⋯ Distal tibia fractures may be treated successfully with plates or nails. Delayed union, malunion, and secondary procedures were more frequent after nailing. Randomized prospective assessment may further clarify these issues and provide information about costs associated with these fractures.
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Traditionally, both high- and low-energy tibial plateau fractures are classified on the basis of the anteroposterior (AP) plain radiograph. Several fracture types exist that are not included in currently used classification schemes, including posteromedial shear and coronal plane fractures. These fracture types can appear as isolated fracture lines or as a part of a bicondylar plateau fracture. ⋯ Posteromedial shear fractures of the tibial plateau are not uncommon. This pattern is assessable using the preoperative CT scan. A supine posteromedial approach with antiglide plating provides a good clinical solution for these complex injuries.
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Concomitant injuries of the radiocarpal, intercarpal, and carpometacarpal joints are rare and usually result from very high-energy trauma. The skeletal injury is often accompanied by severe soft tissue trauma. ⋯ We describe our experience in 2 patients using a technique in which a wrist arthrodesis plate is temporarily placed from the radius to metacarpal to span the carpus and protect the radiocarpal and intercarpal repairs. The plate is removed after 3 months.
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To prospectively analyze a homogenous group of trauma patients with pure sacroiliac (SI) joint dislocations treated with iliosacral screws (ISS), with specific attention to functional outcome and its correlation with the presence or absence of SI joint ankylosis and quality of reduction. ⋯ Based on the results of this study, in the treatment of vertically displaced, pure SI joint dislocations, an anatomic reduction (whether closed or open), followed by ISS fixation should be the goal because this appears to be the only predictor of a more favorable functional outcome in patients with this injury. Complete SI joint ankylosis appears to have no effect, either positive or negative, on functional outcome in these patients.