Journal of orthopaedic trauma
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Review Meta Analysis
A systematic review of thromboprophylaxis for pelvic and acetabular fractures.
Pelvic and acetabular fractures have been identified as risk factors for deep venous thrombosis (DVT) and thromboembolic complications. A systematic review was performed to evaluate the effectiveness of thromboprophylactic strategies to prevent DVT or pulmonary embolism (PE) after pelvic or acetabular fractures. ⋯ Although several strategies have been used to prevent thromboembolism in pelvic and acetabular fracture patients, our results suggest that clinicians have limited data to guide their prophylactic decisions. Well-designed clinical trials to prevent and detect venous thromboembolism in pelvic and acetabular trauma are still needed.
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To radiographically demonstrate the upper sacral nerve root tunnel (USNRT) in both cadaveric specimens and a clinical cohort and to quantify its clinical relevance. ⋯ The USNRTs have a consistent radiographic appearance that is best seen on the pelvic outlet and true lateral sacral views, but their course is best understood when seen on all 3 views. Awareness and understanding of the USNRT, its course, and its radiographic landmarks allow the surgeon to avoid tunnel intrusion by an iliosacral screw.
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Many approaches to the acetabulum have been described for the treatment of displaced acetabular fractures. However, the treatment of complex anterior column fractures remains difficult. Commonly used approaches allow access to the internal cortical surface of the anterior column or a limited view of the outer cortical surface of the anterior column. We present a modification of a traditional Smith-Peterson approach with osteotomies for extensile exposure to the anterior column of the acetabulum.
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Intramedullary nailing of the femur is often the treatment of choice in isolated fractures of the femoral shaft. Some surgeons are reticent to use intramedullary nailing for proximal and distal femoral fractures. ⋯ Deforming forces of the muscles of the hip, knee and thigh are neutralized with reduction tools applied percutaneously, blocking screws and Schanz pins. Mastery of these techniques and appropriate reduction are incumbent on the orthopaedic surgeon treating femoral shaft fractures.
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Vertically unstable pelvic ring injuries associated with comminuted transforaminal sacral fractures present a special problem to the treating surgeon in applying stable fixation for maintaining reduction. Triangular osteosynthesis and spinal-pelvic constructs are relatively new techniques used to avoid loss of reduction for treating these difficult fractures, and the last decade has seen a marked increase in the use of these techniques. This article aims to describe the indications and technical aspects in the use of spinal-pelvic constructs for vertical shear sacral fractures such that they can be applied to better help the patients with these injuries.