Journal of orthopaedic trauma
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Review Meta Analysis
Clearance of the asymptomatic cervical spine: a meta-analysis.
To perform a comprehensive review of the literature and subsequent meta-analysis of data regarding appropriate clearance of the asymptomatic cervical spine in blunt trauma patients. The goal is to identify an asymptomatic patient group that can safely be cleared of cervical spine immobilization without radiographic evaluation. ⋯ An alert, asymptomatic patient without a distracting injury or neurologic deficit who is able to complete a functional range-of-motion examination may safely be cleared from cervical spine immobilization without radiographic evaluation (sensitivity = 98.1%, negative predictive value = 99.8%).
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Case Reports
Medial migration of lag screw with intrapelvic dislocation in gamma nailing--a unique problem? A report of 2 cases.
Within the last decade, intramedullary nailing systems have gained popularity in the treatment of unstable fractures of the trochanteric region with good clinical results. However, these implants are not free of complications. Commonly reported treatment failures include implant cutout through the femoral neck, stress-derived femur fractures at the distal end of the nail, and secondary rotational displacement and varus deformity of the femoral neck and head. ⋯ Complete separation of the implant occurred, and the lag screw penetrated through the acetabulum into the pelvis. The patient's histories and course of treatment are reported. The literature on this topic is discussed.
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Comparative Study
The treatment of nonisthmal femoral shaft nonunions with im nail exchange versus augmentation plating.
The purpose of this study was to compare the results between exchange nailing (EN) and augmentation plating (AP) with a nail left in situ for nonisthmal femoral shaft nonunion after femoral nailing. ⋯ AP with autogenous bone grafting may be a better option than EN for nonisthmal femoral nonunions.
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Fracture displacement, a high Pauwels angle, and delayed presentation decrease the potential for healing of femoral neck fractures. In the young individual, head preservation is paramount. ⋯ Ten patients younger than 60 years of age with delayed presentation of displaced Pauwels III femoral neck fractures were treated by osteosynthesis and valgus intertrochanteric osteotomy fixed by dynamic hip screws. All osteotomies and nine fractures united with one case developing avascular necrosis.
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Rotational malalignment during femoral nailing is common. The difference in cortical width of the proximal and distal fracture fragments, the cortical step sign, is a commonly used yet poorly studied method of evaluating rotational alignment. This study aims to critically analyze the cortical step sign in cadaveric specimens using radiographic and direct measurements. ⋯ The cortical step sign, or incongruity of cortical widths on either side of a femur fracture, is indicative of rotational malreduction. Whether such malreduction is the result of internal rotation or external rotation, however, cannot be easily determined from this radiographic sign.