Journal of orthopaedic trauma
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To evaluate the prevalence and magnitude of sagittal plane deformity in bicondylar tibial plateau fractures. ⋯ Considerable sagittal plane deformity exists in the majority of bicondylar tibial plateau fractures. The lateral plateau has a higher propensity for sagittal angulation and tends to have increased posterior slope. Most patients have a substantial difference between the lateral and medial plateau slopes. The identification of this deformity allows for accurate preoperative planning and specific reduction maneuvers to restore anatomic alignment.
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To compare radiographic reduction, intraoperative factors, and perioperative complications for transversely oriented acetabular fractures treated by the Kocher-Langenbeck approach with the patient in either the prone or lateral position. ⋯ This study demonstrated a trend toward higher radiographic residual fracture displacement in patients with transversely oriented acetabular fractures reduced and stabilized through the Kocher-Langenbeck approach in the lateral position compared with those positioned prone. However, no significant differences were observed in operative time, estimated blood loss, or perioperative complications between the two groups.
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To describe the technique and results of stress examination with fluoroscopy under anesthesia (EUA) to determine stability and the need for operative stabilization of traumatic pelvic ring injuries. ⋯ The reported incidence of poor functional outcomes associated with pelvic fracture may be attributable, in part, to inadequate treatment of misdiagnosed injuries and chronic instability and/or malunion. Performing an examination under anesthesia with dynamic stress fluoroscopy as described in this series revealed occult instability in 50% of presumed APC-1 injuries, 39% of APC-2 injuries, and 37% of LC-1 injuries. We propose a modification to the Young-Burgess Classification system to reflect the dynamic component of pelvic ring instability disclosed on EUA as follows: APC-2a for those injuries requiring anterior only fixation, APC-2b for those injuries that may require treatment with anterior and posterior fixation, LC-1a for those injuries that are stable and do not require internal fixation, and LC-1b for those lateral compression injuries that may require treatment with internal fixation. We conclude that pelvic EUA merits further analysis as an important diagnostic tool that may provide additional information regarding instability of the pelvic ring.
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The proximal femoral nail antirotation is a new generation of intramedullary device for the treatment of trochanteric femoral fractures, having a helical blade rather than a screw for suggested better purchase in osteoporotic bone. However, it is not free of complications. Few reports are available on postoperative perforation of the helical blade through the femoral head as a unique complication of proximal femoral nail antirotation. We report a 79-year-old woman with acetabular perforation after migration of the helical blade through the femoral head after an unstable trochanteric fracture, which was fixed with a proximal femoral nail antirotation.
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The purpose of this study is to determine the rate of late (secondary) amputation and to identify risk factors for amputation in injuries that were initially treated with limb preservation on the battlefield. ⋯ The rate of amputation in severe blast-induced extremity fractures combined with an arterial injury initially treated with limb preservation on the battlefield and before transfer to the definitive military treatment facility is extremely high. Blast-injured lower limbs with a combined severe bony and soft tissue injury should be carefully assessed when arterial injury is present because they may require early amputation during initial surgical care on the battlefield.