Journal of orthopaedic trauma
-
Randomized Controlled Trial
Prophylactic antibiotics in open fractures: a pilot randomized clinical safety study.
To develop preliminary data on Staphylococcus aureus colonization and surgical site infections (SSIs) in patients with open fractures who received standard antibiotic prophylaxis compared with a regimen including targeted methicillin-resistant Staphylococcus aureus (MRSA) coverage. ⋯ Staphylococcus aureus nasal colonization in trauma patients with open fractures is similar to that of the general community. In this pilot study, the addition of vancomycin to standard antibiotic prophylaxis was found safe, but its efficacy should be evaluated in a larger multiinstitutional trial.
-
To determine if the routine use of intraoperative blood cell salvage in acetabular fracture internal fixation reduces the need for allogenic blood transfusion, is cost effective, and whether it is influenced by the acetabular fracture pattern. ⋯ The use of blood cell salvage for internal fixation surgery for acetabular fracture is cost effective, particularly when treating AF types, and its routine use is advocated to limit the need for allogenic blood transfusion.
-
To determine long-term outcomes and costs of Ilizarov bone transport and flap coverage for lower limb salvage. ⋯ The long-term results and costs of bone transport and flap coverage strongly support complex limb salvage in this patient population.
-
Case Reports
Failure and salvage of "INFIX" instrumentation for pelvic ring disruption in a morbidly obese patient.
Open-book pelvic fractures in the obese patient are accompanied by an increased risk of fixation failure. We report on the use of a recently described anterior subcutaneous pelvic internal fixator, the "INFIX" technique, in a morbidly obese patient. In this case, single and double rod constructs alone did not maintain adequate fixation due to the extreme forces in a morbidly obese patient. Successful salvage of the construct and satisfactory healing was achieved with the addition of 2 cross-links between the double rods of the INFIX.
-
Displaced intra-articular fractures of the calcaneus can lead to severe pain and disability if not treated appropriately. Failure to treat may require fusion of the subtalar joint, supplemented by additional osteotomies. Occasionally, these fractures are seen after the fracture has just healed, and the decision to treat can be a difficult one. ⋯ The mean American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score improved significantly from 19.0 preoperatively to 81.2 at follow-up (P < 0.001). The radiographic parameters (the Böhler angle, talocalcaneal height, and heel width) were substantially corrected. A joint-preserving osteotomy with axial realignment can be a treatment option for malunited intra-articular calcaneal fractures encountered early on, before the development of subtalar arthrosis.