Journal of orthopaedic trauma
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Clavicle fractures are commonly plated as a method of fixation, with superior and anterior techniques described. Although advantages and disadvantages have been attributed to both, it is unclear if one approach provides a lower risk of neurovascular injury. The aim of this study was to compare the potential for neurovascular injury between these 2 plate locations in a cadaveric model. ⋯ The majority of our specimens showed no significant difference between superior and anterior plating in regard to potential risk for injury to the underlying neurovasculature. However, there appears to be a subset of the population with a more caudal position of the neurovascular structures in which anterior plating may be potentially safer.
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Review Case Reports
Cervicocephalic medial screw migration after intertrochanteric fracture fixation, OTA/AO 31-A2, using intramedullary nail Gamma3: report of 2 cases and literature review.
Cervicocephalic screw medialization is a rare complication after intertrochanteric fracture synthesis with a Gamma3-type intramedullary nail. Only 6 cases of intrapelvic penetration by Gamma3 lag screw have been described. We now describe 2 additional cases and a review of the literature.
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Randomized Controlled Trial
Nonoperative treatment of the medial malleolus in bimalleolar and trimalleolar ankle fractures: a randomized controlled trial.
To compare internal fixation with no fixation of the medial malleolus after open reduction and internal fixation of the lateral malleolus and if needed, the posterior malleolus. ⋯ Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Anatomic reduction of the fibula with regard to the tibia is the goal when treating syndesmotic injuries. No objective method exists to describe the distal tibiofibular relationship. The primary and secondary objectives of this study was to describe and validate radiologic measurements of the syndesmosis and to establish a set of normal values, respectively. ⋯ Several studies have shown that the reduction of the syndesmosis is essential to restore normal ankle mechanics and prevent secondary degenerative changes. The evaluation criteria developed in this study can give the surgeon a guideline for evaluating syndesmosis anatomy with reliable parameters. Concerning the normal range of motion, our radiologic measurements of 100 normal ankles showed that a significant amount of variability exists in the uninjured distal tibiofibular relationship.
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Comparative Study
Using decision analysis to assess comparative clinical efficacy of surgical treatment of unstable ankle fractures.
The development of a robust treatment algorithm for ankle fractures based on well-established stability criteria has been shown to be prognostic with respect to treatment and outcomes. In parallel with the development of improved understanding of the biomechanical rationale of ankle fracture treatment has been an increased emphasis on assessing the effectiveness of medical and surgical interventions. The purpose of this study was to investigate the use of using decision analysis in the assessment of the cost effectiveness of operative treatment of ankle fractures based on the existing clinical data in the literature. ⋯ Economic Level II. See Instructions for Authors for a complete description of levels of evidence.