Journal of orthopaedic trauma
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Randomized Controlled Trial Multicenter Study
Incisional negative pressure wound therapy after high-risk lower extremity fractures.
To investigate negative pressure wound therapy (NPWT) to prevent wound dehiscence and infection after high-risk lower extremity trauma. ⋯ There have been no studies evaluating incisional NPWT as a prophylactic treatment to prevent infection and wound dehiscence of high-risk surgical incisions. Our data demonstrate that there is a decreased incidence of wound dehiscence and total infections after high-risk fractures when patients have NPWT applied to their surgical incisions after closure. There is also a strong trend for decreases in acute infections after NPWT. Based on our data in this multicenter prospective randomized clinical trial, NPWT should be considered for high-risk wounds after severe skeletal trauma.
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Traumatic anterior shoulder dislocation can be associated with anteroinferior glenoid bone loss causing potential recurrent instability. We report on a 62-year-old man with a first-time traumatic anterior dislocation of the right shoulder, resulting in both an infraglenoid tubercle triceps avulsion fracture and a greater tuberosity fracture. ⋯ At latest follow-up, the patient had recovered his shoulder function. Avulsion fractures of the infraglenoid tubercle are uncommon lesions after an anterior shoulder dislocation and, without signs of instability, can be treated conservatively.
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Assessing femoral neck shortening (FNS) and varus collapse after internal fixation of femoral neck fractures using computerized navigation (CN). ⋯ Our results show a high degree of FNS associated with the use of CN for fixation of femoral neck fractures, similar to recently published series using nonnavigated implants. However, no varus collapse occurred in our series. Our preliminary clinical data show a trend toward an adverse effect of FNS on quality-of-life measures.
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To present a novel internal fixation device for stabilizing unstable pelvic fractures using supra-acetabular spinal pedicle screws and a subcutaneous connecting rod (INFIX). ⋯ The reported technique allows for a definitive and stable anterior fixation of vertically and rotationally unstable pelvic fractures when combined with the appropriate posterior fixation if indicated. The potential complications are acceptable with this technique and good outcomes were achieved. A second operative procedure is required for removal of the device. It is our view that its best indication is in obese individuals, in whom other options have shortcomings.
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Comminuted osteoporotic olecranon fractures in the elderly are relatively common. Open reduction and internal plate fixation is a frequently used treatment option. In highly comminuted osteoporotic bone, fixation may be tenuous leading to an increased risk of fixation failure with loss of reduction and displacement of fracture fragments. The off-loading triceps suture technique is a load-sharing mechanism to decreases distraction forces caused by the extensor mechanism on comminuted osteopenic olecranon fracture fragments managed with plate fixation.