Journal of orthopaedic trauma
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Intramedullary nail (IMN) fixation is a proven, efficient, and effective surgical intervention for diaphyseal tibia fractures. We present a case report of two patients who sustained diaphyseal tibial fractures, were treated with IMN fixation, and subsequently developed lateral and posterolateral knee pain secondary to interlocking screw penetration into the proximal tibiofibular joint (PTFJ). We performed a retrospective radiographic review of 50 consecutive knee computed tomographic scans to define the fibula's respective anatomic relationship to the tibia on axial computed tomographic images in addition to a cadaveric study of four IMN implants to evaluate the orientation of the medial inserted proximal oblique interlock screw with three-dimensional reconstructive fluoroscopy. ⋯ These findings were correlated to an anatomically based "clock face" guide. To our knowledge, this report is the first to illuminate a PTFJ injury with the initial presenting complaint of lateral and posterolateral knee pain from a medially inserted proximal oblique interlocking screw after IMN for a diaphyseal tibia fracture. Using the proposed reproducible "clock face" diagram and understanding the computed tomography-derived PTFJ "danger zone" for placement of proximal oblique interlock screws for IMN fixation of tibia fractures, surgeons can avoid violation of the PTFJ.
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Comparative Study
A comparison of screw insertion torque and pullout strength.
Pullout strength of screws is a parameter used to evaluate plate screw fixation strength. However, screw fixation strength may be more closely related to its ability to generate sufficient insertion because stable nonlocked plate-screw fracture fixation requires sufficient compression between plate and bone such that no motion occurs between the plate and bone under physiological loads. Compression is generated by tightening of screws. In osteoporotic cancellous bone, sufficient screw insertion torque may not be generated before screw stripping. The effect of screw thread pitch on generation of maximum insertion torque (MIT) and pullout strength (POS) was investigated in an osteoporotic cancellous bone model and the relationship between MIT and POS was analyzed. ⋯ These results indicate that the ability of different screw designs to generate high screw insertion torque in a model of osteoporotic cancellous bone is unrelated to their pullout strength. Therefore, extrapolation of results for POS to identify optimal screw design for osteoporotic bone may not be valid. Screw designs that optimize MIT should be sought for fixation in osteoporotic bone.
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This study was designed to evaluate the frequency of intraoperative problems and complications involved with Less Invasive Stabilization System (LISS) plate removal. ⋯ Difficulty with removal due to cold welding or screw head stripping is common in locking LISS plate screws. LISS plate removal can often require prolonged operating time and the use of specialized removal tools. Surgeons should anticipate the possibility of difficulties when removing these implants and be appropriately prepared.
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Pilon fractures associated with compartment syndrome are rare occurrences despite the relatively high-energy mechanisms that cause many pilon fractures. We report an unusual case of pilon fracture in an adult, which was complicated by development of compartment syndrome. It was successfully treated with four-compartment leg fasciotomy with good results. A high index of suspicion for compartment syndrome should be maintained in patients with intractable pain after pilon fracture.
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To quantify the area of osseous exposure and identify six anatomic landmarks using a direct anterior approach to the hip. ⋯ The minimally invasive Smith-Petersen approach to the hip allows for a wide exposure of the femoral neck averaging 20.31 cm(2) and identification of six bony critical landmarks of the hip. It may be used for open reduction of subcapital, mid-cervical, and basicervical femoral neck fractures.