Journal of orthopaedic trauma
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Comparative Study
Use of the Reamer-Irrigator-Aspirator for bone graft harvest: a mechanical comparison of three starting points in cadaveric femurs.
The mechanical behavior of cadaveric femurs after intramedullary reaming using the Reamer-Irrigator-Aspirator (RIA) for autogenous bone graft harvest has not been fully described. We hypothesized that reamed femurs, regardless of starting point, would adequately withstand cyclic loading simulating postoperative single-leg stance. ⋯ Intramedullary reaming for bone graft harvest using the RIA without subsequent intramedullary stabilization did not significantly degrade the mechanical behavior of cadaveric femurs in simulated single-leg stance regardless of reamer starting point. It appears safe to allow single-leg stance weightbearing on a reamed, unstabilized femur after bone graft harvesting using the RIA.
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Screw fixation of the injured syndesmosis restores stability but may reduce motion. The purpose of this study is to determine whether functional outcomes and radiographic results after ankle fracture are affected by the status of the syndesmosis screw. ⋯ An intact syndesmosis screw was associated with a worse functional outcome compared with loose, fractured, or removed screws. However, there were no differences in functional outcomes comparing loose or fractured screws with removed screws. Screw removal is unlikely to benefit patients with loose or fractured screws but may be indicated in patients with intact syndesmosis screws.
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Ankle fractures with a syndesmotic injury have historically been treated with syndesmotic screw fixation. We compared range of motion and functional outcomes' scores to assess patient benefit from syndesmotic screw and plate removal. ⋯ Locked screw and plate removal improved function both subjectively and objectively. Transsyndesmotic implant removal seems to assist improvements in the speed of rehabilitation.
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Case Reports
Technical tricks when using the reamer irrigator aspirator technique for autologous bone graft harvesting.
This report describes technical tricks for using the reamer irrigator aspirator to harvest autologous bone graft from the femur. This device is a focus of interest in orthopaedics because it can be used to harvest bone graft from the femoral canal and medial condyle in voluminous quantities. Moreover, according to some authors, the osteogenic potential of this graft is at least as effective as that of autogenous bone obtained from the iliac crest. ⋯ At the same time, however, this sharp front-end cutting design can increase the risk of iatrogenic fracture if reaming is performed without caution. Third, a powerful suctioning device is connected to the reamer such that the blood loss that can occur during continuous reaming, irrigation, and aspiration must be considered with this technique. We hereby discuss these potential dangers and describe the correct use of this device with technical tricks to minimize the risk of unexpected intraoperative events.
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Multicenter Study
Surgeons and their patients disagree regarding cosmetic and overall outcomes after surgery for high-energy lower extremity trauma.
To determine whether surgeons' and patients' perceptions of outcomes after high-energy lower-extremity trauma are similar and to identify factors associated with disagreement. ⋯ Surgeons' perceptions of patients' cosmetic and overall outcomes differed significantly from those of patients. Agreement was significantly worse for certain subgroups of patients. Further study of this discordance might improve our understanding of patient dissatisfaction and allow development of a more patient-centered care process.