Journal of orthopaedic trauma
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Intramedullary nailing of the femur is often the treatment of choice in isolated fractures of the femoral shaft. Some surgeons are reticent to use intramedullary nailing for proximal and distal femoral fractures. ⋯ Deforming forces of the muscles of the hip, knee and thigh are neutralized with reduction tools applied percutaneously, blocking screws and Schanz pins. Mastery of these techniques and appropriate reduction are incumbent on the orthopaedic surgeon treating femoral shaft fractures.
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Vertically unstable pelvic ring injuries associated with comminuted transforaminal sacral fractures present a special problem to the treating surgeon in applying stable fixation for maintaining reduction. Triangular osteosynthesis and spinal-pelvic constructs are relatively new techniques used to avoid loss of reduction for treating these difficult fractures, and the last decade has seen a marked increase in the use of these techniques. This article aims to describe the indications and technical aspects in the use of spinal-pelvic constructs for vertical shear sacral fractures such that they can be applied to better help the patients with these injuries.
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External rotation of the disrupted hemipelvis is a common deformity after pelvic ring trauma, especially in anteroposterior compression injury patterns. This displacement is associated with significant pelvic hemorrhage. ⋯ In such scenarios, circumferential pelvic area sheeting does not always achieve a complete reduction. We present a technique of internal rotation and taping of the lower extremities as an alternative or supplemental pelvic closed reduction method.
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To analyze the radiographic, clinical, and functional results of triangular osteosynthesis constructs for the treatment of vertically unstable comminuted transforaminal sacral fractures. ⋯ Triangular osteosynthesis fixation is a reliable form of fixation that allows early full weight-bearing at 6 weeks while preventing loss of reduction in comminuted vertical shear transforaminal sacral fractures. For this study group, operative reduction was maintained until healing in 95% of patients. However, the 1-year follow-up shows a substantial rate of potential technical problems and complications. Of primary concern were the asymmetric L5 tilting with L5-S1 facet joint distraction and the need for a second surgery in all patients to remove painful fixation. Iatrogenic nerve injury occurred in 5 patients (13%) and is thought to arise secondary to fracture manipulation and reduction. We recommend selective use of this technique for comminuted transforaminal sacral fractures in situations only where reliable iliosacral or trans-sacral screw fixation is not obtainable.
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Injuries are common during combat operations. The high costs of extremity injuries both in resource utilization and disability are well known in the civilian sector. We hypothesized that, similarly, combat-related extremity injuries, when compared with other injures from the current conflicts in Iraq and Afghanistan, require the largest percentage of medical resources, account for the greatest number of disabled soldiers, and have greater costs of disability benefits. ⋯ Combat-related extremity injuries require the greatest utilization of resources for inpatient treatment in the initial postinjury period, cause the greatest number of disabled soldiers, and have the greatest projected disability benefit costs. This study highlights the need for continued or increased funding and support for military orthopaedic surgeons and extremity trauma research efforts.