Journal of orthopaedic trauma
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To review the efficacy of the current diagnostic methods of acute compartment syndrome (ACS) after leg fractures. ⋯ Early diagnosis of an ACS is important. Despite its drawbacks, clinical assessment is still the diagnostic cornerstone of ACS. Intracompartmental pressure measurement can confirm the diagnosis in suspected patients and may have a role in the diagnosis of this condition in unconscious patients or those unable to cooperate. Whitesides suggests that the perfusion of the compartment depends on the difference between the diastolic blood pressure and the intracompartmental pressure. They recommend fasciotomy when this pressure difference, known as the Delta p, is less than 30 mm Hg. Access to a precise, reliable, and noninvasive method for early diagnosis of ACS would be a landmark achievement in orthopaedic and emergency medicine.
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We conducted a study to evaluate the long-term functional outcomes of patients with an isolated tibial shaft fracture treated with locked intramedullary nailing. ⋯ At a median 14 years after tibial nailing of isolated tibial fractures, patients' function is comparable to population norms, but objective and subjective evaluation shows persistent sequelae which are not insignificant. This study is the first to describe the long-term functional outcomes after tibial shaft fractures treated with intramedullary nailing nails. It may allow surgeons to better inform patients on the expected long-term function after intramedullary nailing of a tibia fracture. It may also prove useful when comparing intramedullary nailing nailing to other treatment techniques.
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Comparative Study
The biomechanics of ipsilateral intertrochanteric and femoral shaft fractures: a comparison of 5 fracture fixation techniques.
The aim of the present study was to examine biomechanically 5 different construct combinations for fixation of ipsilateral intertrochanteric and femoral shaft fractures. ⋯ All constructs showed no statistical differences when compared with one another, with the exception of construct E, which provided the least torsional stiffness. However, the current in vitro model did not simulate fracture healing or support offered by soft tissues, both of which would affect the stiffness and load-to-failure levels reached.
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Case Reports
Scapulothoracic dissociation with acromioclavicular separation: a case report of a novel fixation method.
We present a case of 39-year-old female with a scapulothoracic dissociation and acromioclavicular (AC) separation and who had fixation of the AC joint with a locking plate, coracoclavicular screw, and transarticular AC screw. The coracoclavicular and AC relationships were maintained during postoperative rehabilitation and after hardware removal. Use of a locking plate can lead to good functional outcome without the complications associated with the use of pin and wire constructs or without violating the subacromial space.
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A validated canine critical-sized segmental defect model was used to compare efficacy of volumetric ratios of recombinant human bone morphogenetic protein-2 (rhBMP-2)/absorbable collagen sponge (ACS) with cancellous allograft bone or biphasic calcium phosphate ceramic granules using radiographic, biomechanical, and histologic analyses. ⋯ In this study, efficacy of the treatment correlated with the ratio of rhBMP-2/ACS to allograft. As volume of rhBMP-2/ACS decreased below a 1:1 volume ratio, the overall efficacy decreased, thus indicating a potential limit to extending rhBMP-2/ACS past a 1:1 volumetric ratio in large segmental defects. Furthermore, ceramic was found to be a successful replacement for cancellous allograft bone at a 1:1 volumetric ratio. Clinical application using graft expanders or bone void fillers with rhBMP-2 should be used carefully and requires further investigation.