Journal of orthopaedic trauma
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Comparative Study
A comparison of optical and electromagnetic computer-assisted navigation systems for fluoroscopic targeting.
Freehand targeting using fluoroscopic guidance is routine for placement of interlocking screws associated with intramedullary nailing and for insertion of screws for reconstruction of pelvic and acetabular injuries. New technologies that use fluoroscopy with the assistance of computer guidance have the potential to improve accuracy and reduce radiation exposure to patient and surgeon. We sought to compare 2 fluoroscopic navigation tracking technologies, optical and electromagnetic versus standard freehand fluoroscopic targeting in a standardized model. ⋯ Both optical and electromagnetic computer-assisted guidance systems have the potential to improve accuracy and reduce radiation use for freehand fluoroscopic targeting in orthopaedic surgery.
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Case Reports
Irreducible fracture-dislocation of the ankle caused by an entrapped medial malleolus at the syndesmosis.
A 55-year-old fisherman sustained an unusual and irreducible fracture-dislocation of the ankle joint. An entrapped medial malleolar fragment was discovered by computed tomography between the distal tibia and lateral malleolus. ⋯ At the 18-month follow-up visit, the patient was working normally and was asymptomatic. At previous visits, he demonstrated a full range of ankle motion and had normal radiograph.
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Bicondylar tibial plateau fracture management remains therapeutically challenging, partly because of multiplanar articular comminution. This study was performed to evaluate the frequency and morphologic characteristics of the posteromedial fragment in this injury pattern. ⋯ A posteromedial fragment was observed in nearly one third of the bicondylar plateau fractures evaluated. The morphologic features of this fragment may have clinical implications when using currently available laterally applied fixed-angle screw/plate implants to stabilize these injuries. Alternate or supplementary fixation methods may be required when managing this injury pattern.
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To investigate the bone-implant-anchorage of 90-degree double-plate osteosynthesis in simulated complete intra-articular distal humerus fractures using conventional reconstruction plates (CRP), locking compression plates (LCP), and distal humerus plates (DHP), depending on the bone mineral density (BMD) of the cadaver specimens. ⋯ Bone-implant anchorage was different between locking and nonlocking plate constructs and depended on BMD. While in good bone quality implant choice was not critical, both locking plates provided superior resistance against screw loosening as compared to the CRP at low BMD values (<420 mg/cm). Based on our laboratory results, we conclude that locking plates such as the LCP and DHP are constructs designed to keep anatomical reduction in the presence of comminution and poor bone quality in a low intra-articular fracture of the distal humerus.
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The purpose of this study is to present the early complications of percutaneous screw fixation of superior pubic ramus fractures and to present a new classification scheme for superior pubic ramus fractures. ⋯ The prevalence of loss of reduction after percutaneous screw fixation of pubic ramus fractures is 15%. Loss of reduction is more common in elderly and female patients and in patients whose ramus screws are placed in a retrograde fashion. Also, loss of reduction appears to be more common in fractures medial to the lateral border of the obturator foramen.