Journal of orthopaedic trauma
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Syndesmotic instability may coexist with unstable Weber B supination-external rotation (SE) lateral malleolar fractures. Current recommendations suggest that Weber B injuries should not have associated syndesmotic instability after open reduction and internal fixation of the lateral malleolus. The purpose of this study was to evaluate syndesmotic stability with respect to the current recommendations for syndesmotic fixation in Weber B SE pattern lateral malleolar fractures. ⋯ We found syndesmotic instability to be common after anatomic and stable bony fixation in unstable Weber B SE pattern lateral malleolar fractures. Previously published criteria for syndesmotic instability based on cadaveric studies are not representative of the clinical situation. Syndesmotic instability in conjunction with unstable Weber B SE pattern lateral malleolar fractures must be sought out in the operating room with an intraoperative stress examination.
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To describe a minimal anterolateral acromial approach for minimally invasive (MI) treatment of fractures of the proximal humerus (PH) with the Non-Contact-Bridging (NCB) plate. ⋯ The minimal anterolateral acromial approach is suitable for MI technique to apply the NCB-PH. The relationship of the axillary nerve to the plate is anatomically close. We recommend that strict bone contact be maintained during plate insertion and that screw insertion complies with the guidelines provided for this technique. In a small clinical cases series, the plate and screws were inserted in accordance with these guidelines and no axillary nerve lesions have yet been detected.
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The reduction of displaced pelvic ring injuries remains a technical challenge, especially when treatment is delayed. A pelvic frame (Orthopaedic Systems Inc, Union City, California) provides a means of external skeletal fixation, rigidly stabilizing the intact hemipelvis to the operating room table. The fractured and displaced fragments can then be manipulated around the securely fixed uninjured hemipelvis, allowing the application of more directions and magnitudes of force for reduction maneuvers than allowed by the traditional means of pelvic reduction. The surgical technique and 1 case each of an acute fracture and pelvic nonunion/malunion are presented.
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To evaluate the outcomes of patients with atrophic humeral shaft nonunion (HSNU) treated by Ilizarov frame fixation without the use of bone graft. ⋯ Ilizarov circular frame fixation without bone graft is a reliable method for the treatment of atrophic nonunion of the humerus, even after failed previous surgery.
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Multicenter Study Comparative Study Clinical Trial
Results of femoral intramedullary nailing in patients who are obese versus those who are not obese: a prospective multicenter comparison study.
Antegrade femoral nailing through a piriformis fossa starting point in patients who are obese has been demonstrated to be problematic. Retrograde femoral nailing therefore has been advocated in this patient population, but little data exist to support such a recommendation. The purpose of this study was to evaluate and compare antegrade and retrograde femoral nailing technique in both patients who are and are not obese. ⋯ This study provides evidence, in the form of decreased operative and radiation exposure times, to support the use of retrograde nailing technique for the treatment of femoral shaft fractures in patients who are obese. Also, antegrade nailing was found to require significantly more operative and radiation exposure time in the patient who is obese as opposed to the patients who is not obese. Although having similar baseline functional scores, patients who are obese recovered at a slower rate and more incompletely than patients who are not obese.