Journal of orthopaedic trauma
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Multicenter Study
Open reduction and internal fixation of tibial pilon fractures using a lateral approach.
To assess the wound complications and reductions achieved in a cohort of patients with pilon fractures who were treated using a novel lateral approach. ⋯ When applied in a staged fashion, the lateral surgical approach for pilon fractures provides excellent protection of the soft-tissue envelopes by creating thick flaps while allowing excellent visualization for reconstruction of the anterior and lateral distal tibia.
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Case Reports
Use of a 30-degree external rotation view for posteromedial tubercle fractures of the talus.
A fracture of the posteromedial talar tubercle is also referred to as the Cedell fracture and is an infrequently described injury. Failure to recognize this injury may lead to posteromedial ankle pain and tarsal tunnel syndrome. It is therefore important to diagnose these fractures at the time of the initial presentation to avoid future morbidity. ⋯ On the 30-degree external rotation view of the ankle, all fractures of the posteromedial tubercle of the talus were revealed. In contrast, the fracture was visualized in only 2 cases using the standard lateral radiograph of the ankle, and not once in the anteroposterior or mortise views. In conclusion, a 30-degree external rotation view is likely to show a fracture of the posteromedial tubercle of the talus in contrast to the 3 routine trauma views of the ankle, aiding in diagnosis and treatment strategy at time of initial presentation.
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To determine the prognostic reliability, sensitivity, and specificity of the Hawkins sign. The Hawkins sign is a subchondral radiolucent band in the talar dome that is indicative of viability at 6 to 8 weeks after a talus fracture. It is visible in the anterior-posterior view, but seldom appears on lateral radiographs. ⋯ The Hawkins sign is a good indicator of talus vascularity following fracture. If a full or partial positive Hawkins sign is detected, it is unlikely that AVN will develop at a later stage after injury.
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Femoral neck fractures in young individuals are typically high angled shear fractures. These injuries are difficult to stabilize due to a strong varus displacement force across the hip with weight bearing. The purpose of this study was to compare the biomechanical stability of four differing fixation techniques for stabilizing vertical shear femoral neck fractures. ⋯ The strongest construct for stabilizing a vertical shear femoral neck fracture is the proximal femoral locking plate, followed in descending order by the dynamic condylar screw, the dynamic hip screw, and the 3 cannulated screw configuration.
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To compare the mechanical stability of a medial tibial plateau fracture model secured with a lateral locking periarticular plate versus a medial buttress plate in cyclic testing and load to failure. ⋯ In the setting of a vertically oriented fracture in a medial tibial plateau without comminution, the medial buttress plate provides significantly greater stability in static loading, and a trend toward improved stability with cyclic loading. Clinical correlation is necessary to substantiate these findings.