Journal of orthopaedic trauma
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The majority of proximal humerus fractures are treated nonoperatively with good functional results. Multiple options exist for treating displaced fractures, without a clear advantage of any one method for a given fracture type. Goals include an adequate reduction and stable fixation to initiate early motion and rehabilitation. ⋯ Locked plating may improve fracture stability in some complex patterns and facilitate early rehabilitation. It is possible that some fractures previously treated with hemiarthroplasty may be managed successfully with locking plates. Prospective study to assess the complications, outcomes, and cost effectiveness of nonoperative management compared to various surgical treatment options is warranted.
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We sought to determine whether inaccurate C-arm positioning could create images that lead to inaccurate interpretation of iliosacral screw positions. ⋯ Improper malrotated fluoroscopic inlet and outlet views of the pelvis will distort the anatomic landmarks of the pelvis before improperly placed guide wires appear to be correctly placed. Properly placed guide wires will always appear correctly positioned regardless of the malrotation of the C-arm. "Malrotated" views, however, can be used to rule out certain incorrect screw positions.
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When open joint injury is suspected in a knee laceration, the saline load test has been recommended as a diagnostic modality, especially in small wounds, where inspection and palpation cannot confirm joint violation. The goals of this study are: 1) to correlate fluid volume needed for positive diagnosis with demographic factors, 2) to assess the sensitivity of using the commonly recommended volume of 50 mL, and 3) to identify the minimum fluid volume necessary to obtain 95% sensitivity. ⋯ For small lacerations around the knee, saline loads of less than 194 mL are of questionable sensitivity, and surgeons should not use the saline load test to rule out open knee injuries.
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At our institution, a standardized protocol using magnetic resonance imaging (MRI) to evaluate ankle stability and need for surgery following a positive manual stress test for isolated lateral malleolus fractures has been used. The purpose of this study was to evaluate the results using this standardized protocol. ⋯ Using our protocol, we were able to identify and provide effective nonoperative care to 19 patients who otherwise might have underwent operative treatment after an isolated lateral malleolus fracture. Further work is needed to identify the subset of patients who could be treated nonoperatively without a need for MRI scanning.
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The Smith-Petersen or modified direct anterior hip surgical exposures have not previously been described for open reduction of femoral neck fractures. This technique of reduction provides a direct approach to the femoral neck and hip joint. Displaced fractures of the femoral neck can easily be reduced through this approach, local osseus defects resulting from impaction can be supported with bone graft, and fracture fixation is then placed through a separate lateral exposure or through small stab incisions. The technique of reduction is presented.