Journal of orthopaedic trauma
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Comparative Study
Biomechanical considerations in plate osteosynthesis: the effect of plate-to-bone compression with and without angular screw stability.
We compared the biomechanical stability of bone-plate constructs using a compression plate (CP), an internal fixator (IF), and a combination plate (CP/IF). ⋯ Under compression, IF provides similar fixation in comminuted fractures and was better than the CP for avoiding loss of reduction, whereas under torsional loading, CP was more important for stiffness, plastic deformation, and load to failure than IF. However, combination (CP/IF) fixation seems advisable in intraarticular and extraarticular fractures of long bones with a metaphyseal comminution. These data may be utilized by surgeons to build a more specific treatment plan in patients with these fracture types.
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Describe the use of a radiographic parameter (pelvic incidence) to assess the sagittal plane reduction of H-type sacral fractures associated with spinopelvic dissociation, and assess the relationship between standing lumbar lordosis to pelvic incidence after spinopelvic dissociation. ⋯ Pelvic incidence is a potentially useful radiographic parameter that can be used to assess the adequacy of sagittal plane reduction in patients with spinopelvic dissociation injuries.
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Case Reports
Chipping and lengthening technique for delayed unions and nonunions with shortening or bone loss.
Autologous bone graft is usually necessary for reconstruction of nonunions with shortening or bone loss. We developed a new technique to reconstruct such nonunions or delayed unions without bone grafting by chipping and lengthening of bone at the original fracture site. Five in six nonunions with shortening or bone loss could be successfully united without bone graft by using our method. The chipping and lengthening technique, which requires neither bone grafting nor change in the anatomy of muscles, is a useful technique for delayed unions and nonunions accompanied by shortening or bone loss.
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The purpose of this study is to evaluate clinical results and outcomes of a strict cohort of high-energy injuries of the metaphyseal distal tibia with minimal or no intraarticular involvement treated using the minimally invasive plating concept. ⋯ Minimally invasive medial plating will restore limb alignment and yield successful clinical outcomes for high-energy metaphyseal fractures of the distal tibia. Despite the significant reoperation rate and prolonged time to union, most patients can expect a predictable return of function. Strong consideration should be given to adjunctive measures in at-risk patients, including those with highly comminuted fracture patterns, bone loss, or Type II or III open fractures.
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We hypothesize that clinical results and patient outcomes following treatment of olecranon fractures with a congruent elbow plating system will be comparable to other available plating systems. Our results will be compared to previously published reports. ⋯ Congruent anatomic plating is a safe, effective option for the treatment of olecranon fractures with a low rate of hardware removal and stability with early motion.