Journal of orthopaedic trauma
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Clinical Trial
Reconstruction of distal tibia fractures using a posterolateral approach and a blade plate.
The aim of this article is to report a technique for the management of distal tibia fractures with significant anteromedial soft-tissue injury. The patients were initially treated with a spanning external fixator, open reduction and internal fixation (ORIF) of the fibula at the discretion of the surgeon, and soft-tissue management or flap coverage. ORIF of the tibia was performed on a staged basis, using a 90-degree cannulated blade plate and autogenous iliac crest bone graft through a posterolateral approach. ⋯ The staged treatment of high-energy distal tibia fractures with soft-tissue injury can lead to good outcomes and consistent bone union. Our results were obtained by the combination of the posterolateral approach, careful soft-tissue management, and stable internal fixation.
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Clinical Trial
Effects of varying pulsatile lavage pressure on cancellous bone structure and fracture healing.
To study the effects of variations in pulsatile lavage irrigation pressure on the rate of new bone formation and the degree to which cellular elements are removed from cancellous bone after fracture. ⋯ There are presently no recommended guidelines as to the optimal irrigation pressure, and this study is the first to address the effects of variations in pressure on bone healing. The results of this study indicate that early new bone formation in an intraarticular fracture rabbit model is inhibited by irrigation pressure of 50 psi or greater. Additionally, this study demonstrates a direct relationship between irrigation pressure and the amount of cellular material removed from the trabecula at the irrigation site. Surgeons should be aware of the potentially detrimental effects of using irrigation pressures at or above 50 psi in the treatment of fractures.
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Multicenter Study
Simultaneous treatment of tibial bone and soft-tissue defects with the Ilizarov method.
To evaluate the potential for limb salvage using the Ilizarov method to simultaneously treat bone and soft-tissue defects of the leg without flap coverage. ⋯ The Ilizarov method can be successfully used to reconstruct the leg with tibial bone loss and an accompanying soft-tissue defect. This limb salvage method can be used in patients who are not believed to be candidates for flap coverage. One also may consider using this technique to avoid the need for a flap. Gradual closure of the defect is accomplished resulting in bony union and soft-tissue closure. Lengthening can be performed at another site. A trifocal approach should be considered for large defects (>6 cm). Advances in technique and frame design should help prevent residual deformity.
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In isolation, dislocations of the hip and knee require emergent reduction to minimize the risks of serious complications, including vascular and neurologic injury, osteonecrosis of the femoral head, and loss of motion and function. With simultaneous dislocation of the ipsilateral hip and knee, as in the situation of hip dislocation with concomitant femoral shaft fracture, reduction of the hip may prove difficult because of the inability to control the femoral segment. In this setting, general anesthesia is commonly required. We present the case of a patient who sustained an ipsilateral hip and knee dislocation who underwent closed reduction of the knee in the emergency department but required general anesthesia and the insertion of Schanz pins in the femur to reduce the hip dislocation.