Journal of orthopaedic trauma
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Comparative Study
A critical analysis of the eccentric starting point for trochanteric intramedullary femoral nailing.
Antegrade femoral intramedullary nailing through a greater trochanteric insertion site has been proposed for the treatment of subtrochanteric fractures. The currently available trochanteric nails have dissimilar characteristics, and the most appropriate insertion site for satisfactory subtrochanteric fracture alignment has not been determined. This study is an analysis of 5 different trochanteric femoral nails and 3 different insertion sites using a cadaveric model of a reverse obliquity subtrochanteric femur fracture to determine the optimal trochanteric entry site. ⋯ Subtrochanteric fractures treated with a trochanteric antegrade nail should have an acceptable reduction before nail insertion. The tip of the trochanter, or even slightly medial, on anteroposterior fluoroscopy is recommended as the universal starting point for these nails. However, slight deviations from this point and nail geometry can cause fracture site malalignment. A lateral starting point led to varus alignment and should be avoided.
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Clinical Trial
Treatment of unstable peritrochanteric femoral fractures using a 95 degrees angled blade plate.
To clarify the efficacy of a 95-degree angled blade plate fixation in the treatment of unstable peritrochanteric fractures of the femur. ⋯ A 95 angled blade plate can be a useful alternative fixation device for the treatment of unstable peritrochanteric femoral fractures.
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We present a case of compartment syndrome of the thigh due to blunt injury in a Division I American football player managed with fasciotomy and vacuum-assisted wound closure. This case report discusses the vacuum-assisted wound closure dressing as an alternative to more traditional closure techniques such as suture retention devices and split-thickness skin grafting. We feel that any surgeon involved in performing fasciotomies should be familiar with this increasingly used closure device and its potential complications.
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Comparative Study Clinical Trial
Intraoperative diagnosis of syndesmosis injuries in external rotation ankle fractures.
This study was designed to compare intraoperative fluoroscopic stress testing, static radiographs, and biomechanical criteria for the diagnosis of distal tibiofibular syndesmotic instability associated with external rotation type ankle fractures. ⋯ Preoperative radiographs and biomechanical criteria are unable to routinely predict the presence or absence of syndesmosis instability. Rigid bimalleolar fixation was frequently not sufficient to stabilize syndesmotic disruption. Intraoperative stress fluoroscopy is a valuable tool for detection of unstable syndesmotic injuries.
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Randomized Controlled Trial
Computer-assisted guidewire insertion for hip fracture fixation.
: This study was designed to test in a laboratory setting a novel computer-assisted fluoroscopic technique and a conventional fluoroscopic technique for open reduction and internal fixation (ORIF) of hip fractures. Our hypothesis is that a novel computer-assisted fluoroscopic technique will achieve acceptable guidewire placement in one pass, with decreased fluoroscopic time and with accuracy and precision better than conventional technique. ⋯ The computer-assisted technique was significantly more accurate and precise than conventional technique. It also required fewer drill tracks through the femur and exposed the patient and the surgical team to significantly less ionizing radiation.