Journal of orthopaedic trauma
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Fractures of the clavicle were reported to represent 2.6% of all fractures with an overall incidence of 64 per 100,000 per year (1987, Malmö, Sweden). Midshaft fractures account for approximately 69% to 81% of all clavicle fractures. Treatment options for acute midshaft clavicle fractures include nonoperative treatment (mostly sling or figure-of-eight bandage), open reduction and internal fixation with plates, and closed or open reduction and internal fixation with intramedullary pins, wires, or a nail. Most surgeons prefer nonoperative treatment of nondisplaced midshaft clavicle fractures. However, the optimal treatment option for isolated acute displaced midshaft clavicle fractures remains controversial. ⋯ This study was designed to systematically summarize and compare results of different treatment options (nonoperative, operative extramedullary fixation, and operative intramedullary fixation) in the management of midshaft clavicle fractures, specifically for displaced fractures.
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This study evaluated the use of a staged protocol involving temporary spanning external fixation and delayed formal definitive fixation in the management of high-energy proximal tibia fractures (OTA types 41) with regard to soft-tissue management, development of complications, and functional outcomes. ⋯ This study supports the practice of delayed internal fixation until the soft-tissue envelope allows for definitive fixation.
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Transverse fractures of the sternum or sacrum each present specific surgical challenges. Here, we report the successful use of a locking compression plate system in a 69-year-old woman with a displaced segmental fracture of the sternum following a motor vehicle accident and a 15-year-old girl with a low transverse fracture of the sacrum (S3-S4) as a result of a snowboarding accident. In both cases, the system provided adequate fixation to allow healing in the 2 fractures, despite the poor bone quality (sternal case) and the thin bone stock (sacral case).
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We reviewed those patients who developed a postoperative infection after reamed intramedullary nailing of tibial shaft fractures to investigate the possible causes of infection, its effect on union time, and the requirement for reconstructive surgery. ⋯ A number of deep infections after reamed intramedullary tibial nailing are avoidable. Particular attention must be paid to correct reaming, exchange nailing, and fasciotomy closure in closed fractures. In open fractures, marginal flap necrosis should be actively treated and not left to granulate.
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The tension-band-wiring technique is a well-accepted method of internal fixation of olecranon fractures. In addition, it is suggested that transcortical placement of the k-wires results in lower rates wire migration. We encountered two clinical cases in which transcortical placement of the k-wires led to impairment of forearm rotation. ⋯ Using specimens from 10 embalmed cadavers, we found that transcortical wires inserted in <30 degrees of ulnar angulation in the coronal plane to the medial ridge of the olecranon, impinged on the radial neck, supinator muscle, or biceps tendon. This was avoided in all 10 specimens when the wires were inserted, with the forearm in supination, at 30 degrees of ulnar angulation. We recommend this technique to be adopted to avoid forearm rotation impairment.