Journal of orthopaedic trauma
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Case Reports
Subtrochanteric fracture after cannulated screw fixation of femoral neck fractures: a report of four cases.
Subtrochanteric fractures after screw or pin fixation of femoral neck fractures are a recognized complication. No literature is available on this complication after fixation using the recently popularized cannulated screws. We present our experience in treating four of these complications. The common denominator for all four patients seemed to be an entry point in the lateral cortex below the level of the most inferior edge of the lesser trochanter.
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Intramedullary nailing is accepted as the technique of choice for treatment of unstable tibial diaphyseal fractures. Indirect closed reduction must first be obtained to allow passage of the guide wire and reamers. We describe the use of a simple frame that allows precise reduction, control of rotation and easy imaging access, without increasing operating or screening time.
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Case Reports
Osteochondral flap fracture of the olecranon with dislocation of the elbow in a child: a case report.
An osteochondral intraarticular fracture of the ulnotrochlear joint in a child is rare. The author reports on a 12-year-old child with an osteochondral intraarticular flap fracture of the proximal ulna associated with a dislocation of the elbow joint. ⋯ This fracture has been previously described by Rang (1974), but no illustration was provided. To date, only one other case in a child was reported by Blasier (1989), but it did not confirm an exact correlation between the osteochondral intraarticular fracture with dislocation of the elbow, which would have suggested the mechanism of injury.
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To determine the effects of cranial displacement on the safe placement of iliosacral screws for zone II sacral fractures. ⋯ Although previous authors have accepted up to 15 mm of cranial displacement, the data demonstrate substantial compromise of available screw space with displacements greater than 1 cm. Fracture reduction is mandatory, as screw placement with residual displacement of 10 mm or more can endanger adjacent neural and vascular structures.
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To determine the effect of anode location on the current threshold required to provoke an electromyograph response during stimulus-evoked electromyography for iliosacral screw placement. ⋯ The physical location of the anode during stimulus-evoked electromyography monitoring for iliosacral screw placement significantly changes the current thresholds required to provoke an electromyograph response. Current thresholds required to stimulate nerves increase as the anode is moved toward the stimulating electrode. Anode placement ipsilateral to the stimulating electrode may provide a false indication of safe guidewire placement. We recommend anode location at or beyond the midline for stimulus-evoked electromyography monitoring during iliosacral screw placement.