Journal of orthopaedic trauma
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For intramedullary nailing of tibial shaft fractures, a recent study has determined that the entry site should be just medial to the lateral tibial spine at the anterior margin of the articular surface. Gaining access to this site is often through a medial parapatellar or transpatellar approach. Several studies have indicated that a transpatellar approach may contribute to anterior knee pain. Our study sought to use anatomic measurement to determine the ideal incision site for insertion of an intramedullary tibial nail. DESIGN Part I: survey of Orthopaedic Trauma Association (OTA) members. Part II: anatomic study. ⋯ Individual variations in patellar tendon anatomy should be considered when choosing the proper entry site for tibial nailing. Based on the assumption that the ideal entry point for tibial nailing is just medial to the tibial spine at the anterior margin of the articular surface, a preoperative fluoroscopic measurement before incision can guide the surgeon as to whether a medial parapatellar, transpatellar, or lateral parapatellar approach provides the most direct access to this entry site. The routine use of a single approach for all tibial nails may no longer be justified.
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The treatment of intramedullary infections after nailing usually includes removal of the rod, debridement of the canal, and, in many cases, insertion of antibiotic-impregnated cement beads. These beads offer no mechanical support and are difficult to remove if left in place for more than 2 weeks. We present an alternative for filling the medullary canal's noncollapsible dead space with an antibiotic-impregnated cement rod. ⋯ The cement rod was removed between 29 and 753 days after implantation. Fracture of the rod occurred in one case in which the rod was left in place for more than 1 year. We conclude that this method is a relatively simple and inexpensive alternative for the treatment of intramedullary infections.
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The classic ilioinguinal approach has become well established in the treatment of acetabular fractures. However, in certain cases with extensive low anterior column or anterior wall fractures less than optimal exposure may be obtained. ⋯ In addition, the risk of iatrogenic lateral femoral cutaneous nerve damage is diminished. In this article the technique of this modification is described and illustrated.
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Clinical Trial
Surgical dislocation of the femoral head for joint debridement and accurate reduction of fractures of the acetabulum.
To evaluate fracture reduction, femoral head viability, and outcome of selected acetabular fractures treated operatively using a modified Kocher-Langenbeck approach with a trochanteric flip osteotomy and surgical dislocation of the femoral head. ⋯ This study indicates that this technique for surgical dislocation of the femoral head is safe and facilitates assessment of fracture reduction in selected acetabular fractures.
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The purpose of this study is to identify and characterize the nature of internal knee derangement associated with ipsilateral femur fractures. ⋯ Given the large number of soft tissue injuries about the knee, it would be prudent to emphasize the importance of a thorough intraoperative examination once the femur fracture has been stabilized. Additionally, there should be a low threshold to obtain an MRI if the postoperative clinical examination suggests an associated knee injury. Bone bruises, which can only be identified by MRI studies, are increasingly being acknowledged as a source of persistent symptoms.