Journal of orthopaedic trauma
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To determine if age, fracture pattern, systolic blood pressure on arrival, base deficit, or the Revised Trauma Score is predictive of mortality, transfusion requirements, use of pelvic arteriography, later complications, or injuries associated with the pelvic ring disruption. ⋯ Shock on arrival and the Revised Trauma Score are useful predictors of mortality and transfusion requirements, Injury Severity Score, and Abbreviated Injury Scores for the head and neck, face, chest, abdomen, and extremities. In addition, the Revised Trauma Score predicts the use of pelvic arteriography and later complications. Age predicted transfusion requirement, Injury Severity Score, the chest and skin Abbreviated Injury Scores, use of arteriography, and death.
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The assessment of fracture healing is both a clinically relevant and frequently used outcome measure following lower extremity trauma. However, it remains uncertain whether there is a consensus in the assessment of fracture healing among orthopaedic surgeons. Variability in the assessment of healing may have important implications in surgeons' decisions to intervene when they perceive fracture healing is slow to progress. ⋯ There is a lack of consensus in the assessment of fracture healing in tibial shaft fractures among orthopaedic surgeons. Varying definitions of nonunion and malunion may influence the decision to intervene in an effort to promote fracture healing and/or realign the fracture.
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Case Reports
Massive perineal wound slough after treatment of complex pelvic and acetabular fractures using a traction table.
An operating table with the capacity for skeletal traction against a pudendal post is a helpful and commonly used piece of equipment for certain pelvic and acetabular fracture patterns. Perineal soft tissue trauma and urogenital injuries are associated with some pelvic and acetabular fractures. ⋯ We present here a case in which prolonged traction against a pudendal post during operative fixation of complex pelvic and acetabular fractures resulted in massive perineal wound slough. This case should heighten surgeons' awareness of the vulnerability of the perineum to injury with the use of a traction table and should prompt measures to prevent complications.
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Review Case Reports
Endoscopic-assisted, minimally invasive anterior pelvic ring stabilization: a new technique and case report.
This report describes the technique of endoscopic-assisted reduction and stabilization of the anterior pelvic ring with endoscopic visualization of all critical bone and soft tissue structures. Compared with the conventional ilioinguinal approach of Letournel, the endoscopic technique facilitates a reliable internal fixation of anterior pelvic ring fractures with minimal soft tissue trauma. Thus, the use of the endoscope enables us to apply the concept of minimal invasive plate osteosynthesis to the pelvis. We recommend the described technique for complex anterior pelvic ring fractures, in which the anterior stabilization has to be achieved with a plate from the symphyseal region to the iliac wing.
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The purpose of this study was twofold: (a) to introduce a new three-dimensional digital assessment technique for the estimation of angular and rotational malunion and (b) to determine if an association exists between tibial malunion and functionally defined post-traumatic degeneration at the knee and ankle joint. ⋯ This study suggests that failure to meet conventionally accepted standards for tibial alignment might be common. Fortunately, these values were not associated with adverse functional outcomes. A three-dimensional system, which determines the functional mechanical axis of the knee and tibiotalar joints, may be a valuable and reliable method by which to determine malunion after fracture fixation.