Journal of orthopaedic trauma
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The objectives of this study are to describe the anatomic findings relative to anterior pelvic endoscopy, determine the potential use of endoscopy for reduction and fixation of fractures of the anterior pelvic ring, and report two illustrative cases performed using this method. Using the windows described, endoscopy permits placement of plates and screws on top of the symphysis pubis, reduction of internally displaced fragments, and performance of percutaneous procedures that do not harm anatomic structures.
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To investigate the use of the Ilizarov circular fixator and nail retention in treating diaphyseal nonunion following previous intramedullary nailing. ⋯ There is a role for the use of the Ilizarov fixator with nail retention in resistant long bone diaphyseal nonunion in carefully selected patients. This method can achieve high union rates where other treatment methods have failed.
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The incidence of nonunion and osteonecrosis after femoral neck fracture has been well documented. In older patients implant arthroplasty is well established as an acceptable treatment of these problems. However, in the younger population alternatives to implant arthroplasty are favored to preserve the femoral head. Surgical treatments for nonunion of the femoral neck include osteotomy, nonvascularized bone grafting, muscle-pedicle bone grafting, and vascularized bone grafting. The purpose of this study is to examine the results of free vascularized fibular grafting as a treatment of nonunion of the femoral neck in patients younger than fifty years. ⋯ Rates of complications, such as nonunion and osteonecrosis, after femoral neck fractures in young patients have been reported to be as high as 86 percent. Treatments such as osteotomy, muscle-pedicle bone grafting, nonvascularized bone grafting, and vascularized bone grafting have reported variable results. Based on the results reported in this study, vascularized fibular bone grafting compares favorably with a high union rate (91 percent initially, 100 percent after secondary procedures) and successful long-term salvage of the femoral head in 91 percent of the patients. Free vascularized fibular bone grafting represents a promising solution for this difficult problem.
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Assess the characteristics associated with the risk of complications and mortality in children sustaining pelvic fractures. ⋯ Children with pediatric pelvic fractures require careful evaluation for other body-area injuries, as these are most likely to be related to hemorrhage or mortality.
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Comparative Study
Assessment of articular fragment displacement in acetabular fractures: a comparison of computerized tomography and plain radiographs.
Quantitatively evaluate plain radiographs, relative to computed tomography (CT) scans, for assessment of articular fragment displacement (step and gap) in displaced acetabular fractures and in canine osteotomized acetabular specimens. ⋯ 1) Plain radiographs showed poor sensitivity for the detection of step and gap deformities in patients with acetabular fractures and in osteotomized canine specimens, relative to CT scans; 2) differences between CT and plain radiographs in both specimen types were greatest with the most clinically relevant deformity-i.e., step; and 3) CT scans are essential and should continue to be used in conjunction with plain radiographs in the preoperative evaluation of displaced acetabular fractures and perhaps should be considered in the postoperative assessment of fracture reduction.