Journal of orthopaedic trauma
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A technique for closed reduction and percutaneous screw fixation of fractures of the iliac wing and fracture-dislocations of the sacro-iliac joint is presented. Twenty-seven pelvic fractures were treated with attempted closed reduction followed by percutaneous screw fixation. Closed reduction failed in two patients. ⋯ All but two of the patients who were working before injury returned to work. All but one of the patients was satisfied with the outcome of their pelvic fracture treatment. Closed reduction and percutaneous screw fixation of fractures of the posterior portion of the iliac wing yields acceptable reductions, with minimal blood loss and limited damage to the surrounding soft tissues.
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To evaluate objectively the effectiveness of current surgical management of displaced acetabular fractures. To provide insight into how these evaluation methods can be used to identify areas in which improvements in surgery and rehabilitation can be pursued to improve patient outcomes. ⋯ Standardized muscle strength determination, gait, and motion analysis, and completion of an MFA questionnaire provided a thorough and revealing evaluation of patients who have undergone open reduction and internal fixation (ORIF) of a displaced acetabular fracture. Minimal alterations in body posture and affected limb motion were present in patients displaying relatively normal gait parameters, including stride length, speed, and cadence. Despite dissection of the hip musculature during surgery, normal muscle strength recovery was possible after operative repair of these acetabular fractures. However, functional outcome, as determined by MFA scores, was considerably poorer in those patients with significantly weaker hip flexion and extension strength, compared with those of patients with more desirable MFA scores. Based on the current data, it appears that the use of these and similar evaluation instruments can allow determination of factors that negatively affect outcome (hip flexion and extension strength), which otherwise may remain unknown. It is possible that identification and treatment of these factors will improve the quality of life for patients after this type of injury.
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We report a case of dorsal subluxation of the first metatarsophalangeal joint without dislocation of the sesamoids or destruction of the sesamoid complex. Closed reduction was unsuccessful. ⋯ After restoration of the tendon to its normal anatomic alignment, the joint was successfully reduced. One year after the injury, the patient was asymptomatic and had full range of motion of the metatarsophalangeal joint.
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To analyze injury pattern, surgical therapy, radiologic results, and functional outcome in unstable B-type and C-type pelvic ring fractures. ⋯ Unstable pelvic ring fractures require a staged approach. Mortality is higher in C-type than in B-type lesions. Functional outcome is worse in C-type than in B-type lesions. Within the B-type group, B1 lesions have a worse functional end result than B2/B3 fractures. These findings are not only related to the stability and symmetry of the pelvic ring, as seen in the radiologic picture, but also depend on the severity and amount of damage to the soft tissues around the pelvis.
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Comparative Study
The role of plain films and computed tomography in the evaluation of scapular neck fractures.
To assess the ability of plain films and computed tomography scans to show the pattern, displacement, and angulation of scapular neck fractures. To assess the ability of computed tomography to identify concomitant occult shoulder injuries. ⋯ Scapular neck fracture displacement, angulation, and anatomic classification showed moderate interobserver reliability by plain films but were not enhanced by computed tomography. Computed tomography confused, rather than clarified, the assessment of these characteristics. Computed tomography may be useful to identify associated injuries to the superior shoulder suspensory complex, which can be missed by plain films alone. Routine computed tomography in patients with scapular neck fractures cannot be recommended based on this study. Computed tomography of scapular neck fractures may be useful in selected cases in which intraarticular extension is noted on plain films.