Journal of orthopaedic trauma
-
To locate the proper insertion point for a tibial intramedullary nail in the coronal plane. ⋯ The insertion point of a tibial nail should be over the medial aspect of the tibial tubercle in the coronal plane. Our data supports using a medial or patellar splitting approach for nail insertion. Insertion sites lateral to the tibial tubercle should be avoided.
-
To determine the biomechanical consequences of cutting one centimeter off the tip of a tibial nail when treating distal tibia fractures with intramedullary nails. ⋯ Removal of one centimeter from the tip of a tibial nail allows placement of two distal interlocking screws in tibial fractures located four centimeters from the tibiotalar joint. The fixation strength achieved is comparable to that of standard intramedullary nailing of tibial fractures located five centimeters from the tibiotalar joint using two distal interlocking screws. Fixation strength with these distal fractures, however, is not strong enough to resist moderate compression-bending loads. Thus, patients with distal tibia fractures treated with intramedullary nailing must follow weight-bearing restrictions until significant fracture healing occurs to prevent coronal plane malalignment of the fracture.
-
The case of a patient who sustained an avulsion fracture of the femoral head (Pipkin Type I) that was unrecognized is described. The patient was referred to the authors' institution four months after injury, and radiographic studies showed a malunited avulsion fracture of the femoral head to the acetabulum. The patient subsequently went on to an excellent result after surgical debridement. The authors recommend additional radiographic studies in cases to exclude unrecognized fractures where a possible hip subluxation may have occurred.
-
Case Reports
Early pin failure following external femoral fracture fixation in a head-injured child.
External fixation facilitates nursing care and early rehabilitation of head-injured children with femoral shaft fractures. We report an unusual complication of early fatigue failure of the external fixator pins without the patient ever bearing weight.
-
To determine which soft tissue structures are at risk and when joint violation can occur during small wire placement for hybrid external fixation of distal tibial fractures while adhering to published guidelines. ⋯ This study shows that tendons and neurovascular structures above the ankle are at risk during small transfixion pin placement, even when using safe corridors. Pins placed within two centimeters of the anterior joint line or three centimeters from the medial malleolus may be intracapsular.