Journal of orthopaedic trauma
-
Multicenter Study Comparative Study
Rates and odds ratios for complications in closed and open tibial fractures treated with unreamed, small diameter tibial nails: a multicenter analysis of 467 cases.
A multicenter trial analyzed complications and odds for complications in open and closed tibial fractures stabilized by small diameter nails. ⋯ Fracture distraction of more than three millimeters should not be tolerated when stabilizing tibial fractures with unreamed, small-diameter nails as this increases the odds of having a delayed union by twelve times (p < 0.001) and a nonunion by four times (p = 0.057). There was a significant increase of complications in the group of Grade III open fractures (p < 0.001), AO/OTA Type C fractures (p = 0.002), and to a lesser extent in distal fractures. However, the rate of severe complications resulting in major morbidity was low.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Prospective randomized controlled trial of an intramedullary nail versus dynamic screw and plate for intertrochanteric fractures of the femur.
To compare the surgical complications and functional outcome of the Gamma nail intramedullary fixation device versus the Richards sliding hip screw and plate device in intertrochanteric femoral fractures. ⋯ The use of an intramedullary device in the treatment of intertrochanteric femoral fractures is still associated with a higher but nonsignificant risk of postoperative complications. Routine use of the Gamma nail in this type of fracture cannot be recommended over the current standard treatment of dynamic hip screw and plate.
-
Review Case Reports
Marginal plafond impaction in association with supination-adduction ankle fractures: a report of eight cases.
In five years, approximately 800 ankle fractures were seen at the authors' institution, forty-four (5 percent) of which were of the supination-adduction pattern. Nineteen of these injuries had displaced vertical medial malleolus fractures, of which eight (42 percent) showed marginal impaction of the tibial plafond. All eight patients underwent open reduction and internal fixation with elevation of the impacted articular component and had good to excellent functional outcome with no arthritis on radiograph at the time of the most recent follow-up. The index of suspicion of marginal impaction of the tibial plafond should be high when treating supination-adduction pattern ankle fractures with displaced medial malleolus.
-
Following intramedullary rodding of two long-bone fractures, a twenty-year-old woman developed the clinical picture of fat embolism syndrome with severe neurological involvement. Corroborating evidence suggested paradoxical embolization of fat as the precipitating cause of this neurologic deterioration. The suspected pathophysiology of this event is discussed.
-
Comparative Study
Potential of increased risk of neurovascular injury using proximal interlocking screws of retrograde femoral nails in patients with acetabular fractures.
Neurologic and vascular structures are at risk of iatrogenic injury from proximal interlocking screw insertion after retrograde nailing. This risk may increase in the presence of acetabular fractures because of the displacement of soft tissues resulting from hematoma. The purpose of this study was to establish and compare the relative safe zones (RSZs) for interlocking screw insertion in adults with and without concomitant acetabular fractures. ⋯ Lateral-medial screw insertion is safer than anteroposterior insertion. Anteroposterior screw insertion becomes even more critical if the acetabulum is fractured. Femoral external rotation after rod insertion, but before screw insertion, will enlarge the safe zones.