Journal of orthopaedic trauma
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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.
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To review the long-term functional results of the surgical treatment of tibial plateau fractures using standard techniques of open reduction and internal fixation. ⋯ Open reduction and internal fixation is a satisfactory technique for the treatment of displaced fractures of the tibial plateau, particularly for patients younger than forty years.
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A case report of simultaneous traumatic bilateral anterior and posterior hip dislocations is presented, and the management of this injury is discussed.
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To determine in a cohort of children with polytrauma which variables are predictive of the development of complications related to immobilization. ⋯ Complications of immobilization in children with polytrauma are associated with age greater than seven years and a MISS score greater than forty. Further study is needed to evaluate the effect of early fracture stabilization. Timing of osteosynthesis showed a trend but did not reach statistical significance in this study.
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To present the technique and early results of percutaneous stabilization of U-shaped sacral fractures with attention to neurologic recovery and maintenance of fracture reduction of the sacrum. ⋯ These sacral fractures are rare and occur after significant spinal axial loading. A paradoxic inlet view of the upper sacrum on the anteroposterior plain pelvic radiograph heralds the diagnosis. Delayed diagnosis is avoided by a high clinical suspicion, early lateral sacral radiographs, and pelvic computed tomography scans. Surgical stabilization may assist in early mobilization of the patient from recumbency and prevents progressive deformity with associated nerve root injury. Percutaneous fixation diminishes potential blood loss and operative times, yet still allows subsequent sacral decompression of the local neural elements using open techniques when necessary. Early percutaneous iliosacral screw fixation is effective treatment for these injuries.