Journal of orthopaedic trauma
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Comparative Study
Schuhli augmentation of plate and screw fixation for humeral shaft fractures: a laboratory study.
Schuhli locking nuts provide a mechanism to lock 4.5-millimeter bone screws to a standard dynamic compression plate (DCP plate). It has been proposed that Schuhlis can provide increased fixation stability in areas of a proximal cortical defect or osteopenic bone and may keep screws from loosening and backing out from the plate. A biomechanical study was performed to investigate the effect of Schuhli augmentation of a ten-hole broad DCP plate for fixation of a simulated humeral shaft fracture versus standard DCP plate fixation. ⋯ In this model of humeral shaft fractures in the elderly, the addition of Schuhlis did not significantly change the mechanical stability of plate and screw fixation. However, load and angular deformation at failure were significantly greater in the Schuhli augmented specimens.
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Comparative Study
Anatomical variations of the lateral femoral cutaneous nerve and the consequences for surgery.
This two-part study was undertaken to (a) determine the course and variations of the lateral femoral cutaneous nerve in a cadaver study and (b) develop prospectively the preoperative protocol to diminish the possibility of a postoperative meralgia paresthetica; the latter was achieved by reviewing the patient series retrospectively for complaints of a lateral femoral cutaneous nerve (LFCN) lesion and by studying the relation of the course of the LFCN and meralgia paresthetica. ⋯ The practical importance of the present study lies in alerting the surgeon to a possible anatomical variation of the LFCN in about 25 percent of the patient population. It also confirms that the new perioperative protocol lowers the incidence of meralgia paresthetica.
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Percutaneous fixation of an unstable pelvic ring injury is becoming a popular method of pelvic stabilization. As posterior pelvic percutaneous techniques become more common, the possibility of iatrogenic complications increases. This case report describes an injury to the superior gluteal artery during percutaneous iliosacral screw insertion and the treatment of this potentially devastating injury.
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Case Reports
The spiral compression plate for proximal humeral shaft nonunion: a case report and description of a new technique.
We present a case of humeral nonunion managed with a dynamic compression plate (DCP) contoured in a spiral fashion to preserve the deltoid muscle insertion. A forty-one-year-old woman sustained a closed proximal third humeral shaft fracture with an associated supraclavicular brachial plexus injury. She presented five months later with an atrophic nonunion of the proximal humeral shaft, inferior subluxation of the humeral head, and a resolving brachial plexopathy. ⋯ During the postoperative period, the humeral head reduced spontaneously. Five months after surgery, the fracture healed, and an excellent clinical result was achieved. We recommend the use of the spiral DCP for proximal shaft fractures and nonunions when preservation of the deltoid insertion is desirable.
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Comparative Study
Osteogenic ability of free periosteal autografts in tibial fractures with severe soft tissue damage: an experimental study.
The present study was undertaken to assess whether free nonvascularized autologous periosteum transplants enhance bone healing in a rabbit fracture model designed to resemble a tibial fracture with severe soft tissue damage. ⋯ Our data suggest that orthotopically placed autologous nonvascularized periosteum retains its osteogenic potential in a poorly vascularized environment such as a tibial fracture with severe soft tissue damage. The effect is enhanced if the graft is in contact with intact periosteum. Histologically, callus formation after periosteal grafting resembles endochondral and intramembranous ossification.