Journal of orthopaedic trauma
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A modified anterior approach to the distal femur is presented. The approach allows surgical exposure of the entire articular surface of the distal femur. The quadriceps muscle bellies are spared during the approach. The skin incision used will not interfere with subsequent total knee arthroplasty, if posttraumatic arthritis develops and arthroplasty is necessary.
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Comparative Study
A staged protocol for soft tissue management in the treatment of complex pilon fractures.
To determine whether open reduction and internal fixation of intra-articular pilon fractures using a staged treatment protocol results in minimal surgical wound complications. ⋯ Based on our data, it appears that the historically high rates of infection associated with open reduction and internal fixation of pilon fractures may be due to attempts at immediate fixation through swollen, compromised soft tissues. When a staged procedure is performed with initial restoration of fibula length and tibial external fixation, soft tissue stabilization is possible. Once soft tissue swelling has significantly diminished, anatomic reduction and internal fixation can then be performed semi-electively with only minimal wound problems. This is evidenced by the lack of skin grafts, rotation flaps, or free tissue transfers in our series. This technique appears to be effective in closed and open fractures alike.
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To evaluate the effectiveness of the use of iliosacral screw fixation in the management of the vertically unstable pelvis. ⋯ Iliosacral screw fixation is a useful method of fixation in the vertically unstable pelvis but needs to be augmented by rigid anterior fixation to minimize malunion.
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To evaluate the use of a two-staged technique for the treatment of C3 pilon fractures. ⋯ A two-staged approach offers acceptable results for the treatment of severe pilon fractures. These results compare favorably with those of primary open reduction and of internal fixation and external fixation techniques. The major advantages include limited soft tissue complications and improved articular reconstruction.
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To determine factors that may influence the appearance of avascular necrosis after intertrochanteric fractures. ⋯ Avascular necrosis of the femoral head is an uncommon complication after intertrochanteric fractures. The pathogenesis is unknown, but in patients developing pain who have had intertrochanteric fractures, osteonecrosis should be included in the differential diagnosis, especially in cases with risk factors for osteonecrosis or a proximal intertrochanteric fracture line that perhaps disrupts the vascular anastomotic ring at the base of the femoral neck.