Journal of orthopaedic trauma
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To prospectively evaluate the results of retrograde intramedullary nailing of femoral shaft fractures. ⋯ This consecutive series had a 95 percent union rate after nailing and dynamization as necessary. No knee problems were associated with the retrograde femoral intramedullary nailing technique. The one septic knee raises concerns about the use of retrograde nailing in severe open femoral shaft fractures. Retrograde femoral nailing should be given serious consideration as an alternative to antegrade femoral nailing.
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To evaluate the effects of pulsatile lavage and bulb syringe irrigation on fracture healing in vivo. ⋯ Pulsatile lavage irrigation of fresh intraarticular fractures in rabbits has a detrimental effect on early new bone formation; this effect, however, is no longer apparent two weeks following irrigation. While this study evaluated the effects of pulsatile lavage irrigation in noncontaminated fractures without extensive soft tissue injury, the detrimental effects observed on early new bone formation may translate to an increased risk of nonunion in the setting of a contaminated open fracture with extensive soft tissue injury. Based on the results of this investigation, the selective use of pulsatile lavage irrigation appears warranted. In the absence of gross wound contamination, irrigation with a bulb syringe appears less likely to impair fracture healing than does pulsatile lavage irrigation. Expansion of the model used in this study to include bacterial contamination and soft tissue crushing may further elucidate the effects of pulsatile lavage irrigation on fracture healing.
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We describe a technique for the use of modified Ilizarov olive wires to stabilize bone fragments or segments or to act as a "motor" to move individual bone fragments. This technique was used in twelve patients with severe articular or comminuted open fractures referred to the unit for reconstruction with the Ilizarov frame. ⋯ In these cases the articular fragments were reduced and stabilized until union. The modified pushing olive wire is a valuable adjunct to the Ilizarov frame.
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Comparative Study Clinical Trial
Comparison of the Nebraska collar, a new prototype cervical immobilization collar, with three standard models.
To determine whether a novel immobilization collar called the Nebraska collar would restrict motion of the cervical spine better than three traditional designs: the Philadelphia collar, the sterno occipital mandibular immobilizer (S.O.M.I.), and the Lehrman-Minerva cervical orthosis. ⋯ The new Nebraska collar provides stabilization that is significantly more rigid than the other models tested, with no difference in patient comfort.
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To evaluate whether the implantation of the modular trochanter stabilizing plate (TSP) in addition to the dynamic hip screw (DHS) prevents excessive telescoping and limb shortening in four-part and selected three-part trochanteric fractures. ⋯ In unstable pertrochanteric fractures with small or missing lateral cortical buttress, the addition of a TSP to the DHS effectively supports the unstable greater trochanter fragment and can prevent rotation of the head-neck fragment. Excessive fracture impaction and consecutive limb shortening was prevented by this additional implant in 90 percent of these patients.