Journal of orthopaedic trauma
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Comparative Study
Effect of limited and standard reaming on cortical bone blood flow and early strength of union following segmental fracture.
To quantitatively determine the extent to which limited and standard intramedullary reaming disrupts cortical circulation and to evaluate the effect on the biomechanical properties of the united fracture. ⋯ Both limited reaming and standard reaming negatively affect diaphyseal cortical circulation. Limited reaming spares cortical perfusion compared with standard reaming at the time of nail insertion. No long-term advantage for limited reaming was demonstrated. Limited reaming may be advantageous acutely for the stabilization of tibial fractures in which the circulation is already compromised.
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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.
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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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The successful treatment of a very rare case of multiple carpal bone fractures in a child is described. Fractures of the scaphoid, the capitate, and the hamate were treated with wire fixation, leading to good clinical results twenty-nine months after surgery.
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To evaluate the neurovascular structures at risk with the placement of anterior-posterior locking screws in the proximal femur. ⋯ Risks to the neurovascular structures during anterior-posterior locking in the proximal femur are diminished if locking is performed above the level of the lesser trochanter.