Journal of orthopaedic trauma
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Seven children (3-10 years of age) were treated for a type III supracondylar fracture of the humerus. All fractures were reduced and pinned. Closed reduction was performed in four patients; three required open reduction. ⋯ At an average follow-up of 30 months, all seven patients had normal circulatory status, including a radial pulse. All fractures had healed, and all extremities had a normal carrying angle and normal elbow motion. Immediate exploration of the antecubital fossa should be considered if an extremity remains pulseless (to palpation and Doppler) after reduction and stabilization of significantly displaced supracondylar fractures of the humerus.
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Between 1989 and 1995 a total of 47 patients with 50 fractures of the ipsilateral femoral and tibial shafts without significant articular involvement were treated at Tampa General Hospital. Within this group were 24 patients with 26 fractures who were treated with intramedullary fixation of both bones using a technique of retrograde insertion of a femoral nail and unreamed insertion of an interlocking tibial nail. Information concerning the injuries, treatments, and much of the follow-up was gleaned from a trauma registry. ⋯ No significant knee problem related to the femoral nailing technique was identified. This method of treatment can be performed using a standard radiolucent table and a single medial parapatellar incision. It is expedient and allows other procedures to be performed simultaneously in this group of severely injured patients.
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This case describes the successful treatment of a child with a vascular injury and two ipsilateral grade IIIB open lower leg fractures using two local-advancement soft-tissue techniques. Multiple relaxing skin incisions were used for closure of the wound associated with the patient's midshaft tibial fracture, whereas a randomly patterned rotational fasciocutaneous flap was used for coverage of the wound associated with the patient's medial malleolar fracture. These straightforward local-advancement soft-tissue coverage techniques allowed for treatment of a child with vascular injuries, ensuring the viability of the foot, while preventing distant donor site morbidity and functional sacrifice. Additionally, no special microsurgical or specialty training is necessary to achieve a similar result.
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Review Case Reports
Avulsion of the patellar ligament with combined fracture luxation of the proximal tibial epiphysis: case report and review of the literature.
Disruption of the extensor mechanism of the knee joint at the insertion site of the patellar tendon into bone is a somewhat common injury. Avulsion of the patellar ligament associated with fractures of the proximal tibial epiphysis is an extremely rare injury. ⋯ We are reporting a case that has previously not been reported to our knowledge: an avulsion of the ligament in a closed fracture of the proximal tibial epiphysis with integrity of the tibial tubercle. We propose a three-type classification of an avulsion patellar ligament injury.
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Review Case Reports
Concomitant fracture of the coracoid and acromion after direct shoulder trauma.
Fractures of the acromial process or coracoid process of the scapula are rare. We present a combined fracture of the coracoid and acromion after direct trauma to the shoulder. An anteroposterior radiography with the central x-ray beam angled 25 degrees cephalad or an axillary lateral radiograph may be needed to detect these fractures.