Journal of orthopaedic trauma
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Fifteen cadaveric adult bony hemipelvis specimens and 30 adult dry bone specimens were obtained to evaluate the configuration of the anterior column of the acetabulum and to develop a safe path for screw placement into it. Each cadaveric specimen was sectioned at 1-cm intervals, beginning at the level of the inferior border of the acetabulum (junction between the anteroinferior edge of the acetabulum and the most anterolateral edge of the superior ramus of the pubic bone). The plane of the cross-section was perpendicular to the anterior column. ⋯ At 3.0 cm superior to the inferior acetabular margin, these angles were found to be 20.7 +/- 4.3 degrees, 29.4 +/- 6.0 degrees, and 39.3 +/- 5.9 degrees, respectively. All of the above mentioned angles are with respect to the perpendicular of the longitudinal axis of the anterior column without violation of the hip joint. Screws placed 1.0 cm lateral to the pelvic brim at the levels of 1.0, 2.0, 3.0, and 4.0 cm superior to the inferior acetabular margin and directed perpendicular to the anterior column penetrated the hip joint.
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Case Reports
Recalcitrant femoral pseudarthrosis healed with a torsionally stiff intramedullary nail.
A case of long-standing femoral pseudarthrosis was successfully treated by replacement of a torsionally less rigid intramedullary nail by one approximately 20 times more rigid. Complete union occurred 6 months after nail exchange.
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Fifteen fresh-frozen adult cadaver feet were dissected to investigate areas in the hindfoot where external fixation pins could be safely inserted with the least risk to underlying nerves, vessels, and tendons. Using palpable anatomic landmarks, four relative "safe zones" on the calcaneus and talus were delineated. These included an area on the medial calcaneus, the medial talus, the lateral calcaneus, and the lateral talus. ⋯ The structures most at risk for injury during pin insertion in the zones described were the medial and lateral calcaneal nerve branches, which inconsistently crossed the medial and lateral calcaneal safe zones, respectively. In these areas overlying the tuberosity, however, the subcutaneous tissues were thin, and iatrogenic nerve injury during pin insertion appeared avoidable if blunt dissection was used to reach the calcaneal cortex. The data presented here provide information to assist selection of pin sites that minimize risk to underlying soft tissues during external fixation of the talus and calcaneus.
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Comparative Study
Hematoma block for ankle fractures: a safe and efficacious technique for manipulations.
The purpose of this study was to examine the safety and efficacy of the hematoma block technique for closed ankle fracture manipulation. Twenty-three patients received a hematoma block with or without supplemental analgesia and/or sedation for the manipulative reduction of an ankle fracture, and 37 patients received parenteral agents alone. At an average of 12 months post-reduction, patients were administered a questionnaire concerning their level of discomfort surrounding the manipulation of their acute injury. ⋯ In addition, the hematoma block procedure resulted in no associated complications. The results of this study led us to conclude that the hematoma block with or without supplemental analgesia for the manipulation of ankle fractures was safe and effective and is a useful technique. This is particularly true in those patients in whom an adequate dosage of parenteral medication is contraindicated or unsafe.
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This study examines the risk of injury to medial soft-tissue structures during the fixation of calcaneal fractures performed through a lateral approach. An L-shaped lateral incision was performed on 10 fresh cadaver feet. The calcaneus was divided into three zones for study. ⋯ Wires placed in the subchondral bone of the posterior facet or anterior to the critical angle of Gissane were determined to be at high risk of injury to the medial soft tissues. Structures at risk included the medial and lateral plantar nerves and vessels and the flexor hallucis longus tendon. Caution should be exercised when inserting K-wires, drills, and screws into high-risk areas to avoid iatrogenic injury to the medial structures.