Journal of orthopaedic trauma
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Comparative Study
Early versus delayed treatment of severe ankle fractures: a comparison of results.
A retrospective review of 202 closed Weber B bimalleolar or bimalleolar equivalent ankle fractures treated using open reduction and internal fixation (ORIF) from January 1, 1991, through January 1, 1994 was completed at our institution. A total of 105 ankles (52%) were treated using ORIF within 5 days of injury (early group), with a mean 1.5 days from injury to surgery. A total of 97 ankles (48%) were treated after 5 days (delayed group), with a mean of 13.6 days from injury to surgery. ⋯ We conclude that the results and complications of early versus delayed treatment is not significantly different, except for a shorter median hospital stay in the delayed group. Delayed ORIF is an acceptable alternative when soft-tissue swelling, fracture blisters, or abrasions are present that offer an undesirable environment for surgical incisions. Using contemporary, a traumatic techniques, delayed surgery can provide anatomic reduction with minimal complications in severe ankle fractures.
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Between March 1989 and August 1993, 16 distal femoral nonunions (16 patients) were treated using the supracondylar intramedullary nail. The time between the initial event and retrograde nailing averaged 33 months. The nonunion level was infraisthmal in four patients and supracondylar in 12. ⋯ At an average follow-up of 16 months (range 9-23), none of the nine had united. Nine nails fractured at an average of 11 months, all through a screw hole near the nonunion. Based on these results, we cannot recommend use of the supracondylar intramedullary nail in its present form for the treatment of distal femoral nonunions.
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From 1985 to 1991, 623 cases of supracondylar fracture of the humerus in children were admitted to one center, of which 403 were analyzed in detail. Of these, 180 cases were classified as Gartland type III extension fractures, and 111 were treated via primary closed reduction and percutaneous smooth Kirschner wire pinning, of which 82 were followed up for an average of 3.5 years and were studied in detail clinically and radiologically. There were two cases of superficial pin tract infection and one of ulnar nerve palsy associated with the pinning. ⋯ Ipsilateral fracture of the same limb occurred in 4.4% of the cases, the majority being a fracture of the distal radius. The average anesthetic time for the procedure was 54 min, and the average hospital stay was 2.9 days. Our study shows that cross or lateral percutaneous pinning was found to be effective in the treatment of Gartland type III extension fractures with a high success rate and minimal complications.
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We report an isolated anterior dislocation of the radial head in an adult after sustaining a fall on the outstretched arm. Based on history and presentation, we speculate that the injury occurred in a position of hyperextension and supination. Reduction was achieved by a pronation maneuver.
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Thirty-seven patients with 37 proximal femoral fractures were treated with a reconstruction locked femoral nail. There were four ipsilateral intracapsular femoral neck and shaft fractures, two intertrochanteric fractures, 18 intertrochanteric fractures with diaphyseal extension, eight subtrochanteric fractures with involvement of the lesser trochanter, and five subtrochanteric fractures without involvement of the lesser trochanter. The overall union rate was 92%. ⋯ We conclude that the reconstruction locked femoral nail is not a good choice for ipsilateral intracapsular neck and shaft fractures. Our recommendation is that anatomic reduction should be achieved for all cases using the reconstruction femoral nail, but it is absolutely required when treating the intertrochanteric fracture with diaphyseal extension. Reconstruction femoral nails have a high rate of complication due to the complex nature of the fractures as well as the device.