Journal of orthopaedic trauma
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Twelve patients with tibial shaft fractures and evidence of compartment syndrome or with documented elevated compartment pressures were treated with an unreamed locked intramedullary nail and a single-incision lateral four-compartment fasciotomy. There were six closed fractures and three grade I and three grade II open fractures. Ten fractures have achieved a solid union without shortening or significant angulation at an average follow-up of 8.1 months (range 4-26). ⋯ All patients obtained an excellent range of motion of the knee and ankle. Unreamed nailing of diaphyseal tibial fractures with an associated compartment syndrome provides optimal internal fixation while allowing excellent access for soft tissue care. We believe that the unreamed tibial nail, when combined with a single-incision, lateral, four-compartment fasciotomy, offers substantial advantage in the treatment of this injury, permitting optimal treatment of a difficult fracture and soft tissue injury.
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We report three cases of tibial compartment syndrome after closed intramedullary nailing of the tibia. In no case was there any obvious other predisposing factor for the development of the syndrome apart from the surgery and the fracture potential itself. It is recommended that tibial compartment syndrome be regarded as a rare, but significant complication of tibial nailing.
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Transcarpal fractures in children are rare in the orthopaedic literature. This is a case report of a 10-year-old boy who sustained fractures across the distal radius, scaphoid, lunate, and triquetrum with gross displacement. ⋯ The injury healed with good wrist function but abnormal carpal development. This unusual pattern of injury is described so that it may be more readily appreciated in the future.
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To determine patient-perceived functional outcome after lower extremity fracture (LEF), a prospective, follow-up study of patients managed at three level I trauma centers was conducted. Patients with unilateral LEF involving the acetabulum and distally were eligible for the study. A total of 444 patients were enrolled. ⋯ Analysis of the 12 subscores comprising the SIP indicated particularly high scores in ambulation (16.2 postdischarge vs. 1.1 preinjury), sleep/rest (13.1 vs. 5.1), household management (14.5 vs. 2.6), recreation (17.6 vs. 4.2), emotional well-being (9.9 vs. 2.1), and most significantly work (33.2 vs. 8.8). Of those working preinjury, only 49% had returned by 6 months. SIP scores were highest for persons with three or more fractures to the same extremity and for fracture patterns typical of high-energy forces.
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Damage to the brachial artery associated with closed elbow dislocation but without accompanying fracture is rare. Only 25 cases have been reported to date. We present a case that responded well to brachial artery vein grafting, and review the literature on this subject. Operative repair is recommended in this uncommon complication of closed dislocation of the elbow.