Journal of orthopaedic trauma
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Pudendal nerve palsy after femoral intramedullary (IM) nailing was retrospectively reviewed in 65 nailings performed on 63 patients. Ten pudendal nerve palsies (15%) were noted in eight male patients and two female patients. Three male patients had autonomic involvement affecting erections. ⋯ Other factors may be operating time and amount of traction. As prevention, the perineal post must always be adequately padded, and the operating time and amount of traction should be minimized to decrease the incidence of pudendal nerve palsy. Because pudendal nerve palsy appears to be a common complication in femoral IM nailing, the patient must be informed of this possibility.
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Case Reports
Traumatic lateral scapular displacement: an expanded spectrum of associated neurovascular injury.
The clinical entity of "scapulothoracic dissociation" has been reported as an uncommon but devastating shoulder girdle disruption. All previously identified closed injuries have been associated with arterial and brachial plexus compromise; therefore, neurovascular disruption has been presented as an essential diagnostic clinical finding of scapulothoracic dissociation. ⋯ These patients illustrate a previously unrecognized, or at least unreported, continuum of potential neurovascular compromise associated with disruption of the scapulothoracic articulation. An expanded and more descriptive classification scheme for "traumatic lateral scapular displacement" is proposed to emphasize the spectrum of possible presentations of this injury.
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This study evaluated the rotational and bending stability of three interlocking nail systems in paired cadaveric humeri. The Russell-Taylor Humeral Interlocking Nail, the Seidel Humeral Locking Nail, and the True-Flex Humeral Nail were mechanically tested in torsion and four-point bending. The Russell-Taylor and the Seidel interlocking nails are reamed systems that rely on proximal interlocking screws and distal screws or phalanges respectively for rotational stability. ⋯ However, the results indicate the cross-sectional geometry of the True-Flex nail is not able to provide the same degree of static locking as the Russell-Taylor or Seidel interlocking nails. Humeri implanted with the Russell-Taylor and Seidel nails also had a significantly greater torsional stiffness than the True-Flex nail. As expected, humeri implanted with the Russell-Taylor and Seidel nails also had a significantly greater bending stiffness than the True-Flex nail in both anterior-posterior and medial-lateral bending.
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Influences of some design parameters on the biomechanics of the unreamed tibial intramedullary nail.
Several questions relating to the biomechanics of the AO unreamed tibial nail were addressed in this study. These included the effects of the location of the nail bend on the reduction of a high proximal fracture, and the relation of proximal locking screw hole orientation and fracture component cortical contact to the mechanical stiffness of the construct. To measure fracture site malalignment with nail insertion, a motion transducer mounted on the distal tibial shaft was used to track the position of the proximal component during and after insertion of the nail. ⋯ In an experimental model with an osteotomy located proximal to the position of the bend in the nail when fully inserted, anterior displacement of the proximal fracture component (or posterior displacement of the distal component) of up to 1 cm was measured. Oblique proximal locking screws significantly decreased both varus/valgus angulation and medial/lateral translation under load, compared with the parallel screws. Constructs were 117% and 55% as rigid as the intact tibia in axial loading with and without cortical contact, and 6.5% and 3.1% as stiff in torsion.(ABSTRACT TRUNCATED AT 250 WORDS)
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The purpose of this study was to evaluate the efficacy of using multiple relaxing skin incisions (MRSIs) to facilitate the closure of difficult lower extremity wounds. Such wounds are caused by direct trauma or by surgical intervention for management of bone and soft tissue injury that result in wound closure under tension. Common alternatives include closure by secondary intention, delayed primary closure, split thickness skin grafting, or flap coverage. ⋯ Cosmetic results were excellent. The use of MRSIs is a safe, simple, and reliable technique where wound closure is complicated by swelling due to trauma or soft tissue defects. No specialized training or equipment is required, and postoperative wound care is greatly simplified.