Journal of orthopaedic trauma
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A retrospective review of all patients with femur fractures was performed to determine whether isolated femoral shaft fractures were associated with hypotensive shock. One hundred patients were identified who had either an isolated femoral shaft fracture (group F, 62 patients) or a femoral shaft fracture in addition to other non-shock producing fractures or minor injuries (group A, 38 patients). No patients in this study were in class III or IV (hypotensive) shock; however, 11% progressed from no shock to class I and 13% from class I to class II. ⋯ Mechanism of injury, although significant as an independent variable, was highly associated with the presence of additional fractures and so is not required in the joint model. Femur fractures alone or in combination with other minor injuries should not be considered the cause of hypotensive shock in the traumatized patient. In the traumatized patient who presents with a closed femoral shaft fracture and hypotension, an alternative source of hemorrhage should be sought.
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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.
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A retrospective study of 53 patients with isolated femur fractures was performed to evaluate blood loss and transfusion incidence. Patients with other long bone fractures, abdominal, chest, mediastinal, and vascular injuries were excluded. Twenty-one patients required transfusion during the initial hospitalization averaging 2.5 units PRBCs. ⋯ Fracture patterns, classified as high or low energy, were not found to correlate with pre- or intraoperative blood loss, incidence of transfusion, delay to surgery or duration of hospital stay. The estimated blood loss in the study group averaged 1,276 cc, stressing the significance of long bone fractures in trauma patients. Preoperative hemorrhage determined transfusion need in contrast to intraoperative blood loss.
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A prospective study on tension band fixation of medial malleolus fractures was performed on 30 consecutive patients with 31 fractures from October 1987 until December 1990. All patients had at least a displaced medial malleolus fracture unreduced by closed methods. The fractures were classified into small, medium and large using a modified Lauge-Hansen classification. ⋯ The tension band fixation provided the greatest resistance to pronation forces: for times stiffer than the two screws and 62% of the intact specimen. Tension band fixation of the medial malleolus is a biomechanically strong and clinically acceptable method of treatment for displaced medial malleolus fractures. This method of fixation may be especially useful for small fragments and in osteoporotic bone.
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Comparative Study
Operative management of displaced femoral head fractures: case-matched comparison of anterior versus posterior approaches for Pipkin I and Pipkin II fractures.
Because of the controversy surrounding the selection of the surgical approach for the operative management of femoral head fractures, we retrospectively reviewed the combined experience with femoral head fractures at two major trauma centers. Forty-three femoral head fractures in 41 patients were identified. Twenty-six of the 43 fractures were Pipkin types I and II, and were managed operatively. ⋯ The functional results in the two groups were identical; 67% good and excellent in each. There were no cases of avascular necrosis of the femoral head associated with an anterior approach. Because of the greater ease of access to the fracture, the anterior approach is recommended when operative reduction of a displaced Pipkin type I or II is indicated, but newer methods of minimizing heterotopic ossification must be developed.