Journal of orthopaedic trauma
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Thirty-four patients with ipsilateral fractures of the femur and tibia with intraarticular extension into the knee of at least one fracture were reviewed at an average follow-up of 38 months. Joint involvement was present in 22 (65%) femoral fractures and 23 (68%) tibial fractures. In 11 (32%) patients, both fractures were intraarticular. ⋯ Only eight (24%) patients had good or excellent results. Complications were frequent, with deep infections occurring in 11 (32%) extremities, leading to above-knee amputations in three (9%) patients. This subgroup of floating knee injuries appears to be associated with a higher degree of systemic trauma, a higher percentage of open injuries, and a much graver prognosis.
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A case report of a patient with posterior dislocation of an intact fibula at the distal tibiofibular joint is presented. This rare injury is a variant of a Bosworth fracture, which is a posterior dislocation of the fibula usually accompanied by an oblique fibular fracture. The injury was initially treated by open reduction of the fibular dislocation, repair of avulsed lateral and deltoid ligaments, and placement of a syndesmotic screw. At one year postoperative, the patient has a poor result secondary to talar avascular necrosis and secondary degenerative ankle arthritis.
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Pedestrians struck by motor vehicles have the highest mortality and morbidity rates of all motor-vehicle traumas. Fracture patterns and mechanisms were reviewed in a retrospective study of 115 consecutive patients. The most common fracture was tibia-fibula (39 patients), followed by pelvic (35 patients) and femur fractures (31 patients). ⋯ Several characteristic fracture patterns were discovered: femur fractures associated with an accompanying pelvic fracture, and the ipsilateral dyad, an upper- and lower-extremity fracture on the same side, were found to occur with statistical significance (p less than 0.05). A lower extremity fracture warrants particularly close attention to the examination of the corresponding upper extremity, and a femur fracture should alert the clinician to the possibility of pelvic injury. The ipsilateral dyad has not been described previously in the literature and should be appreciated by physicians evaluating and treating pedestrian MVA victims.
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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.
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Proximal radioulnar transposition in an elbow dislocation is rare. Only three cases have been recorded. ⋯ Proximal radioulnar translocation has been believed to be iatrogenic. The injury we report was not iatrogenic, and mechanical locking of radial head and neck fracture necessitated open reduction.