Journal of orthopaedic trauma
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This is a case of late-onset (6 weeks) radial nerve paralysis following open reduction and internal fixation of a comminuted distal humerus fracture. A transected radial nerve within the callus was found at reoperation. ⋯ The nerve was repaired and tendon transfers done subsequently with less than full functional recovery at 16 months. No such case has been previously reported.
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Open reduction and internal fixation (ORIF), the current treatment of choice of posterior pelvic ring disruptions with instability, has significant disadvantages. These include relatively "blind" placement of the fixation screws, infection, exsanguinating hemorrhage, and high wound complication rates. We feel fluoroscopy does not offer significant clarity in defining the posterior structure. ⋯ Following CT confirmation of the position of the pin, the screw tract was drilled and the cannulated screw was placed into position. Radiographic and clinical follow-up observation (7-24 months) showed healing with no significant complications in all 13 patients. Computed tomography-guided sacral fixation is a safe alternative to ORIF in selected patients with reducible unstable pelvic fractures.
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We report on three cases of a rare fracture of the posterior body of C2. This is a variant of the classic traumatic spondylolisthesis and appears to respond to conservative management.
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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.