Journal of orthopaedic trauma
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Sciatic, peroneal, and tibial nerves were isolated in 18 hind limbs in 10 adult mongrel cats. A pair of needle electrodes was used to stimulate both divisions of the sciatic nerve individually at the level of the popliteal fossa. The sciatic nerve was injured by complete or partial transection, crush, and controlled compression. ⋯ We observed that significant changes in the waveforms of cortical somatosensory evoked potential and spinal somatosensory evoked potential tracings immediately precede postoperative peripheral nerve deficits, and that loss of motor function may be avoided by immediate response to significant spinal somatosensory evoked potential and cortical somatosensory evoked potential waveform changes. A complete motor palsy can be created in one division of the sciatic nerve while normal tracings are being obtained in the other division of the nerve. Stimulating both divisions may result in a spinal somatosensory-evoked potential/cortical somatosensory evoked potential tracing that masks the deficit that is present in only one nerve division.
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The danger zone of the acetabulum is defined by Marvin Tile as that part of the posterior wall and column at the mid-acetabulum lying above the ischial spine. Screws inserted in the danger zone are at risk of violating the hip joint. Unfortunately, this zone is frequently used in the fixation of posterior wall and column fractures. ⋯ The angulation was respective to the perpendicular to the posterior column. In this study, the average width of the posterior column at the mid-acetabular level was 4.8 cm. Computed tomography scan of the acetabulum yielded valuable information regarding screw placement in the posterior column.(ABSTRACT TRUNCATED AT 250 WORDS)
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Screw placement at the posterior margin of the acetabulum during open reduction and internal fixation of posterior acetabular wall fractures must avoid intraarticular penetration of the hip joint. Analysis of the preoperative computed tomography (CT) scan, operative positioning of the patient in a secure reference plane, and placement of the screws in the coronal plane perpendicular to the long axis of the body will help avoid this surgical complication.
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Thirteen patients with segmental fractures involving the distal femur and femoral shaft were treated with internal fixation. Nine of the distal femur fractures were intraarticular. Priority was given to restoration of the articular surface and the alignment of the distal femur. ⋯ One patient was treated with Ender nails. All the fractures eventually healed, but the recovery time was long. Although no patient was asymptomatic, 10 have resumed their preinjury level of function.
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Between 1980 and 1988, 127 patients with 131 low-velocity gunshot wounds to the forearm were treated. In 71 extremities there was no bony injury; 60 extremities sustained fractures. The diagnosis of a compartment syndrome was based on tissue pressure measurements and/or clinical examination. ⋯ Low-velocity gunshot injuries to the forearm are at definite risk for the occurrence of a compartment syndrome. A high index of suspicion is necessary to prevent untoward sequelae. Patients with this injury, especially those with a proximal one-third fracture who constitute an extremely high-risk group, should be monitored closely.