Journal of orthopaedic trauma
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A Weber type C ankle fracture was sequentially reproduced in 12 cadaver lower extremities and an external rotation torque was applied at each interval. The fractures were then repaired in staged fashion and the rotational stability of the mortise evaluated. Maximum external rotation of the talus within the mortise averaged 7.7 degrees in the intact ankle and increased by 311% to 31.8 degrees after creation of a Weber C injury. ⋯ Fibular fixation combined with a syndesmotic screw restored 51% of original stability, and the addition of medial malleolar fixation improved stability to 101%. Bimalleolar fixation without a syndesmotic screw yielded 73% of the original rotational stability. The results of this study suggest that when rigid medial and lateral osteosynthesis can be achieved, syndesmotic fixation may not be necessary.
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Of 36 patients who presented over a 3-year period with nailgun injuries, nine of these injuries were found to have penetrated into the knee joint. Six of these injuries were treated by operative nail removal, curettage of the nail tract, and examination of the joint. The remaining three patients had nail removal, followed by irrigation of the joint in the emergency room. ⋯ In three of six patients treated by operative irrigation and debridement, a piece of clothing or nailgun resin was discovered in the nail tract or floating within the knee joint. None of the patients in the group treated by operative nail removal, joint visualization, irrigation, and nail tract curettage experienced any complications, whereas one patient treated nonoperatively developed a septic knee. Due to the unique nature of these nailgun puncture wounds, we strongly advocate operative nail removal, curettage of the nail tract, visualization of the joint, and use of prophylactic antibiotics in the treatment of nailgun arthrotomies.
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Case Reports
Compartment syndrome after closed intramedullary nailing of the tibia: a canine model and report of two cases.
Two patients developed an anterior tibial compartment syndrome after closed reamed intramedullary nailing of their fractured tibial shaft. Subsequently, a study was undertaken using a canine model to evaluate the risk of compartment syndrome after this operative procedure. A closed tibial fracture was created in 20 mongrel canines by applying a torsional load localized to the tibial shaft through a stress riser made with an intramedullary drill. ⋯ In the control group, no pressures higher than 8 mm Hg were recorded. Compartment syndrome is a potential complication of closed intramedullary nailing of the tibia, and the anterior muscle compartment appears to be the one most at risk. Therefore, perioperative tissue pressure monitoring is recommended.
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Randomized Controlled Trial Comparative Study Clinical Trial
A prospective randomized trial of external fixation and plaster cast immobilization in the treatment of distal radial fractures.
Distal radial fractures are common, and many methods of treatment have been reported but there are no studies that compare the different treatment methods. This randomized prospective study demonstrated no advantage in using an external fixator to immobilize reduced distal radial fractures over closed reduction and plaster cast immobilization in patients less than 60 years of age. The external fixator group had a significant complication rate.