Journal of orthopaedic trauma
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A case of open scapulothoracic dissociation with intact neurovascular status in an 8-year-old girl is reported. Scapulothoracic dissociation is a rare injury. ⋯ This case report illustrates that an obvious roentgenographic scapulothoracic dissociation may be seen without any neurovascular deficit in a child. Successful treatment, with anatomical repair of the muscles and stabilization of the scapula, is described.
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Comparative Study
Unstable femoral shaft fractures: a comparison of interlocking nailing versus traction and casting methods.
Among 60 femur fractures not amenable to fixation by simple intramedullary nailing, 30 were treated with balanced skeletal traction followed by cast bracing or spica casting, and 30 were treated with closed interlocking nailing. The criteria for using an interlocking nail were fractures with less than 50% cortical contact or fractures with rotationally insecure purchase of the nail in either the proximal or distal fragment. In terms of fracture severity, patient age, injury severity, and clinical follow-up, the patient groups were similar. ⋯ Failure by the criteria of Johnson et al (2) occurred in 67% of the traction group and in 3% of the interlocking nail group (p less than 0.001). Minor complications were more common in the traction group. On the basis of this study and the experience of others, interlocking nail fixation appears to be the method of choice for managing unstable femoral shaft fractures.
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Interfragmentary lag screw internal fixation was combined with external fixation to treat five difficult oblique lower extremity fractures. Uncomplicated primary bone healing was achieved in all five cases in spite of crush injury, devascularization, or local infection. This method represents a treatment option for the difficult oblique fracture and reconfirms the role of fixation in fracture biology.
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A total of 32 cases of tarsometatarsal fracture dislocations, treated during a 15-year period, have been retrospectively reviewed. Results were assessed in 29 patients with a mean age of 33.8 years and a mean follow-up of 6.3 years. On the basis of Quénu and Küss' classification, five patients had homolateral dislocations, three had divergent dislocations, and 21 had partial dislocations (seven medial partial and 14 lateral partial). ⋯ Good results were associated with an accurate reduction. Open treatment is advocated if minor displacement persists. Routine K-wire fixation is advised for all cases.
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The medullary cavities of both femora in 35 rats were reamed, and bone cement was injected on the left side. A partial transverse osteotomy of the midshaft of both femora was then performed. ⋯ No significant differences were found between the right and left femora. It is concluded that acrylic bone cement injected into the medullary cavity does not significantly impair the healing of osteotomies in rats.