Journal of orthopaedic trauma
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According to the classification of Lauge-Hansen, supination-external rotation IV (OTA 44-B) injuries should not have syndesmotic instability; yet, several studies have suggested disruption is present in up to 40% of these injuries based on stress tests. In this study, we examine various stress radiographic parameters in a cadaver model of supination-external rotation IV equivalent injury. We hypothesize that external rotation stress testing and widening of the medial clear space do not always represent syndesmotic instability. Rather, the better predictor of syndesmotic instability will be an increased tibia-fibula clear space with the lateral stress test. ⋯ Lateral stress test with widening of the tibiofibular clear space is the preferred indicator of syndesmotic instability. The external rotation stress is a poor indicator of syndesmotic injury in the setting of deltoid ligament injury.
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To examine the impact of preoperative coronal plane deformity on functional and radiographic outcomes on endosteal strut augmentation of proximal humerus fracture fixation. ⋯ Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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To review homeless patients with orthopaedic trauma injuries and examine their emergency room (ER) usage, follow-up rates, and complication rates. ⋯ Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Superomedial impaction of the anterior dome of the acetabulum is a known risk factor for poor outcomes after open reduction and internal fixation of acetabular fractures. The authors, using the anterior intrapelvic (modified Stoppa) approach to the acetabulum, describe a novel technique to help reduce and stabilize marginal impaction of the acetabular dome. In the senior author's experience, this technique has been helpful to achieve adequate reduction and stabilization.
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Authors previously have described anatomic structures commonly seen through the modified Stoppa approach; however, no study has formally quantified the areas and amount of visual bony exposure that is obtained. This information is important for proper preoperative planning of acetabulum fractures with regard to fracture reduction and fixation. The aim of this study was to quantify and describe the extent of bony pelvis exposed while identifying the limits of exposure from osseous landmarks within the dissection of the modified Stoppa approach. ⋯ The modified Stoppa approach allows for exposure of most (79%) of the inner true bony pelvis including the entire pelvic brim and 80% of the quadrilateral surface. On average, visualization is possible 2 cm above the pelvic brim and 5 cm below the pelvic brim along the quadrilateral surface, providing adequate anterior exposure for clamp and implant placement.