Journal of orthopaedic trauma
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Intramedullary nails with special lag screw designs may provide improved mechanical performance and alleviate clinical problems. We hypothesize that the proximal design of trochanteric nails affects mechanical performance. ⋯ The interlocking lag screw design reduced movement of the femoral head and relative movement between fracture fragments. Beyond that the trapezoidal nail design of the Intertan reduced toggling within the trochanteric area and prolonged survival. Although this study showed a decrease in the retention of stability over time, failure did not occur until the equivalent of 2-3 months of reduced physical activity in which healing may have occurred under normal clinical conditions.
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Comparative Study
A biomechanical comparison of ipsilateral and contralateral pedicle screw placement for modified triangular osteosynthesis in unstable pelvic fractures.
Iliosacral fixation of unstable pelvic fractures does not produce enough stability to allow for immediate postoperative weight bearing. Triangular osteosynthesis creates additional resistance to vertical displacement and rotation. A disadvantage is the loss of the L5/S1 motion segment. We propose a modification of the standard triangular osteosynthesis construct in which the contralateral S1 pedicle is used. As the ipsilateral L5 pedicle is unavailable for fixation in a saw-bones composite pelvic model, we compared ipsilateral and contralateral S1 pedicle screw constructs. We hypothesized that ipsilateral and contralateral S1 pedicle screw constructs would demonstrate no difference in displacement or rotation. ⋯ Within the limitations of the current model, contralateral S1 constructs for modified triangular osteosynthesis were biomechanically equal to ipsilateral constructs in preventing displacement and superior in preventing rotation.
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To report our experience with computed tomography (CT) scans to detect traumatic arthrotomies of the knee (TAK) joint based on the presence of intra-articular air. ⋯ Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Comparative Study
Assessment of radiographic fracture healing in patients with operatively treated femoral neck fractures.
This study was conducted to determine interrater and intrarater reliabilities on the healing assessment of femoral neck fractures between orthopedic surgeons and radiologists and to test the performance of a checklist system for hip fracture healing. ⋯ The level of agreement between and within orthopedic surgeon and radiologist reviewers in the assessment of fracture healing is low, though intrarater agreement is high. The RUSH score shows promise as a tool to improve agreement on fracture healing. Studies evaluating reliability and accuracy of healing with clinical information and temporal evaluation are needed and may further improve agreement.
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Comparative Study
The role of computed tomography in the assessment of open periarticular fractures associated with deep knee wounds.
To (1) determine the incidence and injury profile of open periarticular fractures about the knee joint in a cohort of patients presenting to the emergency department with a deep periarticular knee wound and to (2) determine the effectiveness of computed tomography (CT) scan to detect and guide management of these open fractures compared with plain radiographs (XRs). ⋯ Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.