The Iowa orthopaedic journal
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Ankle fragility fractures are difficult to treat due to poor bone quality and soft tissues as well as the near ubiquitous presence of comorbidities including diabetes mellitus and peripheral neuropathy. Conventional open reduction and internal fixation in this population has been shown to lead to a significant rate of complications. Given the high rate of complications with contemporary fixation methods, the present study aims to critically evaluate the use of acute hindfoot nailing as a percutaneous fixation technique for high-risk ankle fragility fractures. ⋯ This study shows that retrograde hindfoot nailing is an acceptable treatment option for treatment of ankle fragility fractures. Hindfoot nailing allows early weightbearing, limited soft tissue injury, and a relatively low rate of complications, all of which are advantages to conventional open reduction internal fixation techniques. Given these findings, larger prospective randomized trials comparing this treatment with conventional open reduction internal fixation techniques are warranted.
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Nonunion of long bone fractures is a serious complication for many patients leading to considerable morbidity. The purpose of this study is to elucidate factors affecting continued pain following long bone nonunion surgery and offer better pain control advice to patients. ⋯ Healed patients have improved pain levels after lower extremity nonunion surgery. Orthopedic surgeons should stress smoking cessation programs and minimize delay to nonunion surgery, in order to maximize pain relief in this patient cohort.
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Fracture of the scaphoid bone can be treated with cast immobilization or surgery. Historically, surgery was reserved for displaced fractures. However, because weeks of cast immobilization may result in stiffness, loss of strength, loss of bone density and an inability to work or participate in recreational activities for a prolonged period, operative treatment of non-displaced fractures has become increasingly common. Several surgical techniques for fixation have been described, but their risks and benefits have not yet been clearly elucidated. In a study in cadavers, we investigated whether one approach--volar percutaneous fixation--might pose a risk of injury to surrounding structures. ⋯ Our findings indicate that modification of the volar percutaneous approach to scaphoid fixation may be advisable to avoid damage to adjacent structures. We suggest use of a "mini-open" percutaneous procedure.
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Rupture of the pectoralis major muscle (PMM) is an uncommon injury that occurs during physical exercise and high-impact contact sports; it may result in pain, weakness, and disability. Surgical repair is currently the preferred treatment of PMM rupture. Our study assesses subjective and functional outcomes of patients following repair of acute and chronic PMM ruptures. ⋯ Level 4: Retrospective Case Series.
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Comparative Study
Minimally Invasive Versus Open Lumbar Fusion: A Comparison of Blood Loss, Surgical Complications, and Hospital Course.
Perioperative blood loss is a frequent concern in spine surgery and often necessitates the use of allogeneic transfusion. Minimally invasive technique (MIS) is an option that minimizes surgical trauma and therefore intra-operative bleeding. The purpose of this study is to evaluate the blood loss, surgical complications, and duration of inpatient hospitalization in patients undergoing open posterolateral lumbar fusion (PLF), open posterior lumbar interbody fusion (PLIF) with PLF, or MIS transforaminal lumbar interbody fusion (MIS TLIF). ⋯ Level III, Therapeutic.