The Iowa orthopaedic journal
-
Case Reports
A pediatric comminuted talar fracture treated by minimal K-wire fixation without using a tourniquet.
Pediatric comminuted talar fractures are reported to be rare, and treatment options such as minimal internal K-wire fixation without using a tourniquet to prevent avascular necrosis have not previously been investigated. ⋯ 4.
-
The indications for vancomycin prophylaxis to prevent Methicillin-resistant Staphylococcus aureus (MRSA) surgical site infections are increasing. The recommended dose of vancomycin has traditionally been 1 gram intravenous. However, the increasing prevalence of obesity in our population coupled with increasing resistance of MRSA to vancomycin has resulted in recent recommendations for weight-based dosing of vancomycin at 15 mg/kg. We hypothesize that the standard one gram dose of vancomycin is inadequate to meet the recently recommended dosage of 15 mg/kg. ⋯ In settings such as hospitals, where the risk for resistant bacteria, especially MRSA, is high, it is becoming increasingly important to accurately dose patients who require vancomycin. In order to avoid incorrect dosing of vancomycin health care providers must use weight-based dosing.
-
Use of Computed Tomography (CT) to evaluate syndesmotic reduction following injury has significantly increased in recent years. The aim of this study was to compare existing clinical measurements of syndesmotic reduction to gold standard measurements of fibular motion obtained from a full 3D model. ⋯ While the clinical measurements were adequately reproducible, they showed only moderate to small correlations with the 3D measurements of movement of the fibula in the longitudinal, medial/lateral or rotational directions. The only fibular translation measured by the 3D model that was well described by the three clinical measures was fibular movement in the anterior/ posterior direction. This work demonstrates a need for improved clinical measurements of syndesmotic congruity on axial CT scans to serve as surrogates for the true movement of the fibula.
-
Periprosthetic distal femur fractures are severe injuries occurring in the often osteoporotic bone of the elderly. Far cortical locking (FCL) screws, which have been shown to promote increased callus formation in animal models, have recently become available for clinical use. The purpose of this study is to report preliminary healing and complication rates of periprosthetic distal femur fractures treated with FCL constructs. ⋯ The initial results of this study are comparable to results reported for distal femur periprosthetic fractures treated with locking plate fixation without FCL screws, although it was difficult to compare time to healing between previously published studies. It is the impression of the authors that callus appears earlier and is more robust and uniform between the three cortices in FCL cases compared to their previous experiences with traditional locking plate periprosthetic distal femur fractures. This work suggests that FCL screws may be superior to traditional locking constructs but further studies are needed to directly compare the two methods.
-
The medial patellofemoral ligament (MPFL) is the most frequently injured soft tissue structure following acute lateral patellar dislocation. MPFL reconstruction has become a popular option to restore patellar stability following lateral patellar dislocation due to the high incidence of recurrent instability following conservative management. Anatomic reconstruction of the MPFL minimizes graft length changes during full knee range of motion and restores patellar stability. ⋯ Anatomic MPFL reconstruction displays similar lateral restraining force compared to the intact MPFL at low levels of lateral displacement. At higher levels of displacement, the reconstructed MPFL provides increased lateral restraining force compared to the intact MPFL, improving patellar stability in pathologic knees.