Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Aug 2007
Comparative StudyAntegrade intramedullary splinting or percutaneous retrograde crossed pinning for displaced neck fractures of the fifth metacarpal?
It is generally accepted that severely displaced or malrotated neck fractures of the fifth metacarpal should be treated by closed reduction and pinning. As antegrade intramedullary splinting avoids adhesions of the extensor hood and provides intramedullary stability this technique seems to be advantageous in comparison with traditional retrograde percutaneous crossed pinning. We raised the question whether the antegrade technique would give clinical and radiological results superior to the retrograde technique and investigated this within a comparative clinical study. ⋯ From our clinical and radiological data we conclude that antegrade intramedullary splinting is superior to retrograde percutaneous crossed pinning and thus should be preferentially considered for displaced neck fractures of the fifth metacarpal.
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Arch Orthop Trauma Surg · Aug 2007
Case ReportsCompartment syndrome in the hand due to extravasation of contrast material.
Extravasation of contrast material is a well-recognized complication of contrast-enhanced imaging studies. Most extravasations result only in minimal swelling or erythema; however, severe skin necrosis, ulceration and compartment syndrome may occur with extravasation of large volumes. This article presents a patient in whom extravasation developed after computed tomography (CT) contrast material was injected intravenously in the dorsum of the hand. ⋯ In follow-up, the patient regained full use of the hand. Although the use of contrast material has significantly improved the diagnostic accuracy of CT, anaphylaxis and contrast material extravasation are important complications. Selection of non-ionic contrast material, careful evaluation of the intravenous administration site and close monitoring of the patient during contrast material injection may help minimize or prevent extravasation injuries.
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Arch Orthop Trauma Surg · Aug 2007
Remodeling of the spine in spondylodiscitis of children at the age of 3 years or younger.
Spondylitis/spondylodiscitis is still an uncommon diagnosis often with a delay in diagnosis and treatment due to the uncharacteristic symptoms. The aim of this study is to increase the awareness and outline a pattern of investigation and treatment. We present six children with an average age of 23 months (19-33 months) at time of diagnosis, conservative treated and with a mean follow-up of 31 months (12-65 months). ⋯ Spondylitis/spondylodiscitis should be considered as diagnosis in children with refusal to walk or gait disturbances especially in combination with elevated ESR. MRI is the tool of choice to set the diagnosis early. With an adequate and early therapy of bracing (body-plaster-cast), antibiotics and clinical monitoring good long-term result without spine instability or deformity can be achieved.
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Arch Orthop Trauma Surg · Aug 2007
Mechanical torque measurement predicts load to implant cut-out: a biomechanical study investigating DHS anchorage in femoral heads.
Bone strength plays an important role in implant anchorage. Bone mineral density (BMD) is used as surrogate parameter to quantify bone strength and to predict implant anchorage. BMD can be measured by means of quantitative computer tomography (QCT) or dual energy X-ray absorptiometry (DXA). These noninvasive methods for BMD measurement are not available pre- or intra-operatively. Instead, the surgeon could determine bone strength by direct mechanical measurement. We have evaluated mechanical torque measurement for (A) its capability to quantify local bone strength and (B) its predictive value towards load at implant cut-out. ⋯ Mechanical peak torque measurement is able to quantify bone strength. In an experimental setup, peak torque identifies those specimens that are likely to fail at low load. In clinical routine, implant migration and cut-out depend on several parameters, which are difficult to control, such as fracture type, fracture reduction achieved, and implant position. The predictive value of peak torque towards cut-out in a clinical set-up therefore has to be carefully validated.