Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 2011
Management of non-union of humeral fractures with the Stryker T2 compression nail.
Fractures of the humeral shaft are relatively common injuries and the majority achieve union uneventfully; however, non-union rates of up to 13% are reported when managed either conservatively or operatively. Despite the many surgical techniques described for the management of non-unions, including plate fixation, intramedullary nailing or external fixation, some cases remain resistant to treatment with ongoing problems achieving union. ⋯ We conclude that this technique of intramedullary nailing with a novel compression technique is effective in the treatment of humeral shaft fracture non-union.
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Arch Orthop Trauma Surg · Jan 2011
Case ReportsAnomalous external jugular vein: clinical concerns in treating clavicle fractures.
Operative treatment of clavicle fractures has seen growing acceptance, as evidence emerges to support its use over nonoperative management. Of particular popularity, more recently, is the percutaneous intramedullary techniques for fixation of these injuries. The complex neurovascular anatomy in close proximity to the clavicle requires precision with these procedures. ⋯ Here, we present a case report of an anomalous external jugular vein coursing anterior to the clavicle that was encountered during an open surgical approach to a clavicle fracture. The purpose of this case presentation is to serve as a caution to surgeons treating clavicle fractures by both open and percutaneous means. Inadvertent injury to anomalous neurovascular structures can be devastating to the patient and can be avoided by the careful surgical approaches recommended.
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Arch Orthop Trauma Surg · Jan 2011
Fixation and reconstruction of severe tibial shaft fractures with vascularized fibular grafting.
Based on the considerable experience for management of combined bone and composite soft-tissue defects in the limbs by free vascularized fibula or osteocutaneous fibular flap grafting, the authors present the effective alternative for management of the severe comminuted tibial shaft fractures in one-stage reconstructive technique. ⋯ The attached fibular flap can also provide a large piece of mobile skin to cover the soft-tissue defect in grade III open-tibial fractures. It demonstrates that this early free vascularized fibula graft is a useful and effective option for treating the severe comminuted tibial shaft fractures.
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Arch Orthop Trauma Surg · Dec 2010
Soft tissue rebalancing procedures with and without internal rotation osteotomy for shoulder deformity in children with persistent obstetric brachial plexus palsy.
Children with obstetric brachial plexus palsy (OBPP) frequently have problems related to their shoulder. The aim of the investigation was to determine our results in treating shoulder deformity with tendon transfers and soft tissue releases with and without internal rotational osteotomy. We also evaluated the relationships between neurological status, age and selected clinical parameters. ⋯ Soft tissue rebalancing procedures significantly improve shoulder function in children with persistent OBPP. Addition of internal rotational osteotomy to muscle transfers for severe cases allows maintaining of stabile joint, prevents loosening of internal rotation and does not influence other movements of the shoulder.
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Non-unions of the forearm often cause severe dysfunction of the forearm as they affect the interosseus membrane, elbow and wrist. Treatment of these non-unions can be challenging due to poor bone stock, broken hardware, scarring and stiffness due to long-term immobilisation. ⋯ Our results show that treatment of diaphyseal forearm non-unions using classic techniques of compression plating osteosynthesis and autologous bone grafting if needed will lead to a high union rate (100% in our series). Despite clinical and radiographic bone healing, however, a substantial subset of patients will have a less than optimal functional outcome.