Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Feb 2010
Treatment of midshaft clavicular delayed and non-unions with anteroinferior locking compression plating.
Pain and impaired shoulder function are the predominant symptoms of midshaft clavicle non-unions. Obtaining consolidation and improvement of shoulder function is often successfully achieved with osteosynthesis and bone grafting. Most data in the literature pertain to plate osteosynthesis, placing the plate on the subcutaneous superior aspect of the clavicle. Although union rates are generally high, most patients require hardware removal as the plate is prominent under the skin causing pain and cosmetic problems. ⋯ Anteroinferior plating with a 3.5 mm LCP is a reliable and reproducible treatment of midshaft clavicular delayed and non-union regarding consolidation, function, cosmesis and reduction of second surgery.
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Arch Orthop Trauma Surg · Feb 2010
Reconstruction of a child's forefoot defect using a distally based pedicled medial plantar flap.
This report describes a case of a 10-year-old boy who received a distally based, pedicled medial plantar artery flap to cover a defect on the distal lateral side of his right foot. The defect resulted from amniotic constriction. The flap served as defect coverage and was kept viable solely by the distal medial plantar vessels. Use of this particular kind of flap proves advantageous in that it provides good protection in the weight-bearing area of the foot, while causing only a minor donor site defect.
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Arch Orthop Trauma Surg · Jan 2010
Case ReportsInjury of the right and left inferior epigastric artery during the implantation of a stand-alone ALIF cage through a left retroperitoneal approach: a case report.
Various perioperative vascular complications of anterior lumbar spine procedures have been described in orthopaedic literature. We report the unusual case of a perioperative bleeding from the right and left epigastric inferior artery occurring when using a stand-alone ALIF device (Synfix, Synthes, Oberdorf, Switzerland) at the L5/S1 level through an anterior left retroperitoneal approach. The primary stability of the Synfix is achieved by four divergent screws which are inserted through the anteriorly located plate into the neighbouring vertebral endplates. ⋯ Insertion of divergent screws of the Synfix device may cause severe distension and rupture of the epigastric vessels. This case shows that a lesion of the right epigastric artery may be a hazard even in left retroperitoneal approaches. To the author’s knowledge this is the first case describing a lesion of the right epigastric artery during an ALIF procedure through a left retroperitoneal approach.
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Arch Orthop Trauma Surg · Jan 2010
Digastric trochanteric flip osteotomy and surgical dislocation of hip in the management of acetabular fractures.
To assess the efficacy and safety of digastric trochanteric flip osteotomy technique in the management of acetabular fractures and to evaluate surgical outcome in terms of fracture reduction, femoral head viability of selected acetabular fractures treated operatively using a digastric trochanteric flip osteotomy and a modified Kocher–Langenbeck approach with surgical dislocation of the femoral head. ⋯ This technique gives good exposure (especially in posterior wall, dome area, posterior fracture-dislocation with intra-articular fragments/femoral head fractures and T-fractures), preservation of abductor strength (which may be lost with excessive retraction of abductors to see dome area in classical posterior approach), reliable healing of osteotomy (in contrast to conventional trochanteric osteotomy) without risking the vascularity of femoral head.
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Arch Orthop Trauma Surg · Jan 2010
Dutch orthopedic blood management surveys 2002 and 2007: an increasing use of blood-saving measures.
Hip and knee arthroplasties are frequently complicated by the need for allogeneic blood transfusions. The surveys were developed to assess the use of blood-saving measures in orthopedic surgery in the Netherlands in 2002 and 2007. ⋯ There is an evident increase in the preoperative use of erythropoietin and the postoperative use of autologous retransfusion of drained blood among Dutch orthopedic departments. There appears to be an increasing awareness and positive attitude among Dutch orthopedic surgeons to implement perioperative blood-saving measures.