The American journal of orthopedics
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Kyphoplasty is an effective surgical treatment for the pain and deformity that can accompany vertebral compression fractures. In certain cases, however, defects or clefts in the vertebral body result either from the original fracture or from expansion of inflatable bone tamps (IBTs). Through such a defect, cement may extrude into the epidural space, paraspinal soft tissues, or disc space. ⋯ Then, another batch of cement is mixed and is used to fill the cavities, as in the standard technique. Results for our first 21 patients show a mean correction of more than 6 degrees of kyphosis and no cement leaks into the spinal canal. We believe that this modification of the kyphoplasty technique is effective and safe for certain fractures.
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Severe degloving injuries to the pediatric lower extremity are difficult to treat, traditionally requiring local or free flaps for coverage. Combining vacuum-assisted closure techniques with a dermal regeneration template is proposed as a means for covering these difficult wounds. We retrospectively reviewed the charts of 7 consecutive patients (age range, 2-12 years) who underwent this treatment. ⋯ Mean follow-up was 24.4 months, and mean wound size was 196 cm2. There were 2 superficial graft complications, 1 nonunion successfully treated with bone grafting, 2 patients with subsequent bony deformity, and 1 patient who underwent subsequent soft-tissue procedures for equinus contracture. Use of vacuum-assisted closure and a dermal regeneration template has shown good results as a means of successfully managing grade IIIB injuries without performing complicated flap reconstructions.
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In the prospective cohort study reported here, we used the Short Musculoskeletal Function Assessment (SMFA) questionnaire to assess rate of return of functional outcome after open reduction and internal fixation of unstable ankle fractures (Orthopaedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen [OTA/AO] 44B and 44C) at a level II trauma center over the course of 1 year. The entire group of 69 consecutive adults improved significantly (P<.01) on the SMFA Emotional Status and Dysfunction scales from 2 to 4 months and on the Mobility and Daily Activities scales from 2 to 4 months and from 4 to 6 months. There were no significant changes on the Arm/Hand Function and Bother scales. ⋯ There were no significant differences arising from presence or absence of a fracture of the medial malleolus. Our SMFA data show that older patients (> or = 50 years) and patients with 44C fractures had slower return to maximal function and higher Bother scores at 6 months. All groups reached a relatively stable functional outcome by 6 months after injury, but their mobility did not return to population norms over the same period.
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In this retrospective study, we used anteroposterior plain radiographs of the neck to analyze sternal notch level in relation to the upper thoracic spine and to assess the usefulness of this relation in deciding how to approach the upper thoracic spine. We reviewed 53 patients' anteroposterior plain radiographs of the cervicothoracic spine and thoracic magnetic resonance imaging (MRI) scans. On the plain radiographs, we drew a horizontal line joining the lower-fifth edge of the medial end of the 2 clavicles; on the midsagittal thoracic MRI scans, we drew a tangential line to the sternal notch. ⋯ We evaluated this method in a patient with a fractured T3 vertebral body, in whom a satisfactory procedure was performed using low anterior cervical spine approach. As the level of sternal notch is found to be present below the level of T2 and T3 radiologically in most cases, a low cervical approach can be contemplated in most patients with upper thoracic spine pathology depending on their sternal level as determined by preoperative radiographs. MRI scans are not needed to decide the approach, as it can be assessed with plain radiographs alone, as shown in this study.