The American journal of orthopedics
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An impervious plastic stockinet can facilitate application of a vacuum-assisted closure dressing in complex, traumatic wounds. This article reviews our technique.
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Comparative Study
Use of flexible intramedullary nail fixation in treating femur fractures in children.
We evaluated use of flexible intramedullary nails in the surgical treatment of femoral shaft fractures in 135 children (138 fractures). Mean age was 9.7 years (range, 2-17 years). Mean follow-up was 15.6 months (range, 6.6-53.5 months). ⋯ Fracture patterns were transverse (66), oblique (42), spiral (24), and comminuted (6). There were 16 complications--3 refractures, 2 delayed unions, 3 varus or valgus malalignments, 5 nail-tip irritations, 2 broken interlocking screws (found incidentally on radiographs), and 1 asymptomatic proximal nail migration--for a complication rate of 11.7%. These results demonstrate that use of flexible intramedullary nails in the treatment of femoral shaft fractures in children is successful regardless of patient age, fracture location, or fracture pattern.
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Total hip arthroplasty (THA), an effective treatment for patients with end-stage arthritic hip conditions, provides dramatic pain relief, enhances mobility, and restores function. The success of THA in older patients, in concert with improvements in techniques and biomaterials, has stimulated demand for this procedure in younger, more active patients hoping to regain full activity. ⋯ Unfortunately, the value of these studies is limited because of heterogeneous hip pathology in the younger groups, particularly given that preoperative pathology has proved to significantly affect implant survival. In this review of the literature, we focus on THA survival in young, active patients with a preoperative diagnosis of noninflammatory osteoarthritis.
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Rupture of the pectoralis major tendon is an uncommon injury that typically occurs in young, active people. Of this injury population, active-duty military personnel represent a unique, athletic subset that is commonly treated with operative repair. For the retrospective case series reported here, we hypothesized that active-duty soldiers with acute and chronic pectoralis major tendon ruptures treated with operative repair would have high levels of patient satisfaction, quick return to work and sports, and few long-term complications. ⋯ There was a statistically significant difference between outcomes for the immediate- and delayed- treatment groups, with the immediate-treatment group having better overall DASH and Work Module scores. Patients had a 30% to 40% objective loss of strength after surgery. Active-duty soldiers reported acceptable overall outcomes after both immediate and delayed treatment for pectoralis major tendon ruptures, but a statistically significant difference was found in overall DASH and Work Module scores between the treatment groups.