Eur J Trauma Emerg S
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Eur J Trauma Emerg S · Feb 2008
Bilateral Avulsion Fractures of the Tibial Tuberosity: A Double Case for Open Reduction and Fixation.
Tibial tuberosity fractures are rare and occur mainly in adolescent males during vigorous quadriceps contraction. So far, only ten simultaneous bilateral fractures have been reported. We report the case of a 16-year-old male who avulsed both tibial tuberosities when he landed on his feet after a gymnastics routine. ⋯ He underwent bilateral open reduction and screw fixation with a good functional result after 3 months. While closed reduction and percutaneous fixation has been proposed by some, the intraoperative findings in our patient would have prevented correct adaptation of the fragments because of a flap of periosteum impinged in both fracture gaps. This case emphasizes that minimally invasive techniques may sometimes be inappropriate in the management of these types of fractures.
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Eur J Trauma Emerg S · Feb 2008
Osteosynthesis of Proximal Humeral Fractures with the Fixed Angle PHILOS-plate.
In a retrospective study we analyzed the functional and radiological outcome of 30 proximal humeral fractures, treated by PHILOS-plate, a fixed-angle device. Two of them were characterized as type Neer III, 14 as type Neer IV, 5 as type Neer V and 9 as type Neer VI. There were 2 2-part, 16 3-part and 12 4-part fractures. ⋯ The average time to union was 75 days. Fixation with PHILOS-plate is an adequate treatment for displaced 2- to 4-part fractures. Even in dislocated or 4-part fractures or in patients over 65 years good to excellent results were seen in the majority of cases.
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Eur J Trauma Emerg S · Feb 2008
Long Term Outcomes after Arthroscopic Management of Tibial Plateau Fractures.
Tibial plateau fractures are efficiently treated using arthroscopy when limited to one condyle. Operative technique and early results are now well documented. However, long term results have not been widely reported. The goal of this study was to evaluate clinical and radiological outcomes of arthroscopically treated tibial plateau fractures in the long term. ⋯ Comparisons with historical long-term studies regarding open reduction and internal fixation show similar outcomes. No specific secondary degenerative problem would alleviate the advantages of the arthroscopic management of tibial plateau fractures in the early post-operative period.
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Eur J Trauma Emerg S · Feb 2008
When Should Open Reduction and Internal Fixation Ankle Fractures Begin Weight Bearing? A Systematic Review.
The objective of this paper was to review the literature to assess when open reduction and internal fixation ankle fractures should commence weight bearing for the best outcome. An electronic search was undertaken of the databases AMED, Cinahl, Embase, Medline (via Ovid), Pedro and Pubmed, from their inception to November 2005. References lists were scrutinised and a hand search was also performed. ⋯ Neither early nor later weight bearing significantly improves or jeopardises outcomes. However, due to the plethora of methodological limitations and limited evidence, it is not possible to reference this conclusion with conviction. Further large, well-designed randomized controlled trials are required to evaluate this area.
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The need for surgical decompression for abdominal compartment syndrome is becoming more frequent in patients with severe acute pancreatitis, especially in association with massive fluid resuscitation at the early stages of the disease. Decompression can be achieved with either a full-thickness laparostomy that can be performed through a vertical midline or transverse subcostal incision, or by performing a subcutaneous linea alba fasciotomy. Following a fullthickness laparostomy the open abdomen can be best managed with some form of negative abdominal pressure dressing. ⋯ After a maturation period of 9-12 months definitive repair of the abdominal wall defect is performed utilizing the components separation technique, mesh repair, or a pedicular or microvascular tensor facia lata flap. Knowledge of the available decompression and reconstruction options is essential for individualized management of patients with severe acute pancreatitis and abdominal compartment syndrome. More research and comparative studies are needed to determine the most successful methods to be used.