Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Jul 1993
ReviewThe treatment of acetabular fractures through the ilioinguinal approach.
The ilioinguinal approach was developed in 1965 as an anterior approach to the pelvis and acetabulum. Before this date, the Smith-Petersen incision or a modification of it called the iliofemoral approach provided the only access to the upper part of the anterior column of the acetabulum. In the current study of 195 acetabular fractures, the ilioinguinal approach was used alone in 178 cases (90%) and in combination with the Kocker-Langenbeck as a double incision in 17 cases (10%). ⋯ The complication rate was extremely low, without any evidence of external iliac fossa heterotopic ossification. The ilioinguinal approach provides total and complete access to the anterior column from the sacroiliac joint to the pubic symphysis. An experienced acetabular surgeon may achieve excellent results even with complex fracture patterns.
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Clin. Orthop. Relat. Res. · Jul 1993
External fixation of severely comminuted and open tibial pilon fractures.
Twenty patients with severely comminuted fractures about the ankle, either severely comminuted pilon fractures or open pilon fractures (three Grade II, seven Grade III), were managed with the use of a Delta-framed external fixator across the ankle joint. All fractures had open reduction and internal fixation (ORIF) with either screw fixation or small plates to stabilize the articular surface with minimal soft-tissue dissection. Average external fixator time was 2.5 months, and the time to union averaged 4.5 months. ⋯ Range of motion (ROM) at last follow-up observation was excellent in six patients, good in nine, fair in three, and poor in two. Two patients required ankle arthrodesis because of posttraumatic arthritis. The ROM and outcomes of the severely comminuted or open fractures of the distal intraarticular tibia were very good.
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Clin. Orthop. Relat. Res. · Jul 1993
Surgical decompression for peroneal nerve palsy after total knee arthroplasty.
Five patients were treated by operative exploration and decompression of the peroneal nerve for peroneal nerve palsy complicating total knee arthroplasty (TKA). All patients had failed to demonstrate improvement in the peroneal nerve function despite extended conservative care. The procedure was performed five to 45 months after the index TKA. ⋯ Four of five patients had full peroneal nerve recovery. All patients were able to discontinue their ankle-foot orthoses. This is a rare complication of TKA, and when conservative nonoperative measures do not lead to sufficient improvement in nerve function, consideration may be given to operative decompression of the peroneal nerve.
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Clin. Orthop. Relat. Res. · Jul 1993
Intramedullary fixation of complicated fractures of the humeral shaft.
Since 1973, a specially designed intramedullary nail has been used for fixation of humeral shaft fractures complicated by malalignment, multiple trauma, metastatic disease, radial nerve palsy, or nonunion. A series of 22 consecutive patients with good to excellent results in 20 patients (91%) is reported. ⋯ This method is advocated over routine use of compression plate and screws because incision and surgical time are both minimal, and the fracture site is not exposed in primary cases unless there is radial nerve involvement. Closed reduction remains the preferred treatment for most fractures of the humeral shaft.
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Clin. Orthop. Relat. Res. · Jul 1993
ReviewOpen ankle fractures. The indications for immediate open reduction and internal fixation.
Twenty-two patients with open ankle fractures or fracture-dislocations were treated with irrigation and debridement, reduction, and immediate stable internal fixation at an average of six hours from initial evaluation. There were 13 women (59%) and nine men (41%), having an average follow-up period of 32 months (range, five to 111 months). There were six Grade I (27%), 15 Grade II (68%), and one Grade III (5%) injuries. ⋯ There were four minor complications: two superficial would ulcerations, one loss of reduction requiring revision stabilization, and one distal tibiofibular synostosis. There were no deep infections or nonunions. Immediate debridement, irrigation, reduction, and internal fixation of open ankle fractures is clearly indicated in Grade I and clean Grade II open injuries.