Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Aug 1994
Results of 75 consecutive patients with an acetabular fracture.
From 1988 to 1991, 75 consecutive patients with an acetabular fracture were treated. Follow up was for a minimum of 2 years (average, 3 years; range, 2-5 years). Sixty five patients had a solitary acetabular fracture, and in 10 the acetabular fracture was associated with a pelvic fracture (52 men and 23 women; average age, 46 years; range, 17 to 99 years). ⋯ One patient died perioperatively of pulmonary embolus. In 2 patients a collapse of the posterior wall resulted in a total hip replacement. The results were good to excellent according to the d'Aubigne scale in 76% of all patients.
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Clin. Orthop. Relat. Res. · Aug 1994
Extended iliofemoral versus triradiate approaches in management of associated acetabular fractures.
From July 1988 to June 1991, 110 complex acetabular fractures were operatively treated. A triradiate approach was used in 38 patients and an extended iliofemoral approach in 21. The mean patient age was 32 years (range, 15-80 years). ⋯ Deep infection was seen in one patient in the extended iliofemoral group and two in the triradiate group. Eight patients developed heterotopic ossification of Brooker Grade III or IV despite prophylactic treatment with indomethacin. Both approaches provided good visualization of complex acetabular fractures.
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Clin. Orthop. Relat. Res. · Aug 1994
Case ReportsThe extended ilioinguinal approach for specific both column fractures.
The surgical approach for exposure of an acetabular fracture is determined by Letournel's fracture classification. Both column fractures typically can be treated through the ilioinguinal approach. If a fracture extends posteriorly to involve the sacroiliac joint or the sciatic buttress, exposure through the ilioinguinal approach can be quite difficult and the extended iliofemoral approach is often recommended. ⋯ The approach allows improved visualization and should prevent some morbidity usually associated with the extended iliofemoral approach. Perfect or near perfect reductions were achieved in all cases. The extended ilioinguinal approach can be useful when treating both column fractures extending posteriorly to involve the sacroiliac joint or the sciatic buttress.
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Clin. Orthop. Relat. Res. · Aug 1994
Surgical anatomy of the superficial peroneal nerve in the ankle and foot.
The subcutaneous (sensory) portion of the superficial peroneal nerve was dissected in 25 cadaver lower limbs under loupe magnification. Three distinct branching pattern types were noted. Type A (72%) consisted of a pattern where the nerve penetrated the crural fascia to become subcutaneous at an average distance of 12.3 cm proximal to the ankle joint, then divided at a mean distance of 4.4 cm proximal to the ankle into two major branches: a large medial dorsal cutaneous nerve and a smaller more laterally located intermediate dorsal cutaneous nerve. ⋯ At the level of the malleoli, the medial dorsal cutaneous nerve was located approximately one half the distance from the lateral malleolus to medial malleolus while the intermediate dorsal cutaneous nerve was approximately one third the distance. Appreciation of these branch patterns and the quantified relationships should assist nerve protection during surgical procedures as well as aid rapid nerve isolation for exploration or decompression. Branches especially at risk for iatrogenic injury include: (1) the intermediate dorsal cutaneous nerve of Type B where the nerve crosses the lateral surface of the distal fibula; (2) the intermediate dorsal cutaneous nerve of Type C where the nerve travels adjacent to the anterior border of the fibula; and (3) the intermediate dorsal cutaneous nerve and the medial dorsal cutaneous nerve at the level of the ankle, where they are at risk during anterior ankle arthrotomy or arthroscopy.
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Clin. Orthop. Relat. Res. · Aug 1994
Heterotopic ossification prophylaxis following operative treatment of acetabular fracture.
Eighty seven patients with 88 fractures were retrospectively reviewed to assess the effect of postoperative prophylaxis on the formation of heterotopic ossification (HO). Sixty eight patients with 69 acetabular fractures were followed for an average of 21 months (range, 3-98 months). The grade of HO was assessed using the Brooker classification system. ⋯ There was no significant difference between 13 patients who were not treated prophylactically and 18 indomethacin treated patients stabilized through the Kocher-Langenbeck approach. Only one of 11 patients had HO (Grade I) following an ilioinguinal approach. Postoperative radiation therapy, with or without indomethacin, resulted in three patients with Grade 0 HO (all radiated 1-4 days post surgery), one with Grade II (radiated postoperative Day 8), and one with Grade III HO (significant delay in surgery with preoperative Grade III HO of the hip).(ABSTRACT TRUNCATED AT 250 WORDS)