Clinical orthopaedics and related research
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Although vehicular trauma traditionally has accounted for the majority of spinal cord injuries, gunshot wounds are the second most common cause. Furthermore, the proportion of spinal cord injuries caused by gunshot wounds are increasing although the proportion of injuries caused by high-speed vehicular trauma is decreasing. Gunshot wounds to the spine commonly are thought to be stable injuries. ⋯ Surgical decompression of bullets from the spinal canal has been shown to improve neurologic recovery below the T12 level. Improvement of neurologic recovery after bullet removal has not been shown in other regions of the spine. Rare instances of late neurologic decline because of retained bullet fragments have been documented.
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Clin. Orthop. Relat. Res. · Mar 2003
Case ReportsRecurrent anterior hip instability after a simple hip dislocation: a case report.
A 35-year-old woman sustained a simple anterior hip dislocation after a fall. Initial treatment involved a closed reduction under sedation with brace immobilization. Nine months after the initial dislocation, she began having recurrent anterior hip instability (four events) requiring closed reduction under anesthesia. ⋯ After this procedure she sustained five additional anterior dislocations requiring closed reduction under anesthesia. After nine anterior dislocations, she had periacetabular osteotomy retroverting her acetabulum with repair of the anterior hip capsule which has successfully solved the recurrent instability. To the author's knowledge this is the first reported case of recurrent anterior hip instability treated successfully with a periacetabular osteotomy.
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Clin. Orthop. Relat. Res. · Mar 2003
Recent advances in the treatment of gunshot fractures of the humeral shaft.
The increase in violent crime has lead to an increase in gunshot-induced fractures in the United States. Injuries to the upper extremity are common. The treatment of gunshot injuries depends on the extent of soft tissue disruption and the type and location of fracture. ⋯ Soft tissue disruption plays a more important role in high-energy gunshot-induced fractures. In these cases, external fixation is the treatment of choice for stabilization. Recent advances in the use of external fixation have led to quick fracture stabilization, stability for vascular repair, and access to the wound for debridement and subsequent soft tissue surgery.
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Clin. Orthop. Relat. Res. · Mar 2003
Posteromedial dislocation of the elbow with lateral condyle fracture in children.
Posteromedial dislocation of the elbow in children is an extremely rare injury. The current study describes four boys with posteromedial dislocation of the elbow associated with a displaced fracture of the lateral humeral condyle. The patients ranged in age from 6 to 12 years (average age, 9 years 6 months). ⋯ Healing and return of normal function occurred in all but one patient who had minor loss of full extension. Average duration of followup was 7 years 6 months (range, 3-13 years). Dislocation of the elbow associated with a displaced fracture of the lateral humeral condyle can be treated by closed reduction of the elbow dislocation and open anatomic reduction and fixation of the lateral condyle fracture with good results.
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Clin. Orthop. Relat. Res. · Mar 2003
Elastic stable intramedullary nailing of midclavicular fractures with a titanium nail.
This study presents the results of a minimally invasive operative treatment for markedly displaced midclavicular fractures. In all patients a flexible titanium nail was inserted in an unreamed technique from the sternal end of the clavicle. The result of surgery was determined with clinical and radiographic controls. ⋯ Intramedullary nailing of midclavicular fractures with a flexible titanium nail is a safe minimally invasive surgical technique with excellent functional and cosmetic results compared with plate fixation or conservative treatment. Marked pain reduction along with early restoration of shoulder function and early mobilization are advantageous for patients. This technique can be used as an alternative treatment to conservative procedures or plate fixation in patients with markedly displaced midclavicular fractures, multiple trauma, fractures of the lower extremities, or associated shoulder girdle injuries.