Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Feb 2004
Review Case ReportsTraumatic lumbosacral dislocation: four cases and review of literature.
Diagnosis, physiopathology, and treatments of four patients with traumatic lumbosacral dislocations are described. This is a rare but severe lesion of the lumbosacral junction that usually occurs in patients with multiple trauma. It often is not thought of and the diagnosis may be missed. ⋯ Additional interbody vertebral arthrodesis should be considered when the L5-S1 disc is affected severely. This lesion should be looked for preoperatively with a magnetic resonance imaging scan and intraoperatively by exploring the canal. This can be done at the time of the posterior surgery or during a second anterior surgical procedure.
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Clin. Orthop. Relat. Res. · Feb 2004
Review Comparative StudyNonunion: general principles and experimental data.
Nonunions of long bone fractures can be treated successfully with one operative procedure in more than 90% of patients. In fact, 80% of patients can have good to excellent final restoration of mechanical axis alignment and proper length. ⋯ Treatment must be tailored to the individual patient to address all components of the problem. We reviewed the main experimental data regarding the knowledge of nonunions and the basic methods that may be applied to the treatment of nonunions.
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Humerus fractures comprise 5% to 8% of all fractures. Nonunions are uncommon, but when they occur, they present a challenge to the orthopaedic surgeon and often are debilitating to patients. ⋯ Many methods of treating these nonunions have been described with varying degrees of success. We review the literature concerning the treatment of proximal, midshaft, and distal humeral nonunions and describe our treatment protocol based on the literature.
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Nonunion of a distal radius fracture is extremely uncommon. Healing problems in the distal radius seem to be related to unstable situations, such as concomitant fracture of the distal radius and ulna, and to an inadequate period of immobilization. Nonunion should be suspected if there is continuing pain after remobilization of the wrist in combination with a progressing deformity. ⋯ Because of the rarity of distal radius fracture nonunion, it is not surprising that there is no consensus on the optimum mode of operative treatment. Based on our experience with reconstruction surgery in 23 patients, we think that most nonunions of the distal radius are amenable to attempts to re-align and heal the fracture even when the distal fragment is small. Therefore, surgeons should try to preserve even a small amount of wrist motion and reserve wrist fusion as a final resort.
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Clin. Orthop. Relat. Res. · Feb 2004
Comparative StudyNonunion of fractures of the subtrochanteric region of the femur.
There are no large clinical series to guide the clinician treating a subtrochanteric nonunion. Deformity, bone loss from previous hardware, and the high stresses in the subtrochanteric region all pose challenges to achieving successful bony union with reoperation. The purpose of this study was to retrospectively review a consecutive series of patients treated with reoperation using contemporary techniques for subtrochanteric nonunion. ⋯ There was one postoperative complication (4%), an adynamic ileus that was treated medically. Revision internal fixation and selected bone grafting for subtrochanteric nonunion led to a high rate of fracture union and functional improvement. Intramedullary devices with fixation into the femoral head and neck and fixed angled devices were effective in achieving stable fixation of the proximal bony fragment.