Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Sep 2013
Severity of injury predicts subsequent function in surgically treated displaced intraarticular calcaneal fractures.
The treatment of displaced, intraarticular calcaneal fractures (DIACFs) remains challenging and the best treatment choices remain controversial. The majority of patients will have some lasting functional restrictions. However, it is unclear which patient- or surgeon-related factors predict long-term function. ⋯ We found the severity of a DIACF related to subsequent foot function and quality of life. Both fracture severity classifications predicted function. Anatomic reconstruction of the shape and articular surfaces of the calcaneus leads to predictable function in the medium to long term.
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Clin. Orthop. Relat. Res. · Sep 2013
Surgical technique: Tscherne-Johnson extensile approach for tibial plateau fractures.
The standard approach to lateral tibial plateau fractures involves elevation of the iliotibial band (IT) and anterior tibialis origin in continuity from Gerdy's tubercle and metaphyseal flare. We describe an alternative approach to increase lateral plateau joint exposure and maintain iliotibial band insertion to Gerdy's tubercle. ⋯ This approach reliably increases direct visualization of the lateral plateau articular fractures and maintains IT band insertion. Articular osteotomy of the anterolateral plateau provides access to extensive posterior plateau fractures.
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Development of trauma systems is a demanding process. The United States and Germany both have sophisticated trauma systems. This manuscript is a summary of political, economic, and medical changes that have led to the development of both trauma systems and the current high-quality standards. ⋯ Organized injury prevention programs and systematized professional patient care can address the issues associated with the global burden of trauma. These trauma systems require constant monitoring and improvement.
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Clin. Orthop. Relat. Res. · Sep 2013
Meta AnalysisIs lateral pin fixation for displaced supracondylar fractures of the humerus better than crossed pins in children?
Closed reduction and percutaneous pin fixation is considered standard management for displaced supracondylar fractures of the humerus in children. However, controversy exists regarding whether to use an isolated lateral entry or a crossed medial and lateral pinning technique. ⋯ We conclude that the crossed pinning fixation is more at risk for iatrogenic ulnar nerve injury than the lateral pinning technique. Therefore, we recommend the lateral pinning technique for supracondylar fractures of the humerus in children.
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Clin. Orthop. Relat. Res. · Sep 2013
Heterotopic ossification rates after acetabular fracture surgery are unchanged without indomethacin prophylaxis.
We previously found no reduction in heterotopic ossification (HO) rates after acetabular surgery with indomethacin compared with a placebo. We subsequently abandoned routine indomethacin therapy after acetabular surgery but questioned whether the incidence had changed using a posterior approach. ⋯ Our incidence of moderate and severe HO has not changed since discontinuing indomethacin. These findings support our institutional decision to abandon routine indomethacin prophylaxis after acetabular surgery. We recommend improved surgical techniques to limit damage to the abductors and improved risk stratification of patients when considering treatment options for HO prophylaxis.