Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Apr 2005
Randomized Controlled Trial Comparative Study Clinical TrialTourniquets may increase postoperative swelling and pain after internal fixation of ankle fractures.
Tourniquets frequently are used in orthopaedic surgery to provide a bloodless field. There is still controversy among authors regarding the benefits and potential risks of using a tourniquet. The objective of this prospective randomized study was to quantify the effect of tourniquet use on postoperative swelling, pain, and range of motion after open reduction and internal fixation of ankle fractures. Fifty-four patients with closed ankle fractures were treated surgically; 26 patients were operated on using a thigh tourniquet (Group A), and 28 patients had surgery without the use of a tourniquet (Group B). The groups of patients were similar for age, gender, fracture types, and operative procedures. There was no difference in operation time. Using a tourniquet during open reduction and internal fixation of ankle fractures did increase postoperative swelling and postoperative pain at Day 5 and at Week 6 after surgery. We found a trend for a better range of motion in the ankle until the 6-week followup in the nontourniquet group compared with the group in which the tourniquet was inflated. According to these results we do not recommend using a tourniquet for osteosynthesis of ankle fractures. ⋯ Therapeutic study, Level I-1 (randomized controlled trial). See the Guidelines for Authors for a complete description of levels of evidence.
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Pediatric shoulder trauma is relatively uncommon. Injuries requiring surgical intervention are even rarer. However, it is important for the practicing orthopaedic surgeon to differentiate nonoperative injuries from the urgent and potentially operative injuries. ⋯ Finally, although glenohumeral dislocations, once reduced, are not life threatening or limb threatening, they do have a very high incidence of recurrence in adolescent patients. This should be kept in mind when formulating the treatment plan. If these overall treatment recommendations and plans are adhered to, the majority of pediatric shoulder trauma will result in a good outcome.
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Forearm fractures are common injuries in childhood. There are a number of important principles that should be followed to achieve the ideal goal of fracture healing without deformity or dysfunction. I will review the general principles, classifications, diagnosis, treatment, and complications of pediatric forearm fractures, including some specific injuries such as Monteggia fractures, Galeazzi injuries, and open fractures. ⋯ Unstable metaphyseal fractures should be percutaneously pinned. Unstable diaphyseal fractures can be stabilized by intramedullary fixation of the radius and ulna. If none of these techniques is helpful, plate and screw fixation is the best choice.
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Clin. Orthop. Relat. Res. · Mar 2005
ReviewPediatric fractures and dislocations of the hip and pelvis.
Recognition of an unstable pelvic fracture or a significant hip injury in children is important. Clinical assessment plays a valuable role as does the judicious use of imaging modalities in determining the most effective form of treatment, but the routine use of the standard AP pelvic radiograph is questioned. ⋯ A dual-tier approach to the treatment of pediatric pelvic trauma is suggested with an appreciation that there is no substantial evidence base for the surgical treatment of most injuries. Displaced femoral neck fractures and injuries to the hip joint that damage the articular or physeal cartilages require careful assessment and prompt and careful reduction and stabilization.
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Clin. Orthop. Relat. Res. · Mar 2005
ReviewPediatric skeletal trauma: a review and historical perspective.
Pediatric fractures are commonly classified into five types: plastic deformation, buckle fracture, greenstick fracture, complete fracture, and physeal injuries. The most important anatomic characteristic in the pediatric skeleton is the presence of growth plates and the thick periosteum. It is important to emphasize that just as adult intra-articular fractures require anatomic reduction, so do pediatric articular injuries. ⋯ In this study, I review some basic principles for the treatment of fractures in children, the main complications of pediatric fractures, and the outcomes assessment in children. The main complications of fractures in children are malalignment, physeal arrest, and refracture cause by fast fracture healing. Nearly all fractures in children can be treated in a cast without worry about stiff joints or need for physical therapy to mobilize injured joints.