Clinical orthopaedics and related research
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To clarify which factors influence the final result of surgical management of plafond or pilon fractures, 66 patients with 67 pilon fractures treated at the Orthopaedic Department of the University of Athens between 1978 and 1993 were reviewed. There were eight (11.95%) Type I, 33 (49.25%) Type II, and 26 (38.8%) Type III fractures according to the Ruedi-Allgower classification. Eleven (16.4%) were open injuries. ⋯ The final outcome of the treatment was evaluated after 2 to 17 years followup (mean, 8.1 years) and was based on the subjective, objective, and radiographic results of each case, using the method of Burwell and Charnley. The findings indicate that three parameters significantly influenced the outcome of plafond fracture management. Specifically, the results of surgical management were affected by the clinical type of the fracture, the quality of reduction achieved at surgery, and the specific surgical procedure by which the fracture was managed.
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Clin. Orthop. Relat. Res. · Jun 1997
Nonreamed locking intramedullary nailing for open fractures of the tibia.
The use of nonreamed interlocking tibial nails in the management of open fractures of the tibial shaft has gained wide acceptance. This technique has been reported to have reproducible good results with a low incidence of complications in Type I, Type II, and Type IIIA open tibial shaft fractures. The use of nonreamed nails in Type IIIB fractures continues to be a source of controversy. ⋯ There were three (4.2%) deep infections; one Type II, one Type IIIA, and one Type IIIB. Forty-nine fractures (68%) united by 6 months, all fractures had united by 12 months. The use of nonreamed locking intramedullary nailing in Types I, II, IIIA, and IIIB open fractures of the tibial shaft is supported.
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Clin. Orthop. Relat. Res. · Jun 1997
Case ReportsExtracorporeal life support for patients with significant orthopaedic trauma.
Extracorporeal life support is a therapeutic modality that can provide cardiorespiratory support for multiply injured patients. Fourteen patients with multiple trauma who sustained pelvic or long bone fractures were referred for treatment with extracorporeal life support at the University of Michigan Medical Center. All patients were considered morlbund secondary to their pulmonary injury. ⋯ Patients with significant orthopaedic trauma and severe pulmonary compromise have an extremely high mortality risk. Appropriate aggressive fracture management remains the most important intervention to decrease the risk of pulmonary compromise. Early initiation of extracorporeal life support can be an additional lifesaving intervention in select patients with orthopaedic trauma who have respiratory failure refractory to conventional mechanical ventilation.
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Clin. Orthop. Relat. Res. · Jun 1997
Anatomic basis of lag screw placement in the anterior column of the acetabulum.
The projection point of the axis of the anterior column of the acetabulum on the outer table of the iliac wing was determined in 15 adult bony hemipelves. The optimal entry point for lag screw fixation in the anterior column was located 16 +/- 3.9 mm superior to the midpoint of the line connecting the apex of the sciatic notch with the notch between anterior superior iliac spine and anterior inferior iliac spine, and 46 +/- 5.9 mm superior to the acetabular rim. ⋯ These data may facilitate insertion of a lag screw into the anterior acetabular column and minimize the risk of articular violation or cortical penetration because there is a narrow margin of safety. The lag screw placement also may be aided by palpating the anterior column with a finger and by intraoperative fluoroscopy for visualization of the hip joint and the anterior column in the obturator or pelvic outlet views.
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Clin. Orthop. Relat. Res. · Jun 1997
Reamed femoral nailing in patients with multiple injuries. Adverse effects of tourniquet use.
Limb reperfusion after tourniquet ischemia causes pulmonary microvascular injury. Similarly, microembolization, like that associated with reamed femoral nailing, can induce pulmonary microvascular injury. Both processes result in increased pulmonary capillary membrane permeability and edema. ⋯ Group NT had fewer ventilator dependent days and intensive care days than Group T (NT: ventilator dependent days, 2.5 +/- 5.2; intensive care days, 3.9 +/- 6.5; T: 5.1 +/- 6.4; intensive care days, 6.7 +/- 6.6). Ventilator dependent days and intensive care days increased with increasing tourniquet time (T1: ventilator dependent days, 3.2 +/- 3.6; intensive care days, 5.4 +/- 4.6; T2: ventilator dependent days, 7.5 +/- 8.5; intensive care days, 8.5 +/- 8.5), suggesting that in patients with multitrauma, combining reamed femoral nailing with fracture fixation under tourniquet control increases pulmonary morbidity. Further investigation to measure pulmonary injury associated with ischemia reperfusion and intramedullary nailing in patients with multitrauma is warranted.