Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Jan 1997
Case ReportsAnatomic considerations for a modified posterior approach to the scapula.
A modified posterior approach to the scapula was tested on 20 cadavers. The approach also was used in 2 cases with fractures involving the scapular neck and glenoid fossa. The incision is C shaped, with the convexity directed toward the lateral angle of the scapula. ⋯ The circumflex scapular artery is protected at the lateral border of the scapula at an average of 2.8 +/- 0.5 cm from the inferior glenoid margin. The axillary nerve is protected inferior to the teres minor. However, care should be taken not to excessively retract the teres minor because the nerve lies in close proximity to the shoulder joint capsule.
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From the earliest times, medical practitioners have sought divine help and support to aid them as they go about their busy rounds. In the early Christian era, 4 individuals were singled out as patron saints of medicine, and particularly of physicians and surgeons. ⋯ They were the Apostle Luke, Saints Cosmas and Damian and Saint Panteleimon. Through the centuries, they have served as worthy role models for the physicians who have invoked their aide.
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Clin. Orthop. Relat. Res. · Jan 1997
Analgesia for emergency centers' orthopaedic patients: does an ethnic bias exist?
Several prior studies have demonstrated that Hispanics treated in some emergency centers were prescribed less analgesia than white patients with similar extremity trauma. The purpose of this study was to determine if other institutions had a similar experience with regard to undermedication of certain ethnic groups. Two cohorts were studied, 1 adult and 1 pediatric group. ⋯ The pediatric group consisted of 63 children younger than 16 years, seen between January 1, 1992, and April 30, 1993, with isolated distal radius or ulna fractures requiring a closed reduction. Results indicated that Hispanics were not likely to be undermedicated for fracture reduction in this level I trauma emergency center compared with whites. It is thought that a hospital with a larger populations of underrepresented minorities may be more sensitive than other private institutions.
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Clin. Orthop. Relat. Res. · Nov 1996
Fixation of segmental subtrochanteric fractures. A biomechanical study.
Segmental subtrochanteric fractures have been associated with high rates of malunion, nonunion, and implant failure. Although the use of second generation intramedullary nails with proximal interlocking in the femoral head has been advocated for these fractures, shaft fractures at the tip of short second generation intramedullary rod nails in clinical studies raise concerns about the mechanical suitability of these implants. No biomechanical data are available on the strength of fixation and mode of failure of these newer implants. ⋯ The failure modes for the implants were: screw cut out of the femoral head for the reconstruction nail; fracture of the femoral shaft for the short intramedullary hip screw, and implant bending for the long intramedullary hip screw. This study suggests that the reconstruction nail is the superior implant for segmental subtrochanteric fractures of those tested. Implant bending and shaft fractures at lower loads make the 2 intramedullary rod hip screw implants less suitable.
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Clin. Orthop. Relat. Res. · Nov 1996
Review Case ReportsArthroscopy assisted operative management of tibial plateau fractures.
In recent years the treatment of fractures has evolved from extensive open reduction and internal fixation to minimally invasive surgery and biologically benign internal fixation. The ultimate goal of treatment for tibial plateau fractures is to prevent the late development of degenerative osteoarthritis. Surgery is often required to restore joint congruity and alignment, to stabilize the knee, and to allow early joint motion. ⋯ Arthroscopic reduction and internal fixation offers the advantage of direct visualization of the fracture and its subsequent reduction without a formal arthrotomy or detachment of the anterior horn of the lateral meniscus. Not all types of fractures are amenable to arthroscopic reduction and internal fixation, such as severe bicondylar fractures. This technique is now evolving and some Schatzker Type 6 fractures have been treated with traction on the fracture table, arthroscopy assisted reduction, limited internal fixation of the articular surface, followed by rigid external fixation.