Clinical orthopaedics and related research
-
Ipsilateral femoral neck and shaft fractures occur in 2.5% to 6% of femur fractures. The injury results from high energy trauma. Victims are usually young, with multiple associated injuries. ⋯ Union rate of the neck is high and related to stable, anatomic reduction. The timing of operative fixation often is dictated by the patient's status as a multiple trauma victim, but a delay of days to weeks in the fixation of the neck fracture does not seem to increase the complication rate. The goal of any treatment plan should be anatomic reduction of the neck fracture, and stable fixation of both fractures, so that the patient can be mobilized.
-
Clin. Orthop. Relat. Res. · Aug 1995
Case ReportsMaisonneuve fracture with an associated distal fibular fracture. A case report.
A 46-year-old woman had a severe torsional injury to her left leg. Admission radiographs showed a proximal Maisonneuve-type fibular fracture with an associated distal fibular fracture at the level of the distal tibiofibular syndesmosis. A complete syndesmotic disruption, proximal and distal to the distal fibular fracture, was verified at surgical exploration as was a complete deltoid ligament tear. ⋯ At 1-year followup, the patient reported normal ankle function. This case represents an unusual, and perhaps previously undescribed, variant of the so-called Maisonneuve fracture. The need for careful evaluation of the entire leg in torsional injuries of the ankle is underscored by the injury presented.
-
Pyomyositis appears to be increasing in prevalence in temperate climates, and often the orthopaedist is integral in the decision making and care of these patients. This is the first reported case of spontaneous bacterial pyomyositis involving the obturator internus muscle. Deep pelvic infections involving the psoas, iliacus, piriformis, and obturator internus can be a significant cause of morbidity and mortality. ⋯ Because of the pathology's deep location within the pelvis of the patient described here, all 3 tests were integral in the surgical planning, exposure, and proper diagnosis. Although 95% of pyomyositis cases are caused by Staphylococcus aureus, cases of pyomyositis with negative cultures have been described. Consideration should be made of disseminated Neisseria gonorrhoeae in sexually active individuals, and cultures should include Thayer-Martin agar to decrease the likelihood of a false-negative culture result.
-
Clin. Orthop. Relat. Res. · Jul 1995
Gluteoperineal gangrene and sciatic nerve palsy after umbilical vessel injection.
Thirteen patients with gluteoperineal necrosis of the skin and subcutaneous tissue without muscle involvement associated with palsy of the peroneal branch of the sciatic nerve were examined at the authors' institution. This syndrome was a complication after umbilical vessel catheterization for injection of medications mainly for respiratory distress and apnea. Skin and subcutaneous damaged tissues required debridement without sedation or anesthesia. ⋯ Surgery was required only to correct the deformity of the foot secondary to muscular deficits. In this series, the final results of the muscles involved secondary to nerve palsy were good in 4 patients, fair in 6, and poor in 3. No excellent result was noted.
-
Clin. Orthop. Relat. Res. · Jun 1995
Comparative StudyCost effectiveness of intraoperative autotransfusion in total hip arthroplasty surgery.
The purpose of this study was to analyze the cost effectiveness of the cell saver in reducing homologous blood transfusion requirements in patients undergoing primary total hip arthroplasties. In patients who had predonated autologous blood, the addition of the cell saver neither reduced the homologous blood requirements nor the percentage of patients exposed to banked blood. In patients without predonated autologous blood, the cell saver decreased the percentage of patients exposed to banked blood by 40% and decreased the mean homologous transfusion requirement from 2.6 to 1.5 units per patient (p < 0.05). ⋯ This analysis is confounded by the risk of exposure to blood borne potentially life-threatening pathogens. In patients undergoing elective primary hip arthroplasty, the availability of predonated autologous blood obviates the need for expensive intraoperative blood salvage techniques. If an adequate volume of autologous blood cannot be procured preoperatively, or if the clinician suspects excessive intraoperative bleeding, then using the cell saver may be justified.