Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Dec 1993
A new approach to the internal fixation of unstable pelvic fractures.
Eighteen patients with horizontally or vertically unstable pelvic fractures were operated on with a new intrapelvic technique. There were 11 horizontally unstable and seven vertically unstable pelvic ring fractures. The fractures were exposed through a low Pfannenstiel or lower midline incision combined with an incision at the iliac crest. ⋯ All fractures united. The functional recovery was uneventful in all the patients. The good results obtained in this relatively small series encourage further development of operative techniques in unstable pelvic fractures.
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Clin. Orthop. Relat. Res. · Nov 1993
Case ReportsComplex palmar dislocation of the thumb metacarpophalangeal joint. A case report demonstrating paradoxical function of the extensor pollicis longus.
Thumb metacarpophalangeal (MCP) joint dislocations are infrequent injuries, and palmar dislocations rarely occur. The following is a case report of a complex palmar dislocation of the thumb MCP joint that demonstrates the unique physical finding of paradoxical flexion of the MCP joint (and interphalangeal joint extension) in conjunction with the patient's active attempt to extend the MCP joint. ⋯ A careful clinical examination is essential for an accurate evaluation of these injuries. Thus, a satisfactory clinical outcome can be attained with strict attention to the intraoperative pathology and technique of repair.
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Clin. Orthop. Relat. Res. · Oct 1993
Comparative StudyGentamicin-impregnated polymethylmethacrylate beads compared with systemic antibiotic therapy in the treatment of chronic osteomyelitis.
A model of chronic osteomyelitis was used to evaluate the efficacy of treatment with debridement alone; debridement plus gentamicin-polymethylmethacrylate (PMMA) bead implantation; debridement plus systemic antibiotic therapy; and debridement plus systemic antibiotics and bead implantation. Debridement with the implantation of gentamicin-PMMA beads and debridement followed by systemic antibiotics were significantly more successful forms of treatment for chronic osteomyelitis than debridement alone or debridement with the implantation of PMMA beads not impregnated with antibiotics. Debridement followed by the implantation of PMMA-gentamicin beads and the use of systemic antibiotics produced the greatest success rate. Treatment with a combination of gentamicin-PMMA beads and systemic antibiotics resulted in a 100% success rate, which, although not statistically better than either treatment alone, suggests a trend.
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Clin. Orthop. Relat. Res. · Oct 1993
The role of local antibiotic therapy in the management of compound fractures.
Seven hundred four compound fractures (198 [28%] Grade I, 259 [37%] Grade II, and 247 [35%] Grade III) were treated during a seven-year period at the author's institution. One hundred fifty-seven open fractures (22%) (Group A) received systemic antibiotic prophylaxis only, whereas 547 compound fractures (78%) (Group B) were treated with local application of antibiotic beads (tobramycin) in addition to prophylaxis. Fracture grades, age, gender, fracture location, and length of follow-up period were not significantly different between the two groups. ⋯ However, by subdivision into the fracture grades, only the IIIB types had a statistically significant decrease of infection in Group B versus Group A; the wound infection rate was 39% (9/23) in Group A and 7.3% (7/96) in Group B. The rate of chronic osteomyelitis was 26% (6/23) in Group A and 6.3% (6/96) in Group B. Prophylactic use of antibiotic-laden PMMA beads in addition to systemic antibiotics was of benefit in preventing infectious complications in compound fractures, in particular in Type IIIB open fractures.
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Clin. Orthop. Relat. Res. · Aug 1993
Comparative StudyAnalysis of the external fixator pin-bone interface.
External fixator pins were inserted into tibiae of dogs under four in vivo loading conditions to examine the mechanism of pin loosening. Pins were quantitatively measured for pin torque resistance, and the pin tracts were studied radiographically and histologically. The pins holding an unstable fracture had more gross pin loosening. ⋯ Unstable external fracture fixation is another important factor in producing pin loosening. Pins loaded under unstable fracture fixation had the highest incidence of gross loosening. When applying an external fixator, the fracture rigidity should be critically evaluated and, if necessary, protected weight bearing must be introduced initially to minimize pin loosening.