Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Aug 1993
Bone-healing patterns affected by loading, fracture fragment stability, fracture type, and fracture site compression.
The major factors determining the mechanical milieu of a healing fracture are the rigidity of the selected fixation device, the fracture configuration, the accuracy of fracture reduction, and the amount and type of stresses occurring at the bone ends dictated by functional activity and loading at the fracture gap. Of the effects of these factors on fracture healing and remodeling in the canine tibia under unilateral external fixation, the two most significant factors in promoting periosteal callus formation were the amount of physiologic loading as dictated by the body weight and the presence of a significant fracture gap. Uniform axial loading and motion, performed at two or four weeks, did not increase callus formation but did reduce the existing fracture gap. ⋯ Intracortical new bone formation and porosity were related to the healing pattern and not to the loading magnitude. Endosteal new bone formation showed a strong correlation with the presence of a fracture gap. In terms of torsional strength and energy absorption at failure, the fractures healing through a combination of primary and secondary bone union mechanisms showed the mechanical strength of the healing bone closest to intact bone.
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Clin. Orthop. Relat. Res. · Jul 1993
ReviewThe treatment of acetabular fractures through the ilioinguinal approach.
The ilioinguinal approach was developed in 1965 as an anterior approach to the pelvis and acetabulum. Before this date, the Smith-Petersen incision or a modification of it called the iliofemoral approach provided the only access to the upper part of the anterior column of the acetabulum. In the current study of 195 acetabular fractures, the ilioinguinal approach was used alone in 178 cases (90%) and in combination with the Kocker-Langenbeck as a double incision in 17 cases (10%). ⋯ The complication rate was extremely low, without any evidence of external iliac fossa heterotopic ossification. The ilioinguinal approach provides total and complete access to the anterior column from the sacroiliac joint to the pubic symphysis. An experienced acetabular surgeon may achieve excellent results even with complex fracture patterns.
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Clin. Orthop. Relat. Res. · Jul 1993
External fixation of severely comminuted and open tibial pilon fractures.
Twenty patients with severely comminuted fractures about the ankle, either severely comminuted pilon fractures or open pilon fractures (three Grade II, seven Grade III), were managed with the use of a Delta-framed external fixator across the ankle joint. All fractures had open reduction and internal fixation (ORIF) with either screw fixation or small plates to stabilize the articular surface with minimal soft-tissue dissection. Average external fixator time was 2.5 months, and the time to union averaged 4.5 months. ⋯ Range of motion (ROM) at last follow-up observation was excellent in six patients, good in nine, fair in three, and poor in two. Two patients required ankle arthrodesis because of posttraumatic arthritis. The ROM and outcomes of the severely comminuted or open fractures of the distal intraarticular tibia were very good.
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Clin. Orthop. Relat. Res. · Jul 1993
Surgical decompression for peroneal nerve palsy after total knee arthroplasty.
Five patients were treated by operative exploration and decompression of the peroneal nerve for peroneal nerve palsy complicating total knee arthroplasty (TKA). All patients had failed to demonstrate improvement in the peroneal nerve function despite extended conservative care. The procedure was performed five to 45 months after the index TKA. ⋯ Four of five patients had full peroneal nerve recovery. All patients were able to discontinue their ankle-foot orthoses. This is a rare complication of TKA, and when conservative nonoperative measures do not lead to sufficient improvement in nerve function, consideration may be given to operative decompression of the peroneal nerve.
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Clin. Orthop. Relat. Res. · Jul 1993
Intramedullary fixation of complicated fractures of the humeral shaft.
Since 1973, a specially designed intramedullary nail has been used for fixation of humeral shaft fractures complicated by malalignment, multiple trauma, metastatic disease, radial nerve palsy, or nonunion. A series of 22 consecutive patients with good to excellent results in 20 patients (91%) is reported. ⋯ This method is advocated over routine use of compression plate and screws because incision and surgical time are both minimal, and the fracture site is not exposed in primary cases unless there is radial nerve involvement. Closed reduction remains the preferred treatment for most fractures of the humeral shaft.