Clinical orthopaedics and related research
-
Clin. Orthop. Relat. Res. · Jul 1993
ReviewOpen ankle fractures. The indications for immediate open reduction and internal fixation.
Twenty-two patients with open ankle fractures or fracture-dislocations were treated with irrigation and debridement, reduction, and immediate stable internal fixation at an average of six hours from initial evaluation. There were 13 women (59%) and nine men (41%), having an average follow-up period of 32 months (range, five to 111 months). There were six Grade I (27%), 15 Grade II (68%), and one Grade III (5%) injuries. ⋯ There were four minor complications: two superficial would ulcerations, one loss of reduction requiring revision stabilization, and one distal tibiofibular synostosis. There were no deep infections or nonunions. Immediate debridement, irrigation, reduction, and internal fixation of open ankle fractures is clearly indicated in Grade I and clean Grade II open injuries.
-
Forty-three comminuted fractures of the proximal radius and ulna in 34 patients were treated with operative stabilization using AO/ASIF techniques. The patients were divided into three groups, according to the type of injury: Group I, isolated comminuted fractures of the olecranon (18 patients); Group II, isolated fractures of the radial head (eight patients); Group III, combined olecranon and radial head fractures (eight patients). All fractures were followed until union. ⋯ Each of these patients had delayed (more than 72 hours postinjury) stabilization. A functional elbow was achieved in 29 of the 32 patients who returned for follow-up examination. Operative stabilization of comminuted fractures of the proximal radius and ulna provides a stable painless joint with a functional, but not full, range of motion.
-
Transfusion of autologous blood has become increasingly important as an alternative to the use of conventional allogeneic products. Some areas of autotransfusion, like predeposit and intraoperative salvage, are well standardized and generally recommended by physicians. ⋯ Recently, reinfusion of this salvaged, unprocessed autologous blood has been widely advocated; however, reports on its quality are infrequent in the literature. This pilot study, based on sophisticated laboratory testing, describes an efficient method whereby postoperatively shed blood can be appropriately processed and returned to the patient as a relatively safe product.
-
Clin. Orthop. Relat. Res. · May 1993
Case ReportsComplicated removal of the distal locking device of Brooker-Wills.
Fractures of the femur in two women, ages 17 and 27, were treated with Brooker-Wills nails. While the distal deployment device was inserted into the nail in one patient, the tip of the driver/inserter broke into the proximal end of the distal deployment device. ⋯ In the other patient, removal of the distal locking device and the nail was complicated by inability to engage the tip of the driver inserter into the proximal end of the distal deployment device. The method described here facilitates removal of nails and the distal locks.
-
Clin. Orthop. Relat. Res. · May 1993
ReviewCompartment syndromes of the foot after calcaneal fractures.
Approximately 10% of calcaneal fractures develop compartment syndromes of the foot, and of these, one half develop clawing of the lesser toes and other foot deformities, including stiffness and neurovascular dysfunction. Tense swelling and severe pain are the hallmarks of an impending compartment syndrome. ⋯ Immediate fasciotomy is recommended to prevent the development of ischemic contracture. It is recommended that open reduction and internal fixation of a calcaneal fracture is performed on a delayed basis, after the fasciotomy wounds are closed.