Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Jul 1990
Immediate care of crush injuries and compartment syndromes with the split-thickness skin excision.
Prospective evaluation of the one-stage procedure in 32 patients who suffered from 37 severe friction-avulsion injuries was carried out. Most injuries (81%) were in the lower extremity. Split-thickness skin excision was used for immediate diagnosis of flap vascularity and wound coverage. ⋯ The split-thickness skin excision is effective in the establishment of debridement borders and helps in saving maximal viable flap area (49.4%). All wounds healed with no major wound complications. The split-thickness skin excision can be used immediately in the care of severe crush injuries, compartment syndromes, and open fractures as a one-stage procedure with the following advantages: (1) reliable diagnosis of flap vascularity, (2) immediate wound coverage with the possibility of drainage, (3) elimination of further debridements procedures, (4) elimination of distant skin donor wounds, and (5) less hospitalization.
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Clin. Orthop. Relat. Res. · Jul 1990
Review Case ReportsThe Judet quadricepsplasty for management of severe posttraumatic extension contracture of the knee. A report of a bilateral case and review of the literature.
Extension contracture of the knee is an increasingly recognized complication of severe femur fracture. Traditional management by Thompson quadricepsplasty may result in a variable return of knee flexion and the possibility of significant extension lag. The Judet technique of quadricepsplasty offers the advantages of a controlled, sequential release of the components limiting knee flexion and a reduced potential for iatrogenic quadriceps rupture or extension lag. Judet quadricepsplasty corrected severe bilateral extension contractures with excellent results at 17 months postoperatively in a 29-year-old man.
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Clin. Orthop. Relat. Res. · Jun 1990
Review Case ReportsBosworth fracture-dislocation of the ankle. A case report and review of the literature.
The Bosworth fracture-dislocation is a rare fracture-dislocation of the ankle where the proximal fibular fragment lodges behind the tibia, rendering it irreducible by routine closed manipulations. Clinically the patient's foot is in severe external rotation. ⋯ If properly recognized, these injuries can be successfully treated by closed or open techniques with return of near-normal ankle function. The problem is illustrated in a case involving a 40-year-old woman, as related to a review of the literature and discussion of the treatment rationale.
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Clin. Orthop. Relat. Res. · May 1990
Colonic pseudoobstruction associated with patient-controlled analgesia after total joint arthroplasty.
Patient-controlled analgesia (PCA) is a concept that permits patients to administer a prescribed dose of narcotic to themselves when they experience pain. Six patients developed colonic pseudoobstruction after the use of morphine sulfate administered via a PCA infuser. Early recognition and prompt treatment make this a transient, reversible illness. Treatment includes discontinuing the use of the PCA morphine, eliminating oral intake, ensuring adequate hydration and electrolyte balance, placing a nasogastric tube, rolling the patient, and closely observing for signs and symptoms of worsening colonic distention and possible rupture.
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Clin. Orthop. Relat. Res. · Apr 1990
Case ReportsAnterior dislocation of the hip associated with fracture of the ipsilateral greater trochanter. A case report.
A 22-year-old male motorcyclist fell from a height and sustained an obturator hip dislocation with concomitant fracture of the ipsilateral greater trochanter. The immediate reduction of the dislocation associated with open reduction of the fracture of the greater trochanter showed excellent results at the short-term and long-term follow-up examinations. This extremely rare hip injury seems not to have been previously reported in the literature.