Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Apr 1989
Comparative StudyPlaster cast versus external fixation for unstable intraarticular Colles' fractures.
This study compares 75 consecutive patients with Frykman Type VIII fractures of the distal forearm treated by primary external fixation with 32 patients who sustained similar injuries and were treated by closed reduction and cast immobilization. The latter group of patients served as an historical control. ⋯ All fractures treated with external fixation remained well reduced and aligned, whereas 88% of those treated with casts had unsatisfactory alignment despite the fact that 30% had a second reduction. The external fixator group also had superior results with respect to functional outcome, range of motion, and grip strength.
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Clin. Orthop. Relat. Res. · Apr 1989
Comparative StudyA biomechanical analysis of the Ilizarov external fixator.
Five configurations of the Ilizarov fixator were analyzed in vitro. The overall stiffness, shear stiffness, and axial motion of the fracture site were determined. The data were compared with the results of eight conventional one-half frame fixators previously tested in the same manner. ⋯ The overall stiffness and shear rigidity of the Ilizarov external fixator were similar to those of the one-half pin fixators in bending and torsion. The stability of the Ilizarov fixator was a function of bone position within the fixator rings and fixation wire tension. The use of olive stop wires increased the shear resistance of the Ilizarov system.
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Clin. Orthop. Relat. Res. · Apr 1989
ReviewThe effect of rigidity on fracture healing in external fixation.
Knowledge of the basic biomechanics of external fixation is necessary to obtain the full benefits of the technique for bone fracture treatment. The rigidity of external fixation, including pin-bone interface stresses, is discussed and bone healing and remodeling under different fixation stiffnesses and fracture gap conditions are described. ⋯ Bone union can be achieved under external fixation through different pathways, ranging from callus-free gap healing under a rigid neutralization configuration to direct-contact healing with periosteal new bone formation under axially dynamized stable fixation. Cortical reconstruction by secondary osteons seems to be important for the ultimate strength of the bone union.
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Increased lower-leg intracompartmental pressure compromising neuromuscular function within that compartment is termed compartment syndrome. This condition may be acute (often trauma induced) or chronic (usually exercise related). In a conscious, alert patient, acute compartment syndromes usually are easy to diagnose clinically; however, in the unconscious patient, a diagnostic aid such as the intracompartmental pressure monitor is useful. ⋯ Chronic compartment syndromes require dynamic pressure measurements for an accurate diagnosis. The most important parameters are elevated postexercise pressures and delayed restoration of normal compartmental pressures. Subcutaneous fasciotomy may be sufficient in accurately diagnosed cases of chronic compartment syndrome.
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Clin. Orthop. Relat. Res. · Mar 1989
Comparative StudyTreatment of open ankle fractures. Immediate internal fixation versus closed immobilization and delayed fixation.
Thirty-one open ankle fractures were treated over a period of 11 years and retrospectively reviewed with an average follow-up period of 61 months. Fifteen were managed by closed immobilization and delayed internal fixation. Sixteen were treated with immediate open reduction and internal fixation. ⋯ The fractures treated with immediate open reduction and internal fixation showed less impairment of range of motion but had a greater incidence of chronic ankle swelling. The hospitalization time was significantly shorter for the patients treated by open reduction and internal fixation. Immediate open reduction and internal fixation of open ankle fractures speed recovery with no greater incidence of infection than encountered with conservative treatment.