Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Sep 1987
ReviewThe prevention of injury secondary to motor vehicle accidents.
Motor vehicle accidents are a common cause of death for all age groups but are the most serious threat to life for patients aged one to 34 years. Major progress has been made in reducing these losses through improved highway design, improved laws, adjudication of laws controlling the drunk driver, and the advent of vehicle safety design standards. A federal law enacted in 1966 established the National Highway Traffic Safety Administration (NHTSA) and the Federal Motor Vehicle Safety Standards (FMVSS). ⋯ Safety belts are the single most effective safety device available and are required equipment in virtually all motor vehicles sold in the United States. Passive protection for nonusers of safety belts is rapidly improving with the availability of air bags and automatic belt systems, improved windshields, steering wheels, dashboards, and seats, and other vehicle crashworthiness features. Motorcyclists, bicyclists, and pedestrians are also provided with improved protection because of the FMVSS.
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The two important fractures of the trapeziometacarpal joint are Bennett's fracture and Rolando's fracture. Bennett's fracture is a fracture-dislocation of the joint. ⋯ Rolando's fracture is a comminuted T- or Y-shaped fracture through the base of the first metacarpal. The preferred treatment is an external fixator accompanied by the tension band wiring technique.
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Clin. Orthop. Relat. Res. · Apr 1987
Comparative StudyFracture of the tibia complicated by acute compartment syndrome.
A consecutive series of 32 patients with tibia fractures complicated by compartment syndrome was treated with fasciotomy. One group was also treated with closed reduction of the fracture and cast immobilization and compared with a comparable group treated with internal fixation without case immobilization after fasciotomy. All other patients were treated with fasciotomy and reduction followed with either external skeletal fixation, pins and plaster, or skeletal traction. ⋯ Complications in both groups were similar, although one deep infection, which was resolved with appropriate treatment, occurred in the group treated with internal fixation. Six open tibia fractures were treated with external skeletal fixation after fasciotomy; the results were less satisfactory, but the initial injuries were also more severe in this group. Patients with closed tibial fractures complicated by compartment syndromes should be treated expeditiously with fasciotomy, followed by stable internal fixation.
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Clin. Orthop. Relat. Res. · Apr 1987
Case ReportsFracture-dislocation of the thoracic spine without neurologic lesion.
An 18-year-old man with a fracture-dislocation of the thoracic spine showed remarkable displacement, but without neurologic complications. The halo-femoral traction allowed a reduction, which has been only partially maintained. Despite this, the clinical result is satisfactory. The lesion appears to be more common than the few cases published in the literature would suggest.
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The winter athlete is faced with the hazards of injuries from exposure to low temperatures. Physicians who treat winter sports trauma must be prepared to manage the spectrum of these injuries including hypothermia, frostbite, and the combination of both. ⋯ Spontaneous thawing with further injury to insensitive frostbitten members and refreezing injuries give a poor prognosis. The management of hypothermia and frostbite is directed first to hypothermia to lessen mortality and second to frostbite to decrease the morbidity.