Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Sep 1980
Case ReportsModern concepts of external skeletal fixation of the pelvis.
The treatment of unstable pelvic ring fractures, markedly comminuted and displaced acetabular fractures and combinations of these insults to the pelvis is an unsolved problem. Of all the previously described methods, external fixation has appeared to hold the most promise for certain pelvic bone injuries of major proportions which are accompanied by instability of the pelvic ring. Many of the external fixation devices of the past have not provided adequate stability. ⋯ Complex pelvic and central acetabular fractures also are responsive to treatment by extensive external frames. While this external skeletal fixation is superior to previously available devices, internal fixation is under consideration for stabilization of the posterior portion of the pelvic ring. A combination of internal and external fixation may also be advantageous for severely disrupted pelvic bones.
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The ideal thickness of cement between the prosthesis and bone has not been accurately determined, but there is general agreement that the surgeon should be able to provide and accurately produce a certain thickness of cement between the prosthesis and the bone. Conventional cementing technique could allow the surgeon to ovepush the cup into direct contact with the bone producing a very thin cement coat or a void. We have developed a simple method of achieving a predictable thickness. ⋯ The device has been used in over 50 patients and has proven to be a simple and reliable method of allowing the surgeon to produce a predictable thickness of cement surrounding a joint replacement component. An additional benefit obtained from the use of these spacers is the ability to rigidly hold the acetabular component during polymerization of the acrylic without fear of overpushing. This allows better packing of the bone cement and prevents imperfections caused by the cup contacting the bone.
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Clin. Orthop. Relat. Res. · Sep 1980
External fixation of unstable pelvic fractures: experiences in 22 patients treated with a trapezoid compression frame.
Biomechanical experiments have shown high stability and load acceptance of the pelvis if the external device is mounted as a trapezoid compression frame. Clinical results in 22 patients with double vertical pelvic fractures illustrate the reduction of displaced pelvic fractures and the mounting of the frame. Reduction is obtained under general anesthesia within two days of the trauma. ⋯ At follow-up, the radiographic result was graded as excellent in 15 cases, good in four cases and poor in two cases. Impaired gait was recorded in two patients and persistent low back pain in one. The trapezoid compression frame is applied as soon as possible after admission of all patients with severely unstable pelvic fractures.
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Thirty-one of 738 patients with pelvic fracture (1970--1978) had open pelvic fractures. Eight per cent of all pelvic fractures due to pedestrian accidents and 12.5% due to motorcycle accidents were open. The mortality for open pelvic fractures was 42% compared with 10.3% for closed pelvic fractures. ⋯ Any drainage should be by a closed system. This procedure plus colostomy with perineal, vaginal or rectal injury should decrease septic complications. The high mortality reflects the inadequacy of current methods of treatment of open pelvic fractures.
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Carpal injuries are confusing and treacherous. Understanding the mechanisms are important in diagnosis and treatment. The mechanisms of extension, intercarpal supination and ulnar deviation can lead to most of the fractures and dislocations of the carpus and distal radius. ⋯ They start on the radial side, progress to the central carpals and end on the ulnar side. Stress roentgenographic views obtained acutely can aid in determining the type of injury present and its stability. Chronic residuals include: articular damage, carpal collapse, and contractures, intercarpal, radiocarpal and radioulnarinstability and skeletal loss or defects.