Bulletin (Hospital for Joint Diseases (New York, N.Y.))
-
A 74-year-old male involved in a pedestrian-automobile collision sustained a comminuted supracondylar-diaphyseal femur fracture. The fracture was stabilized by retrograde intramedullary fixation with a Synthes unreamed tibial nail. ⋯ Twelve months after his injury, his knee motion was symmetric to his uninjured side and he had resumed full preinjury activities, including martial arts training. Although antegrade intramedullary nailing remains the treatment of choice for fractures of the femur, this case highlights the usefulness of retrograde nailing and demonstrates the adjunctive application of an existing implant, the tibial nail, in certain special trauma situations.
-
Review Case Reports
Intramedullary nailing after external fixation of the tibia.
Intramedullary nailing after external fixation of fractures of the tibia has high complication rates including nonunion and infection. The authors review the literature regarding this technique and refine the indications for secondary IM nailing. The report distinguishes between sequential secondary nailing and reconstructive secondary nailing. ⋯ The authors conclude that when done by protocol sequential IM nailing is safe and effective. Reconstructive IM nailing, however, has strict contraindications that include: a history of or an active infection of the pin tract, wound, or bone; the presence of an open wound or pin tract; and the presence of a ring or halo sequestrum. Yet reconstructive secondary procedures can be effective in healthy individuals if the soft tissue envelope is completely reestablished, if antibiotics are administered preoperatively, and the nail is placed without reaming.
-
Review Case Reports
Scapular osteochondroma presenting with exostosis bursata.
A 33-year-old male presented with acute onset of scapular winging following an injury to the shoulder girdle. A scapular osteochondroma was identified radiographically that was completely asymptomatic until the time of injury. Clinical presentation included the presence of a large exostosis bursata. Surgical resection of the osteochondroma resulted in resolution of all signs and symptoms.