Orthopaedic review
-
This review focuses on the clinical history, diagnosis, and treatment of chronic exertional compartment syndrome (CECS) of the lower leg. Measurement of muscle compartment pressures, the most conclusive way to confirm the diagnosis, may yield significantly elevated values in CECS patients compared to normal controls. ⋯ Once a diagnosis of CECS is established, surgical decompression of the involved compartment is recommended. For as yet unknown reasons, the results of fasciotomy are almost always satisfactory in the anterior compartment and significantly less so in the posterior compartment.
-
Multicenter Study Clinical Trial
The treatment of open and/or unstable tibial fractures with an unreamed double-locked tibial nail.
A multicenter, prospective study was conducted to assess the efficacy of an unreamed, double-locked tibial nail for the acute management of open and/or unstable tibial fractures. Seventy-seven acute unstable and/or open tibial fractures in 74 patients were treated from December 1986 to February 1989. Forty fractures were closed and 37 were open; 25% occurred in polytraumatized patients and 39% of the patients had additional fractures. ⋯ Difficulty was encountered with proximal screw insertion in one third of the cases. Considering the high energy of these injuries, the treatment of open and/or unstable tibial fractures with an unreamed, double-locked tibial nail can offer the surgeon a high rate of union (97%) with minimal complications. The low infection rate found in this series indicates that this nail may be of particular benefit in the treatment of closed and select open tibial fractures.
-
Fifty patients with intertrochanteric and subtrochanteric fractures of the femur were treated with closed reduction and internal fixation with Vector intramedullary nail (Biomet Inc, Warsaw, Indiana) and lag-screw fixation. Sixty-five percent of intertrochanteric fractures were unstable, with subtrochanteric extension in 12 cases. Lag-screw fixation preceded closed, unreamed nailing. ⋯ The Vector nail has recently been introduced as an alternative form of fixation for complex proximal femur fractures. In the present study, consistently good results were obtained, despite the stability or location of the fracture. We especially recommend using the Vector nail for managing complex, unstable intertrochanteric and subtrochanteric fractures.
-
Review Case Reports
Fracture-dislocation of the ankle with fixed displacement of the fibula behind the tibia.
Fracture-dislocation of the ankle with fixed displacement of the fibula behind the tibia (Bosworth fracture-dislocation) is infrequently encountered in clinical practice. The diagnosis of this entity is often overlooked due to an inability to correlate clinical findings with roentgenographic data. The mismanagement that follows an incorrect diagnosis may render a patient permanently disabled. The authors report a case of Bosworth fracture-dislocation and describe the steps leading to proper diagnosis and treatment of this rare injury.
-
Pilon fractures are relatively rare fractures of the distal metaphysis of the tibia resulting from axial and/or rotational forces. They involve varying degrees of metaphyseal disruption, articular damage, and malleolar displacement. When severe, these injuries represent a tremendous challenge to the orthopaedic trauma surgeon. ⋯ Open reduction and internal fixation in accordance with AO/ASIF principles has greatly improved the outcome in these often disabling fractures. Surgical technique involves anatomic restoration of fibular length, reconstruction of the plafond, bond grafting of the metaphyseal defect, and buttress plating of the medial tibia. Thorough preoperative planning and meticulous surgical technique produce predictably good results in the majority of cases.