Orthopaedic review
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Reamed intramedullary nailing was used within 36 hours of patient admission to treat 32 consecutive femoral shaft fractures caused by low-velocity gunshot wounds. The femoral shaft fracture was classified according to the AO system, and comminution was graded according to the classification of Winquest and Hansen. Patients were followed for an average of 14.7 months (range, 6 to 36 months), and the average time to union was 18.6 weeks. ⋯ The shorter hospital stay represents potential savings of up to $9,000 per patient. Immediate intramedullary rodding is a safe, effective, and economic option for the treatment of a femoral shaft fracture caused by a low-velocity gunshot wound. However, a lack of compliance with instructions concerning weight-bearing in this patient population needs to be taken into account when planning postoperative care.
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Randomized Controlled Trial Comparative Study Clinical Trial
Rush rods versus plate osteosyntheses for unstable ankle fractures in the elderly.
Fifty patients with unstable fibular fracture were randomized into two groups. Twenty-five were treated with Rush rods and 25 with AO plates. ⋯ Full weight bearing was possible 6 weeks earlier with Rush rods than with AO plates, and there was less morbidity in the intramedullary group than in the AO group. This study indicates that Rush rods are a useful tool in elderly patients with soft bone, who are at risk for complications with plate and screw fixation.
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There are 23 cases in the literature of fracture table-induced pudendal nerve palsy. The majority of these patients had full sensory return; however, return of sexual function was unpredictable. The relevant anatomy, etiology, and incidence of this complication are discussed, and suggestions are made for its prevention.
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The saphenous nerve is the largest and longest branch of the femoral nerve. At its proximal origin, it travels with the femoral artery. ⋯ This study may benefit physicians who treat patients with knee pain of obscure etiology. It probably will have direct application to saphenous nerve injection by physicians as part of a pain-management program.
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Traumatic hip dislocations and dislocation of total hip arthroplasties are common injuries. Closed reduction of either a dislocated hip or a total hip arthroplasty can be a demanding procedure and may necessitate open reduction if unsuccessful or lead to further complications. These include fracture or neurovascular injury to the patient, as well as injury to the surgeon when reducing the hip. This article describes a technique that reliably reduces dislocations while minimizing complications.