Orthopaedic review
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Since Gerhard Kuntscher's first cloverleaf design was introduced in the early 1940s, intramedullary nail geometry has become increasingly complex. Many design changes have been introduced, and these have had profound effects upon the mechanical performance of intramedullary devices, making them more versatile. ⋯ Selection of the appropriate nail and bone-nail construct for each fracture configuration requires a knowledge of basic biomechanical principles behind nail design and the implant-host interface. Appropriate clinical application of this knowledge not only ensures the best possible intramedullary fixation of long-bone fractures, but it also aids in avoiding some of the complications that may occur.
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Sciatica can be caused by a herniated disc (compressive neuropathy) or by the process of disc degeneration (noncompressive neuropathy). Laminectomy and discectomy usually produce a good result in compressive neuropathy, whereas surgery for noncompressive neuropathy, if necessary, consists of complete excision of the disc and anterior interbody fusion, posterior fusion, or both. Noncompressive spinal radiculitis is a biochemical, not a biomechanical, problem. Phospholipase A2, substance P, and increased fibrinolytic activity have been implicated in the process.
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Compartment syndrome complicating tibial shaft fractures is a well-documented entity. However, the complication of compartment syndrome after tibial plateau fracture as described in this paper is relatively rare because of dissipation of tissue pressures into the knee-joint compartments. A thorough surgical decompression of all four compartments with continuous postoperative monitoring of compartment pressures was accomplished before the patient's fracture was stabilized. This strategy of delayed reconstruction of the tibial plateau worked well in this patient.
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In a 4-year study on stress fractures of the lower extremities in basic-training soldiers at Fort Dix, New Jersey, 1,338 stress fractures were confirmed in 1,050 soldiers from a total training population of 109,296, for an incidence of 0.96%. There were 691 men with stress fractures from a male training population of 76,237 (0.91%), and 359 women with stress fractures from a female training population of 33,059 (1.09%), with significant sexual differences in the anatomic distribution of fractures as well. Common male stress-fracture sites were the metatarsals (66%), calcaneus (20%), and lower leg (13%). ⋯ Female soldiers suffered more than twice the number of bilateral stress fractures than men. The week of onset of stress fractures during basic training varied directly with the sex of the soldier. Modifications in the physical training program aimed at eliminating continuous, high-impact activities during high-risk weeks resulted in a 12.73% drop in stress-fracture incidence (decreases of 7.32% in women and 16.19% in men).
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Complete knee dislocation is an uncommon but potentially devastating injury with a reported high rate of neurovascular injury. Treatment of this ligamentous injury is controversial. The operative (repair of all ligaments) and nonoperative management of ligament injuries appears to result in a stiff knee (decreased range of motion [ROM]), and/or a significant incidence of clinical instability and pain. We report our data on low-velocity knee dislocations and present a treatment plan of noninvasive assessment of the vascular status, a stabilizing procedure centered on posterior cruciate ligament reconstruction (PCL) and an aggressive rehabilitation program that can result in improved ROM, acceptable stability, and a more optimal functional outcome.