Injury
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Comparative Study
Screw fixation of the syndesmosis: a cadaver model comparing stainless steel and titanium screws and three and four cortical fixation.
We assessed syndesmotic set screw strength and fixation capacity during cyclical testing in a cadaver model simulating protected weight bearing. Sixteen fresh frozen legs with artificial syndesmotic injuries and a syndesmotic set screw made of stainless steel or titanium, inserted through three or four cortices, were axially loaded with 800 N for 225,000 cycles in a materials testing machine. The 225,000 cycles equals the number of paces taken by a person walking in a below knee plaster during 9 weeks. ⋯ This increase in tibiofibular width exceeds values described in literature for the intact syndesmosis loaded with body weight. Based on this laboratory study it is concluded that the syndesmotic set screw cannot prevent excessive syndesmotic widening when loaded with a load comparable with body weight. Therefore, we advise that patients with a syndesmotic set screw in situ should not bear weight.
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In 2002, an ice storm interrupted power to 1.3 million households in North Carolina, USA. Previous reports described storm injuries in regions with frequent winter weather. [Blindauer KM, Rubin C, Morse DL, McGeehin M. The 1996 New York blizzard: impact on noninjury visits. Am J Emerg Med 1999;17(1):23-7; Centers for Disease Control and Prevention. Community needs assessment and morbidity surveillance following an ice storm--Maine, January 1998. MMRW 1998;47(17):351-5; Daley WR, Smith A, Paz-Argandona E, Malilay J, McGeehin M. An outbreak of carbon monoxide poisoning after a major ice storm in Maine. J Emerg Med 2000;18(1):87-93; Hamilton J. Quebec's ice storm'98: "all cards wild, all rules broken" in Quebec's shell-shocked hospitals. Can Med Assoc J 1998;158(4):520-4; Hartling L, Brison RJ, Pickett W. Cluster of unintentional carbon monoxide poisonings presenting to the emergency departments in Kingston, Ontario during 'Ice Storm 98'. Can J Public Health 1998;89(6):388-90; Hartling L, Pickett W, Brison RJ. The injury experience observed in two emergency departments in Kingston, Ontario during 'ice storm 98'. Can J Public Health 1999;90(2):95-8; Houck, PM, Hampson NB. Epidemic carbon monoxide poisoning following a winter storm. J Emerg Med 1997;15(4):469-73; Lewis LM, Lasater LC. Frequency, distribution, and management of injuries due to an ice storm in a large metropolitan area. South Med J 1994;87(2):174-8; Smith RW, Nelson DR. Fractures and other injuries from falls after an ice storm. Am J Emerg Med 1998;16(1):52-5]. We postulated that injuries might differ in a region where ice storms are less common. ⋯ Injuries from storm-related damage and carbon monoxide exposure predominated. Available hyperbaric chambers were quickly filled to capacity. Hispanics experienced a disproportionate number of injuries.
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Previous studies have suggested that the lower-extremities are among the most frequently injured body regions in polytrauma patients and have a major impact on the functional recovery following polytrauma. In particular, injuries to the distal part of the lower-extremity appear to be associated with a poor functional outcome. Therefore, the goal of this study was to evaluate the impact of injuries below the knee joint on the long-term functional outcome following polytrauma. ⋯ Significantly, inferior outcomes were seen in patients with fractures below the knee joint as measured by the modified Karlström-Olerud score, Lysholm score, range of motion, weight bearing status, Hannover score for polytrauma outcome (HASPOC), SF-12, Tegner activity score, and inability to work (P < 0.05). Fractures below the knee joint have a significant impact on the functional recovery following polytrauma. We suggest that delayed treatment, thin soft tissue envelope below the knee joint, high-energy trauma, unfavorable blood supply, and complex fracture patterns contribute to these unfavorable outcomes.
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Fifty-three adults sustaining intracapsular femoral neck fractures (subcapital 38 and transcervical 15) with osteoporosis were treated primarily by osteosynthesis with valgus intertrochanteric osteotomy. Final evaluation was done in 50 patients (1 patient died and 2 lost to follow up, were not considered). Union was achieved in 47 (94%) patients in an average period of 12.2 weeks (range 10-18 weeks) with 100% union at osteotomy site. ⋯ Deep infection in 2%, superficial infection in 4%, implant penetration into the joint in 4%, limb length discrepancy in 6% and external rotation in 68% were other complications. Primary osteosynthesis with valgus intertrochanteric osteotomy is a dependable procedure to provide stable fixation in fresh fractures of the neck of femur with osteoporosis. The potential benefit of retaining a viable biologic joint justifies the usefulness of this procedure.
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To evaluate the clinical results of post traumatic complications treated by the author's own technique using an AO/ASIF conventional external fixator (without special distraction device). ⋯ The author's technique of distraction osteogenesis, using a conventional external fixator combined with a distraction rate of 1 mm/48 h (1 mm/step) adequately treated the post traumatic complications. No extra equipment was needed other than readily available AO/ASIF fixation systems. The described technique, using an AO/ASIF fixator as a lengthening apparatus was simple and cost-effective.