Injury
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The purpose of this biomechanical study was to assess the capacity of dynamic and locking compression plates (DCP and LCP) in improving fracture compression through the use of multiple compression screws, and the effect of alternating their placement between the two sides of the fracture compared with placing them all on one side. The study also compared fracture compression between DCP and LCP, and between the loading and universal drill guides in DCP. ⋯ Fracture compression can be improved either using multiple eccentrically placed screws alternated between the two sides of the plate in LCP and DCP, or by the use of a universal drill guide in DCP. Although the compression hole in the LCP is shorter, it generates compression comparable to the DCP.
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The biomechanical effect of indirect weight loading with the Ilizarov ring fixator using a weight-bearing platform has not yet been investigated. The problem of wire loosening and breakage occurs more frequently when patients are mobilised with a weight-bearing platform. Therefore, the aim of this research was to compare the influence of direct and indirect weight loading on the tensioned wires. ⋯ There is a substantial change in the biomechanical characteristics of the Ilizarov ring fixator when mobilising a patient with a weight-bearing platform. The considerable higher mechanical stress on the wires needs to be considered when patients are mobilised with a weight-bearing platform.
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Previous studies have demonstrated the need for accurate reduction of ankle syndesmosis. Measurement of syndesmosis is difficult on plain radiographs. A computed tomography (CT) scan allows better visualisation of the transverse relationship between the fibula and incisura fibularis. ⋯ However, if a standard value of G (2mm) was used for the injured leg only, all of the 19 cases would have abnormal values of 'G' following reduction. Our study has clearly demonstrated the need for individualising the assessment method to guide surgeons and radiologists prior to revision surgery. A standard value of 'G' of 2mm as the normal limit cannot be applied universally, as apparent from the data presented in this study.
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The use of ring fixators in lower limb reconstruction and deformity correction both for trauma and elective procedures is now widespread. The long course of treatment requires regular outpatient review with frequent radiological imaging to assess the progression of treatment and plan correctional adjustment. Following publication of a technique using a frame mounted spirit-level to aid radiographers in accurately aligning the limb for optimal imaging we implemented a similar technique in our department and carried out a two part prospective comparative study to assess the impact on radiograph quality. ⋯ A significant reduction in the number of inadequate images being taken, with a subsequent reduction in patients requiring return to the radiology department for re-imaging and then re-review in clinic, has clear implications for patients, clinicians and hospital efficiency. The patient journey time is reduced, less time and fewer resources are used in the radiology department and patients in clinic are seen more efficiently and with less wasted time. We conclude that the implementation of a simple frame mounted spirit-level as a guide for radiographers in the outpatient clinic significantly reduces the number of suboptimal and wasted images taken in the assessment of patients being treated by ring fixator.