Injury
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Complex injuries of the foot in the paediatric population present difficult treatment challenges. While standardised protocols exist for the adult population to achieve an optimal result in the treatment of such injuries, therapy in paediatric patientsmust be managed without a firm treatment algorithm. ⋯ A complex trauma of the paediatric foot is a rare and challenging injury. Avoidance of infection, preservation of the soft tissue envelope and fracture healing will provide good functional outcome despite the severity of trauma. Long time follow-up is essential to detect complications.
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Case Reports
Computer-assisted virtual surgical procedure for acetabular fractures based on real CT data.
To develop and evaluate a computer-assisted virtual surgical procedure for preoperative planning that simulates the reduction and plate fixation for acetabular fractures based on real computed tomography (CT) data using computer softwares on personal computers. ⋯ The virtual surgical procedure for acetabular fractures is feasible and useful clinically for surgeons to determine surgical planning. It may be a valuable tool for surgeons in learning about the nature of the fracture and in formulating an appropriate surgical plan.
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We reviewed 77 patients with an acetabular fracture, treated operatively through a non-extensile approach after an average time of 45 months. The ilioinguinal approach was chosen in 41, the Kocher-Langenbeck approach in 36 patients. Following the Letournel classification, the most frequent lesions were posterior wall (26%), two-column (22.1%) and anterior column (14.3%) fractures. ⋯ In accordance with the Harris Hip Score, 29 patients achieved an excellent, 26 a good, 9 a moderate and 13 a bad result. Twenty of twenty-three (Merle d'Aubigné score) and twenty of twenty-two (Harris Hop Score) patients with moderate or bad results had one or more modifiers. Patients with operatively treated acetabular fractures, who had CT-findings such as subchondral impaction, fracture comminution or intra-articular fracture fragments in their preoperative examination, score significantly lower at middle term in the Harris Hip and Merle d'Aubigné scoring systems.
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To determine longitudinal trends in mortality, and the contribution of specific injury characteristics and treatment modalities to the risk of a fatal outcome after severe and complex pelvic trauma. ⋯ In contrast to an overall decline in trauma mortality, complex pelvic ring injuries remain associated with a significant risk of death. Awareness of this potentially life-threatening condition should be increased amongst trauma care professionals, and early management protocols need to be implemented to improve the survival prognosis.
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If distal tibia fractures cannot be treated with intramedullary nails, locking compression plates, such as the LCP Medial Distal Tibia Plate of Synthes, are used. Bridge plating with interfragmentary movement is the strategy for such osteosynthesis. Interfragmentary movement is difficult to predict. Too much movement leads to formation of more, but less stable callus; longer time until complete fracture healing has been reported. Interfragmentary movement can be controlled by the stability and flexibility of the osteosynthesis construct. We used interfragmentary screws to limit interfragmentary movement in certain cases. We noticed a tendency of faster fracture healing in patients with interfragment lag screw compared with those with sole bridge plating. We therefore retrospectively assessed our patients for time until clinical fracture healing (i.e., pain-free weight bearing and visible callus in both layers on conventional plain film radiographs) and callus formation. ⋯ Though interfragmentary screws seem to block necessary interfragmentary movement, we see callus formation as a sign of secondary fracture healing. The osteosynthesis construct with interfragmentary screw seems to be more stable and less flexible than sole bridge plating, leading to faster fracture healing. Interfragmentary screws might help to control and limit interfragmentary movement in certain cases.