Injury
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Ischemia reperfusion (IR) injury occurs when tissue is reperfused following a period of ischemia, and results from acute inflammation involving various mechanisms. IR injury can occur following a range of circumstances, ranging from a seemingly minor condition to major trauma. ⋯ There are many factors which influence the outcome of these injuries, and it is important for clinicians to understand IR injury in order to minimize patient morbidity and mortality. In this paper, we review the pathophysiology, the effects of IR injury in skeletal muscle, and the associated clinical conditions; compartment syndrome, crush syndrome, and vascular injuries.
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Ankle syndesmotic injuries are complex and require anatomic reduction and fixation. Tightrope fixation is a relatively new technique and we present the largest series of syndesmosis fixation using Arthrex Tightrope™ (Naples, FL, USA). ⋯ Arthrex Tightrope™ provides an effective method of syndesmosis stabilisation, which obviates the need for routine removal of implant and facilitates dynamic stabilisation. The results of this study are satisfactory and comparable to previously reported studies. We emphasise that surgeons must be aware of the potential risk of soft-tissue complications and recommend our modified technique. Further long-term prospective studies should be carried out to resolve this issue.
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A sliding hip screw (SHS) is currently the treatment of choice for trochanteric hip fractures, largely due to the low incidence of complications. An alternative treatment is the use of intramedullary proximal femoral nails. Unfortunately these implants have been associated with a risk of later fracture around the implant. The aim of this study was to see if any improvements have been made to the current intramedullary nails, to reduce the incidence of secondary fracture around the distal tip of the nail. ⋯ Secondary fracture around a proximal femoral nail is one of the most significant of fracture healing complications, and this study suggests that continuing design changes to this method of fixation has reduced the risk of this complication occurring.
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Review
Evolving concepts of stability and intramedullary fixation of intertrochanteric fractures--a review.
Intramedullary nailing is gradually emerging as the treatment of choice for pertrochanteric femoral fractures. Nevertheless, prospective randomised trials have failed to demonstrate the assumed superiority of cephalomedullary nails over the traditional treatment with the sliding hip screw. On the contrary, the gamma nail has been implicated in predisposing to secondary femoral fractures, although this seems to be rectified by newer techniques and nail designs. ⋯ Nails seem to prevent failure by opposing the uncontrollable medialisation, and eventual failure, that occurs under these circumstances. The importance of the size of the proximal fracture fragment has not yet been elucidated. Nail fixation is, thus, mandatory in a small percentage of grossly unstable fractures, whose characteristics are still undergoing definition.
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There is little information available about the epidemiology of open fractures. We examined 2386 open fractures over a 15-year period analysing the incidence and severity of the fractures. ⋯ The distribution curves of many open fractures are different to the overall fracture distribution curves with high-energy open fractures being commoner in younger males and low energy open fractures in older females. The mode of injury and the different demographic characteristics between isolated and multiple open fractures are also discussed.