Injury
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Reverse oblique intertrochanteric fractures have unique mechanical characteristics and are often treated with intramedullary implants. We compared the outcomes of the reconstruction trochanteric antegrade nail (TAN) with the proximal femoral nail antirotation (PFNA). Between July 2008 and February 2014, we reviewed all patients with reverse oblique intertrochanteric fractures treated at our hospital. ⋯ Implant failure was associated with the severity of fracture (AO 31. A3.3) but was not related to fracture malreduction or screw position (Tip-apex-distance). Our study suggests that the use of reconstruction system with two screws such as TAN may be more suitable implant for reverse oblique intertrochanteric hip fractures.
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The aim of this study was to identify risk factors for failure of exchange nailing for femoral diaphyseal fracture non-unions. The study cohort comprised 40 patients with femoral diaphyseal non-unions treated by exchange nailing, of which six were open injuries. The median time to exchange nailing from primary fixation was 8.4 months. ⋯ Exchange nailing is an effective treatment for aseptic femoral diaphyseal fracture non-union. However, 50% of patients undergoing exchange nailing in the presence of infection required at least one further procedure. It is important to counsel patients of this so that they can plan for it and do not consider that the first exchange operation has failed.
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The purpose of this study was to investigate the injury characteristics of medial patellofemoral ligament (MPFL), and to analyse the correlations between the injury patterns of MPFL and articular cartilage lesions of the lateral femoral condyle in adults with acute lateral patellar dislocation (LPD). ⋯ Firstly, the MPFL is most easily injured at the FEM, and secondly at the PAT in adults after acute LPD. The complete MPFL tear is more often concomitant with osteochondral lesions of the lateral femoral condyle than the partial MPFL tear. The isolated patellar-sided MPFL tear is more easily concomitant with chondral lesions and osteochondral lesions of the lateral femoral condyle than the isolated femoral-sided MPFL tear.
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The presence of a cortical fragment blocking the intramedullary canal is a challenging problem in the management of comminuted long bone fractures. Recognizing this problem and removing the cortical fragment are crucial to prevent complications from occurring. We present a simple technique to remove intramedullary fragments from within the canal to allow for safe nailing.
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Case Reports
Posterior sternoclavicular joint dislocation with brachiocephalic vein injury: a case report.
Posterior dislocation of the clavicle is an uncommon injury, usually related to road traffic or contact sports accidents. The close proximity of vital structures in the mediastinum should alert the surgeon avoiding a closed reduction in the emergency setting. ⋯ Nevertheless, the risk of developing complications is high. We report this case in order to outline one of the potential complications, to discuss appropriate imaging studies and to describe the details of a safe surgical approach.