Injury
-
Patients may be at an increased risk of atypical proximal femoral fractures with prolonged bisphosphonate use. ⋯ In this small group of patients, management of this fracture pattern can be complex with the potential for delayed or non-union and prodromal symptoms are common.
-
Ankle syndesmotic injuries are a significant source of morbidity and require anatomic reduction to optimize outcomes. Although a previous study concluded that maximal dorsiflexion during syndesmotic fixation was not required, methodologic weaknesses existed and several studies have demonstrated improved ankle dorsiflexion after removal of syndesmotic screws. The purposes of the current investigation are: (1) To assess the effect of compressive syndesmotic screw fixation on ankle dorsiflexion utilizing a controlled load and instrumentation allowing for precise measurement of motion. (2) To assess the effect of anterior & posterior syndesmotic malreduction after compressive syndesmotic screw fixation on ankle dorsiflexion. ⋯ IV.
-
Intramedullary nailing has become the standard for the treatment of long bones diaphyseal fractures. Modern techniques of locking have further enlarged the primary indications to more proximal and distal fractures relying upon a former correct alignment. ⋯ The more complex the fracture is, the more difficult its reduction, not only for the alignment of the proximal or the distal part of bone in relation to the diaphysis, but also correct rotation and length. In this paper, we analyze recommended techniques to achieve accurate bone fracture reduction, to avoid post-operative deformities combined with correct implant insertion.
-
Surgeons should aim to keep radiation exposure "As Low As Reasonably Achievable (ALARA)" during intramedullary nailing and other minimally invasive surgical procedures. This requires understanding the principles of ionizing radiation and methods for minimizing exposure risk. The main source of radiation exposure to surgical personnel during fluoroscopy is from scattered radiation. ⋯ The hands usually have the greatest dose exposure to radiation during surgical procedures, but they are far less radiosensitive than the eyes or thyroid. To minimize exposure to the hands, a surgeon should use the hands-off technique taking fluoroscopic images only when his or her hands are farthest from the radiographic field. Lead gowns, lead thyroid shields, and lead glasses, further reduces an individual's exposure to radiation.