Injury
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This study aims to identify patient and intra-operative factors that contribute to non-union in locked lateral plating for distal femoral fractures. ⋯ This review has identified multiple factors which potentially contribute to non-union including stainless steel plate material, high construct rigidity scores and purely locking screw constructs. These findings may reflect that overly rigid plating constructs can contribute to non-union. However, they should be taken in the context of heterogeneity amongst included studies, with further research necessary to support these findings.
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Common practice in orthopedic surgery is to obtain postoperative radiographs to evaluate for healing or complications. Images obtained in the post-anesthesia care unit (PACU) have not been shown to positively impact patient care. This study plans to evaluate the clinical utility and cost-effectiveness of PACU postoperative radiographs following tibial plateau open reduction and internal fixation (ORIF). ⋯ Routine postoperative radiographs following tibial plateau ORIF resulted in minimal management change patients in this series. The substantial cost of postoperative radiographs yielding little clinical utility suggests the use of routine PACU imaging following tibial plateau ORIF should be discontinued. Imaging would only be indicated in situations where intraoperative complications are suspected, thus reducing unnecessary imaging and patient cost.
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Tibial shaft fractures treated with antegrade rigid tibial intramedullary nailing has been supported worldwide. However, the optimal inlet for nailing is still controversial. Practically, varied inlets may significantly affect the tibial alignment. This retrospective study intended to utilize magnetic resonance imaging (MRI) to investigate the optimal inlet for antegrade tibial nailing. ⋯ The optimal inlet for antegrade rigid tibial intramedullary nailing may be at a site 3 mm laterally to the medial edge of the PT. There are normally no differences for the nail inlet between men and women. The PT splitting approach for nail insertion may require modification.
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The purpose of this study is to determine the biomechanical properties of the bicortical off-axis screw fixation for stabilizing of Pauwels III femoral neck fractures compared with other fixation methods. ⋯ The results of this biomechanical study show statistically significant increases in axial stiffness and ultimate failure load for the off-axis screw placed in bicortical fashion. Once the off-axis screw was positioned unicortically, the largest fracture diastasis was observed as compared to the other two methods.
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The purpose of this study is to retrospect and summarize clinical efficacy and experience of the free perforator flap base on the superficial palmar branch of the radial artery for tissue defect reconstruction in hand. ⋯ The goal of physiological reconstruction and esthetic effect can be achieved for hand tissue defect by the free SPBRA perforator flap, multiple tissues of the flap can be contained according to the defect. Even though the SPBRA is variation, arterial venous flap could be applied thanks to abundant superficial cutaneous veins.