International orthopaedics
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Following tension band wiring of fractures of the patella, proximal K-wire migration is a common complication. To prevent this we have devised the 'self locking tension band' technique. ⋯ We have treated 15 fractures using this technique. At a mean follow up of 30 months, no postoperative complications were found.
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One hundred adolescents undergoing posterior spinal fusion for scoliosis were reviewed to assess the adequacy of postoperative patient-controlled analgesia. There were 94 females and 6 males. The mean settings for morphine dosage were a loading dose of 114.5 micrograms.kg-1, a bolus dose of 24.8 micrograms.kg-1, and a lockout interval of 9.9 minutes. ⋯ Nausea and vomiting occurred in 45% and pruritus in 15%. There were 7 cases of respiratory depression who all recovered promptly and completely. This method is associated with high morphine requirements in adolescents, but can be used safely.
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We report two cases of nonunion of subtrochanteric fractures associated with failure of fixation with a dynamic condylar screw (DCS) due to plate fracture. In both cases the nonunion was successfully treated by insertion of a reconstruction femoral nail. This implant allowed early weightbearing despite the patients' advanced age and poor bone quality. We did not perform direct bone grafting and the fractures healed without complication.
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A retrospective review of complications with the gamma nail has been carried out in 152 patients with stable and unstable pertrochanteric fractures. Operative complications occurred in 10 patients. ⋯ At follow up, pseudarthrosis was present in 2 cases and fractures of the femoral shaft in 4. The incidence of complications could be reduced by using of shorter nails, less valgus angulation and by not introducing distal screws unless essential.
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Case Reports
Fracture of the shaft of the humerus with a fracture-dislocation of the same shoulder. A case report.
We report the case of a man aged 19 who sustained an anterior dislocation of the shoulder with a fracture of the greater tuberosity, and a fracture of the shaft of the same humerus. Open reduction and internal fixation of the shaft fracture was carried out followed by closed manipulation of the dislocation. He recovered full function of the shoulder and elbow.