Orthopedics
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This article presents a rare case of simultaneous triple joint injuries in the same digit. A 54-year-old, right-handed man sustained simultaneous triple joint injuries in a digit, composed of a fracture of the dorsal base of the distal phalanx involving one-third of the phalanx, dorsal dislocation of the proximal interphalangeal joint with a volar plate fracture, and ulnal dislocation of the metacarpophalangeal joint. Surgery was performed on the patient. ⋯ This hyperextension may result in a tear of the volar plate of the proximal interphalangeal joint, leading to a dislocation at that joint. This continuous force directs the metacarpophalangeal joint in a slight ulnal shift, and may result in rupture of the medial collateral ligament in the metacarpophalangeal joint. To our knowledge, this injury has not been reported in the literature.
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Controlled Clinical Trial
Surgical treatment of midclavicular fractures in the elderly: a comparison of locking and nonlocking plates.
Operative treatment of midclavicular fractures in patients older than 60 years poses an increased risk of fixation failure. Although plating of midclavicular fractures in the elderly is still a popular fixation method, osteopenic bone may result in plate loosening and fixation failure. The purpose of this study is to prospectively evaluate and compare the clinical outcomes of midclavicular fractures in patients older than 60 years who are treated with either a locking compression plate or nonlocking plate. ⋯ However, the locking compression plate group had lower complication rates compared to the nonlocking plate group (P=.087). In addition, the locking compression plate group had higher rates of return to work and exercise (P=.02, P=.016, respectively). If surgery of elderly patients with midclavicular fractures is indicated, internal fixation with a locking compression plate is preferable to a nonlocking plate.
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Minimally invasive spine surgery is evolving rapidly. Compared with the traditional posterior approach with long and wide exposure, the minimally invasive approach offers significant advantages in treating patients with spine trauma.
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The beach chair position is commonly used in both arthroscopic and open shoulder procedures. There has been recent concern that beach chair positioning may be an independent risk factor for intraoperative cerebrovascular insult, especially in concert with hypotensive anesthesia. We attempted to quantify the prevalence of intraoperative cerebrovascular events during shoulder surgery in the beach chair position. ⋯ The rate in the beach chair position ranged from 0.00382% (8/209,628) to 0.00461% (8/173,370). If reported primary patient position was used > or = 75% of the time, no significant difference in observed cerebrovascular event rates was found between positions (P=.051-.0233). In relation to orthopedic procedures performed in the supine position, beach chair positioning does not appear to increase the risk of intraoperative cerebrovascular event.
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Acute compartment syndrome of the thigh is rare due to the space's ability to accommodate large volumes of fluid and, with the exception of the lateral septum, its thin compliant linings. This article describes a case of bilateral exercise-induced severe compartment syndrome treated with anterior and posterior fasciotomies. A 29-year-old man was admitted to intensive care with myoglobinuria. ⋯ At 6-month follow-up, he ambulated with the assistance of a left ankle foot orthosis. Acute severe compartment syndrome can occur following vigorous exercise. We recommend fasciotomies after exercise-induced acute compartment syndrome rather than initial observation because of the severity of morbidity associated with undertreated compartment syndrome.