Orthopedics
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Intramedullary nailing is one of the most convenient biological options for treating distal femoral fractures. Because the distal medulla of the femur is wider than the middle diaphysis and intramedullary nails cannot completely fill the intramedullary canal, intramedullary nailing of distal femoral fractures can be difficult when trying to obtain adequate reduction. Some different methods exist for achieving reduction. ⋯ The main purpose of using blocking screws is to achieve reduction, but they are also useful for maintaining permanent reduction. When inserting blocking screws, the screws must be placed 1 to 3 cm away from the fracture line to avoid from propagation of the fracture. When applied properly and in an adequate way, blocking screws provide an efficient solution for deformities encountered during intramedullary nailing of distal femur fractures.
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Injuries to the hand and wrist are commonly encountered in athletes. Decisions regarding the most appropriate treatment, the timing of treatment, and return to play are made while balancing desires to resume athletic activities and sound orthopedic principles. Little recognition in the literature exists regarding the need for a different approach when treating these injuries in elite athletes and the timing to return to play. ⋯ Football surgeons were more likely to recommend earlier return to protected play after thumb ulnar collateral ligament injuries, whereas basketball surgeons were less likely to recommend earlier return to protected play. This study demonstrated wide variability in how consultant hand surgeons approach the treatment of hand and wrist injuries. The findings emphasize the need to individually tailor treatment decisions to the patient's desires and demands, particularly in high-performance athletes.
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Displaced fractures of the lateral end of the clavicle are associated with an increased risk of nonunion with conservative treatment; therefore, operative treatment is recommended. Various operative treatments have been suggested, but no consensus exists regarding a gold standard for the surgical treatment of this type of fracture. The purpose of this study was to evaluate clinical and radiological outcomes using a precontoured locking compressive distal clavicular plate for Neer type II distal clavicle fractures. ⋯ The coracoclavicular distance was not significantly different between the injured and contralateral shoulders in the immediate postoperative period (P=.28) or at final follow-up (P=.35). One superficial wound infection occurred, but no major complications, such as nonunion, plate failure, secondary fracture, or deep infection, occurred. Precontoured locking compressive distal clavicular plate fixation for the treatment of displaced fractures of the lateral end of the clavicle is an acceptable surgical method with good results.
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The literature on distal humeral supracondylar fractures does not systematically define relationships between patient characteristics and the severity or complications of these injuries. This study evaluated age, sex, height, and body mass index (BMI) in relation to fracture severity and posttreatment complications in a pediatric population. The medical records of 382 pediatric patients treated for distal humeral supracondylar fractures over a 5-year period at 1 institution were included. ⋯ Taller children aged 5 to 6 years were at the greatest risk for Gartland type 3 distal humeral supracondylar fractures. Severe fractures are associated with an increased complication risk. Sex, BMI, and BMI-for-age percentile had no effect on fracture severity or complication rates.
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Case Reports
Successful treatment of concomitant ipsilateral intracapsular and extracapsular hip fractures.
Femoral neck fractures and intertrochanteric fractures often occur in elderly patients, but simultaneous ipsilateral intra- and extracapsular hip fractures are rare. Either osteosynthesis or femoral head prosthesis is performed, but careful rehabilitation is necessary because of the instability of the fracture, even postoperatively. This article describes a 76-year-old man who fell and sustained concomitant ipsilateral intra- and extracapsular hip fractures. ⋯ Sufficient fixation was obtained as a result of the molding effect of the cement stem and the tension band function of the plate. These effects collectively made it possible to achieve full weight-bearing gait immediately postoperatively. Although the intramedullary blood circulation was disturbed by the cement, periosteal blood circulation was retained by the virtue of the locking plate, which facilitated early bone union.