Journal of orthopaedic trauma
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Review Case Reports
Pelvic and bladder trauma: a case report and subject review.
Pelvic fracture and bladder rupture resulted in bladder wall entrapment in the fracture site of a patient involved in a severe motor vehicle accident. Although hematuria and bladder rupture are known to occur after fracture of the pelvis, our literature review showed no reports of this type of injury or management. Bladder extravasation was managed with catheter drainage and surgical extraction; viscus repair was performed for the bladder rupture. Fracture healing and bladder continuity resolved uneventfully.
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Alcohol has been shown to confound the initial assessment of trauma victims, and cocaine is associated with numerous medical and anesthetic complications. A prospective study was performed to determine the prevalence of alcohol and illicit drug use in orthopedic trauma patients at an inner-city teaching hospital. All patients admitted to the orthopedic service during a 2-year period (January 1993 to December 1994) were prospectively studied. ⋯ We conclude that drug and alcohol use is widespread in patients presenting with orthopedic injuries and we make recommendations regarding treatment of these patients. The majority of orthopedic trauma resources in this setting is devoted to treating intoxicated patients. Drug and alcohol use is a major social problem and may have an adverse effect on patient care.
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Fifteen cadaveric adult bony hemipelvis specimens and 30 adult dry bone specimens were obtained to evaluate the configuration of the anterior column of the acetabulum and to develop a safe path for screw placement into it. Each cadaveric specimen was sectioned at 1-cm intervals, beginning at the level of the inferior border of the acetabulum (junction between the anteroinferior edge of the acetabulum and the most anterolateral edge of the superior ramus of the pubic bone). The plane of the cross-section was perpendicular to the anterior column. ⋯ At 3.0 cm superior to the inferior acetabular margin, these angles were found to be 20.7 +/- 4.3 degrees, 29.4 +/- 6.0 degrees, and 39.3 +/- 5.9 degrees, respectively. All of the above mentioned angles are with respect to the perpendicular of the longitudinal axis of the anterior column without violation of the hip joint. Screws placed 1.0 cm lateral to the pelvic brim at the levels of 1.0, 2.0, 3.0, and 4.0 cm superior to the inferior acetabular margin and directed perpendicular to the anterior column penetrated the hip joint.
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Fifteen fresh-frozen adult cadaver feet were dissected to investigate areas in the hindfoot where external fixation pins could be safely inserted with the least risk to underlying nerves, vessels, and tendons. Using palpable anatomic landmarks, four relative "safe zones" on the calcaneus and talus were delineated. These included an area on the medial calcaneus, the medial talus, the lateral calcaneus, and the lateral talus. ⋯ The structures most at risk for injury during pin insertion in the zones described were the medial and lateral calcaneal nerve branches, which inconsistently crossed the medial and lateral calcaneal safe zones, respectively. In these areas overlying the tuberosity, however, the subcutaneous tissues were thin, and iatrogenic nerve injury during pin insertion appeared avoidable if blunt dissection was used to reach the calcaneal cortex. The data presented here provide information to assist selection of pin sites that minimize risk to underlying soft tissues during external fixation of the talus and calcaneus.
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Comparative Study
Biomechanical study of nine different tibia locking nails.
We compared different nail types within the Bone/Implant-Complex to look for differences in stiffness for axial load, bending and torsion of the System. We simulated comminuted mid shaft fractures by a 2-cm defect osteotomy in paired human cadaver tibiae. We fixed tibiae with one of nine different interlocking nails [AO Unreamed Tibial Nail 9 mm (UTN9), AO Unreamed Tibial Nail 8 mm (UTN8), Russell & Taylor Delta Tibial Nail 9 mm (RTD), Russell & Taylor Reconstruction Tibial Nail 11 mm (RTR), Brooker & Wills Tibial Nail 11 mm (B&W), Grosse & Kempf Tibial Nail 11 mm (G&K), AO Universal Tibial Nail 11 mm (AOU), Klemm & Schellmann Tibial Nail 11 mm (K&S), and Börner & Mattheck Tibial Nail 11 mm (B-M)] according to the manufacturer's recommendations. ⋯ In axial load testing large diameter nails interlocked by large diameter interlocking bolts (G&K, K&S, B-M) showed significantly higher stiffness. For A-P bending no significant differences between implants were found, but isolated bones showed significantly higher A-P bending stiffness. In varus-valgus bending large diameter nails (RTR, G&K, K&S, B-M) showed significantly higher bending stiffness compared to low diameter (UTN8, B&W) implants.