Journal of orthopaedic trauma
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To evaluate the results in patients with open AO/OTA type C3 pilon fractures with segmental bone loss who were treated with a standard treatment protocol. ⋯ Limb salvage in the most severe open pilon fractures is difficult. In patients with benign soft tissues at several weeks after temporary external fixation, open reduction, antibiotic bead placement, and a delayed bone grafting procedure are associated with a low complication rate and predictable fracture healing.
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Displaced intra-articular fractures of the glenoid are rare and frequently result from high-energy injuries. Types IV, V, and VI fractures have in common a fracture line which extends medially into the scapular body. ⋯ A modified posterior approach allows for the simultaneous exposure of the medial scapular border and the glenoid articular surface. An initial reduction of the medial fracture indirectly restores the scapular relationship, allowing for subsequent completion of the articular reduction via a limited approach to the posterior shoulder using the same incision.
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We designed this study to determine the usefulness of semitubular plates for acute displaced or comminuted fractures of the midclavicle. ⋯ Overall, 95% of patients were satisfied with the surgical procedure. We suggest that a semitubular plate with 4.5-mm cortical and 6.5-mm cancellous screws with wire augmentation if necessary is a reliable procedure for acute severely displaced or comminuted midclavicular fractures.
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Biomechanical and clinical studies have shown that syndesmosis screws may be indicated in repairing Weber C ankle fractures. This study sought to determine the effect of the number of cortices of screw purchase and ankle position on syndesmosis width and tibiotalar rotation in Weber C ankle fracture fixation. ⋯ Because no difference was seen between 3 or 4 cortices, it is the surgeon's choice in determining how many cortices of fixation are achieved.
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Open wounds occur with calcaneus fracture from direct application of force and from tearing along the medial side of the fracture as the tuberosity displaces laterally. Secondary soft tissue injury can also occur from pressure of the displaced fracture fragments. Tongue-type fractures of the calcaneus lead to variable amounts of displacement of the posterior tuberosity. This displacement may threaten the posterior soft tissue envelope. Because many calcaneus fractures are splinted initially and immobilized for several weeks until swelling resolves, failure to acutely recognize the potential for posterior skin breakdown may lead to severe soft tissue morbidity. The purpose of this study was to determine the incidence of posterior skin involvement in tongue-type calcaneus fractures and to determine the patient and fracture characteristics that lead to high-risk situations. ⋯ A high incidence (21%) of posterior skin compromise occurs in tongue-type calcaneus fractures. These should be treated with immediate reduction, plantarflexion splinting, and close monitoring. Although mechanism, displacement, and time to presentation were significantly correlated with posterior skin involvement, the surgeon should be aware of this potential complicating factor in all tongue-type fractures.