Journal of orthopaedic trauma
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To report the outcomes of percutaneous autologous bone marrow injection for nonunion or delayed union of the distal tibial metaphysis in patients with prior plating. ⋯ Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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To describe the use of the saline load test (SLT) using a new definition that more adequately characterizes its use in the emergency department (ED) setting. ⋯ Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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This study was designed to evaluate risk factors of infection after bicondylar tibial plateau fractures. We hypothesized that open fractures and smoking would be associated with deep infection requiring reoperation. ⋯ Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Comparative Study
A biomechanical comparison of ipsilateral and contralateral pedicle screw placement for modified triangular osteosynthesis in unstable pelvic fractures.
Iliosacral fixation of unstable pelvic fractures does not produce enough stability to allow for immediate postoperative weight bearing. Triangular osteosynthesis creates additional resistance to vertical displacement and rotation. A disadvantage is the loss of the L5/S1 motion segment. We propose a modification of the standard triangular osteosynthesis construct in which the contralateral S1 pedicle is used. As the ipsilateral L5 pedicle is unavailable for fixation in a saw-bones composite pelvic model, we compared ipsilateral and contralateral S1 pedicle screw constructs. We hypothesized that ipsilateral and contralateral S1 pedicle screw constructs would demonstrate no difference in displacement or rotation. ⋯ Within the limitations of the current model, contralateral S1 constructs for modified triangular osteosynthesis were biomechanically equal to ipsilateral constructs in preventing displacement and superior in preventing rotation.
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Intramedullary nails with special lag screw designs may provide improved mechanical performance and alleviate clinical problems. We hypothesize that the proximal design of trochanteric nails affects mechanical performance. ⋯ The interlocking lag screw design reduced movement of the femoral head and relative movement between fracture fragments. Beyond that the trapezoidal nail design of the Intertan reduced toggling within the trochanteric area and prolonged survival. Although this study showed a decrease in the retention of stability over time, failure did not occur until the equivalent of 2-3 months of reduced physical activity in which healing may have occurred under normal clinical conditions.