Journal of orthopaedic trauma
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Superomedial impaction of the anterior dome of the acetabulum is a known risk factor for poor outcomes after open reduction and internal fixation of acetabular fractures. The authors, using the anterior intrapelvic (modified Stoppa) approach to the acetabulum, describe a novel technique to help reduce and stabilize marginal impaction of the acetabular dome. In the senior author's experience, this technique has been helpful to achieve adequate reduction and stabilization.
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To investigate the clinical and radiologic outcomes in elderly patients suffering from an acetabular fracture operated with an acute primary acetabular reinforcement ring, autologous bone graft, and a total hip arthroplasty (THA). ⋯ Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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According to the classification of Lauge-Hansen, supination-external rotation IV (OTA 44-B) injuries should not have syndesmotic instability; yet, several studies have suggested disruption is present in up to 40% of these injuries based on stress tests. In this study, we examine various stress radiographic parameters in a cadaver model of supination-external rotation IV equivalent injury. We hypothesize that external rotation stress testing and widening of the medial clear space do not always represent syndesmotic instability. Rather, the better predictor of syndesmotic instability will be an increased tibia-fibula clear space with the lateral stress test. ⋯ Lateral stress test with widening of the tibiofibular clear space is the preferred indicator of syndesmotic instability. The external rotation stress is a poor indicator of syndesmotic injury in the setting of deltoid ligament injury.
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Inlet and outlet views are essential in the evaluation of patients with pelvic injuries. The optimal angles that should be used to obtain these views are still debated. ⋯ This study demonstrated that the ideal angle to obtain inlet views should be approximately 25 degrees and to obtain outlet views should be approximately 45 degrees during screening x-rays to evaluate patients who were diagnosed with pelvic injuries. Application of these new values in the clinical practice would provide higher rates of adequate studies and further prospective clinical studies should be performed to validate these parameters.
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To examine the impact of preoperative coronal plane deformity on functional and radiographic outcomes on endosteal strut augmentation of proximal humerus fracture fixation. ⋯ Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.