Journal of orthopaedic trauma
-
This report presents a retrospective review of several cases of distal fractures of the tibia and fibula with significant injury to the medial soft tissues treated either primarily or in staged fashion with fixed-angle trans-syndesmotic fixation. This fixation strategy was used in an effort to minimize further surgical trauma and implant load in the zone of soft tissue injury. Ten patients were identified between September 2002 and November 2010 who presented to a level I trauma center with fractures of the distal tibia and fibula associated with open medial wounds (9 patients) or extensive closed medial degloving injury (1 patient). ⋯ Trans-syndesmotic fixation has previously been described as providing enhanced fixation of diabetic and osteoporotic ankle fractures but has not, to our knowledge, been described for the treatment of higher energy traumatic injuries. Specifically, the valgus distal tibial fracture, frequently associated with medial traction wounds, can present challenges to the treating surgeon in terms of obtaining adequate fixation although minimizing wound complications associated with the soft tissue injury. In a select subset of injuries, trans-syndesmotic fixation can provide a viable means of obtaining and maintaining either definitive fixation or enhancing the provisional fixation supplied by spanning external fixation.
-
Randomized Controlled Trial Multicenter Study
Training femoral neck screw insertion skills to surgical trainees: computer-assisted surgery versus conventional fluoroscopic technique.
: Femoral neck fractures are among the most common orthopaedic injuries impacting the health care system. Surgical management of such fractures with cannulated screws is a commonly performed procedure. The acquisition of surgical skills necessary to perform this procedure typically involves learning on real patients with fluoroscopic guidance. This study attempts to determine if a novel computer-navigated training model improves the learning of this basic surgical skill. ⋯ The findings of this study suggest that computer navigation may be safely used to train surgical novices in a basic procedure. This model avoids using both live patients and harmful radiation without a compromise in the acquisition of a 3-dimensional technical skill.
-
The purpose of this study was to assess the impact of variations in angulation of clamp placement to hold syndesmotic reduction and how subsequent syndesmotic screw placement affects malreduction of the syndesmosis. We hypothesized that an anatomic syndesmosis reduction cannot be reliably achieved with a clamp alone; and, inaccurate placement of intraoperative clamps and trans-syndesmotic screws after reduction can malreduce the ankle syndesmosis. ⋯ Our study demonstrates that intraoperative clamping and fixation can cause statistically significant malreduction of the syndesmosis. This article should alert clinicians that clamp and screw placement can cause iatrogenic malreduction of the syndesmosis and make them aware that these dangers occur with specific clamp and screw angles in particular.
-
The aim of this study was to investigate factors influencing length of stay and mortality in first and second hip fractures. ⋯ Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
-
Supraspinatus tendon trauma may contribute to residual shoulder pain after nail fixation for proximal humeral fractures. Some have proposed a more medial starting point for humeral nail insertion to avoid cuff tendon footprint damage. We hypothesized that percutaneous nail insertion via Neviaser portal would not only be possible, but would avoid tendon trauma, while sacrificing articular cartilage. ⋯ Short, locked humeral nail insertion is possible in percutaneous fashion via Neviaser portal without tendon injury. However, successful insertion comes at the cost of articular cartilage damage.