Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 1990
Randomized Controlled Trial Clinical TrialAntibiotic prophylaxis in lower-extremity amputations due to ischemia. A prospective, randomized trial of cephalothin versus methicillin.
The efficiency of prophylactic antibiotic therapy in amputation surgery was studied in a prospective, randomized trial of a first-generation cephalosporin (cephalothin) compared with a narrow-spectrum beta-lactam stable penicillin (methicillin). Eighty-eight patients received cephalothin 2 g X 4 on the day of operation, while 86 patients received methicillin 1 g X 4. The patients were followed up for 21 days. ⋯ The reamputation frequency was 18.2% in the cephalothin group compared with 12.8% in the methicillin group; the frequency of below-knee reamputation was 18.4% versus 7.7% (P = 0.1469). No clostridial infections were found. The study did not demonstrate any significant difference between cephalothin and methicillin in the prophylaxis for lower-extremity amputations, although the latter drug tended to be the best choice.
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The locked or unlocked intramedullary nail is considered today in most institutions the first choice for stabilisation of the majority of closed diaphyseal fractures of the femur and tibia. In 1st and 2nd degree open fractures of the tibia, the unreamed locked nail may perhaps become the preferred implant. ⋯ The plate and external fixator will remain indicated in most fractures with meta- and epiphyseal extension as well as in situations in which the intraoperative fluoroscopy is not available. Our experience with the new AO universal femur and tibia nails are being reported.
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Arch Orthop Trauma Surg · Jan 1990
Review Case ReportsBrachial artery injury in closed elbow dislocation. Case report and review of literature.
A case of elbow dislocation with injury to the brachial artery is described. The rarity of the complication makes the treatment controversial. Conservative treatment should be the first line of management of this vascular complication.
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Arch Orthop Trauma Surg · Jan 1990
Review Case ReportsOsteochondritis dissecans of the lateral tibial condyle. Report of a new case and review of the literature.
Osteochondritis dissecans (OD) of the lateral tibial condyle is a rare condition. A review of the literature revealed only nine cases in seven patients. We report about a new case. ⋯ Our case supports this theory. Although comparative roentgenograms of the left knee, taken because of complaints in the right one, were interpreted to be normal, retrospective analysis clearly revealed the lateral intercondylar eminence of the left knee to have been irregular many years before the onset of symptoms. Association with a classical OD in the contralateral knee is striking in most of the reported cases.
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The load axis of the curved proximal femur lies not inside but outside the bone. Therefore, high bending forces are acting, the medial cortex absorbing pressure and the lateral cortex absorbs tension. ⋯ This dilemma is compensated by a wave plate with bone graft: the compression forces are redirected to the lateral cortex, and the plate is again subjected to tension. Furthermore, since the plate stands away from the bone, it does not disturb the blood supply at the fracture site and thus bone healing.