Instructional course lectures
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Treating the spectrum of bone and soft-tissue injuries that can accompany open fractures of the tibia requires experience and judgment. It appears that the non-reamed interlocking nail can safely and reproducibly stabilize most low-energy and selected high-energy open fractures of the leg. Severe open tibial fractures require a staged reconstructive protocol using external fixation as the method of bony stabilization. Differentiation between the requirements of individual injuries remains the key to successful treatment.
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Although almost any spinal deformity can occur in any skeletal dysplasia, there are specific spinal problems in each disorder that require periodic assessment and a particular awareness. Atlantoaxial instability frequently accompanies spondyloepiphyseal dysplasia congenita and Morquio's syndrome. Severe progressive kyphoscoliosis is found in diastrophic dysplasia. ⋯ The most common deformity found in skeletal dysplasias as a whole seems to be kyphosis: cervical kyphosis in diastrophic dysplasia and thoracolumbar kyphosis in achondroplasia, pseudoachondroplasia, and many of the short-stature syndromes of metabolic etiology. Spinal stenosis is extremely common in achondroplasia, both at the lumbar and cervical areas. It is important to establish the correct diagnosis early so that the orthopaedist is able to focus on the areas at highest risk of developing spinal problems, and proceed with efficacious and timely treatment.