Journal of orthopaedics
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Journal of orthopaedics · Jan 2020
The double muscle gastrocnemius-soleus flap in resurfacing large lower limb defects: Modifications and outcomes.
Larger soft tissue defects over critical areas of the lower limb involving the knee and proximal two thirds of the tibia present a challenge to the reconstructive surgeon. Options include a large free flap or pedicled local flaps. The gastrocnemius or soleus flap alone is not sufficient. Combined gastrocnemius-soleus flaps can be used adequately without the need to resort to free flaps. We review the use and outcomes of the combined pedicled gastrocnemius and hemi-soleus double muscle flap to cover large defects of the leg and discuss our technique. ⋯ The combined pedicled gastrocnemius and hemisoleus double muscle flap is a useful alternative for reconstruction of large critical soft tissue defects around the knee and leg.
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Journal of orthopaedics · Nov 2019
Computational modelling of forces acting on the femur in acetabular fractures: A finite element analysis study.
The rising incidence of acetabular fractures in the elderly presents an increasing surgical challenge due to patient co-morbidities, complex fracture patterns' and osteoporotic bone. Of interest in this study are those of the quadrilateral plate, which are more common in elderly patients with osteoporosis. Following such injuries, the weight-bearing surface of the femoral head moves medially. Non-operative management of these fractures can lead to the acetabulum articulating on the femoral neck increasing the risk of subsequent femoral neck fracture as a result of the altered biomechanics.Using finite element analysis (FEA) this study seeks to understand the changing biomechanics of the proximal femur in such instances and to determine if there is a threshold of femoral head medialisation that can predict probability of femoral neck fracture. ⋯ With medialisation of the femur into a fractured acetabulum there is a significant change in the stress distribution within the femoral neck. Clinically, this is indicates that patients with such injuries are at an increased risk of femoral neck fractures once they begin to mobilise after the initial injury, a devastating result. This model may be of use to treating surgeons in predicting the risk of femoral neck fracture.
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Journal of orthopaedics · Dec 2018
ReviewThe Morel-Lavallée lesion and its management: A review of the literature.
Morel-Lavallée lesions can occur in polytrauma patients. Post-operative seroma is more frequently encountered, holds many pathological similarities with MLLs and continues to challenge plastic surgeons. We aimed to provide a comprehensive overview of MLLs to increase awareness of optimum treatment options amongst plastic surgery teams, and to provide a management algorithm that may also be applied to post-operative seromas. ⋯ Our algorithm recommends avoidance of conservative management. For chronic lesions, percutaneous aspiration should not be used in isolation. Sclerodesis using doxycycline is appropriate for lesions up to 400 ml, where evidence suggests high degrees of efficacy. Larger lesions should be treated with open surgery. Quilting sutures, curettage and low suction drains are useful adjuncts. We hypothesise this algorithm would also be effective for post-operative seromas.
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Journal of orthopaedics · Jun 2018
Percutaneous pinning versus volar locking plate fixation for dorsally displaced distal radius fractures- reoperation rates over an eight year period.
To compare reoperation rates between closed reduction with percutaneous pinning (CRPP) and internal fixation with a volar locking plate (VLP) for the treatment of distal radius fractures. ⋯ Overall reoperation rates were similar between both techniques however there were differences in complication profile and nature of revision surgery. This information is useful when discussing treatment options with patients to help guide selection of the best procedure for that individual.
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Journal of orthopaedics · Mar 2018
Stress radiographs for evaluating acromioclavicular joint separations in an active-duty patient population: What have we learned?
Acromioclavicular (AC) joint separation is a common entity in athletic patient populations. The surgical treatment of these injuries varies based upon extent of injury, with numerous imaging modalities recommended to differentiate injury severity and treatment options. The use of weighted stress radiographs is controversial in the diagnostic evaluation of AC separation with previous consensus recommending against their use. No study to date has investigated the clinical utilization of diagnostic studies in the evaluation of AC joint separations in a military surgeon population. ⋯ This study identified substantial practice variation amongst military surgeons treating a relatively homogenous population with AC joint separations, reflective of a lack of definitive evidence to guide diagnosis and treatment. Overall, nonoperative management is the preferred initial approach for Type III injuries and operative treatment is the preferred initial approach for Type V injuries. The diagnostic evaluation varied across the surgeon cohort, but 87% elected against the use of weighted stress radiographs for the evaluation of AC joint separations, with only 10% relying upon them to dictate their recommended treatment. Future research identifying optimal diagnosis and treatment of AC joint separations is needed.