Contemporary orthopaedics
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A retrospective review of all cases of sideswipe elbow fractures (SSEFs) treated at two community hospitals from 1982 to 1992 was conducted to determine the functional outcome of the operative treatment of SSEFs. All five injuries involved the left elbow, and they included open fractures of the olecranon, the radius and ulna, the ulna and humerus, the humerus, and traumatic amputation of the arm. ⋯ Treatment included irrigation, debridement (repeated if necessary), open reduction and internal fixation, external fixation (one case), and delayed amputation (one case). An average of 130/-10 degrees elbow flexion/extension, and 60/60 degrees supination/pronation was obtained for the three of four patients with reconstructions who returned for follow-up.
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The intramedullary hip screw is a short intramedullary nail with interlocking screws that can be used to treat subtrochanteric and intertrochanteric femur fractures. This nail, which has the biomechanical advantage of being an intramedullary appliance but can be placed percutaneously, is inserted under fluoroscopic control with the patient on a fracture table. ⋯ In an initial limited series, complication rates are comparable with existing techniques. Possible future concepts and developments are discussed.
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Contemporary orthopaedics · Sep 1991
Historical ArticleInitial experience with a second generation locking femoral nail: the Russell-Taylor reconstruction nail.
A series of 36 patients with 20 subtrochanteric fractures, 12 ipsilateral neck/shaft fractures, and five intertrochanteric fractures with shaft extension underwent closed intramedullary nailing with the Russell-Taylor reconstruction (RECON) nail. The average Injury Severity Score was 16, and seven of the fractures were open. All fractures were acute injuries, and all but one were treated within 24 hours of admission. Follow-up was obtained at three, six, nine, 12, and 24 months or until the fracture healed. The range of follow-up was one to three years. Complete follow-up was obtained in 33 of 36 patients. Union was achieved in all acute fractures. Shortening occurred in two cases and chondrolysis and avascular necrosis occurred in another patient. Excellent hip and knee range of motion were obtained except in a few cases of ipsilateral limb injuries. While many complex femoral shaft fractures can be treated successfully with first generation locking nails, this study demonstrates that second generation locking nails, such as the RECON nail, offer the added strength and design features necessary for more effective treatment of complex proximal and ipsilateral femoral neck/shaft fractures.
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Contemporary orthopaedics · Mar 1991
Sciatic nerve block for residual limb pain following below-knee amputation.
Ten adult patients with diffuse nonphantom limb pain in the residual limb following below-knee amputation underwent from one to four sciatic nerve blocks for the treatment of that pain. Amputation had been performed for peripheral vascular insufficiency in eight patients and for problems resulting from open fractures in two. None of the patients had responded to prosthetic modification, oral medication, or transcutaneous nerve stimulation for treatment of their pain. At one-year following treatment with sciatic nerve blocks as described in this report, one patient had not responded well to treatment but six patients had a resolution of their symptoms, and three had less subjective pain adequate to resume their normal daily activities.