Development and validation of a delayed presenting clubfoot score to predict the response to Ponseti casting for children aged 2 –10
AbstractThe aim of the study was to develop a simple and reliable clinical scoring system for delayed presenting clubfeet and assess how this score predicts the response to Ponseti casting. We measured all elements of the Dim églio and the Pirani scoring systems. To determine which aspects were useful in assessing children with delayed presenting clubfeet, 4 assessors examined 42 feet (28 patients) between the ages of 2–10 years. Selected variables demonstrating good agreement were combined to make a novel score and were assessed prospectively on a separate consecutive cohort of children with clubfeet age...
Source: Strategies in Trauma and Limb Reconstruction - November 15, 2018 Category: Orthopaedics Source Type: research

Uniting the un-united: should established non-unions of femoral shaft fractures initially treated with IM nails be treated by plate augmentation instead of exchange IM nailing? A systematic review
AbstractThe majority of femoral fractures are surgically treated with intramedullary nails. Non-union rate is low but challenging and costly if it occurs. There have been encouraging results from the use of augmentative plating as a treatment for non-union of femoral fractures. We performed a systematic review of the literature to compare union rates, time to union and complications between exchange nailing and augmentative plating as a primary procedure following a diagnosis of femoral non-union following initial nailing. We found a total of 21 papers, which found the mean union rate of augmentative plating to be 99.8% co...
Source: Strategies in Trauma and Limb Reconstruction - November 13, 2018 Category: Orthopaedics Source Type: research

Unusual case of complex fracture dislocation of the elbow
(Source: Strategies in Trauma and Limb Reconstruction)
Source: Strategies in Trauma and Limb Reconstruction - November 12, 2018 Category: Orthopaedics Source Type: research

Surgical therapy of benign and low-grade malignant intramedullary chondroid lesions of the distal femur: intralesional resection and bone cement filling with or without osteosynthesis
This study may help guide surgeons to avoid overtreatment with additional osteosynthe sis after curettage and bone cement filling of intramedullary lesions of the distal femur. Meta-epiphyseal lesions will need additional osteosynthesis rarely, contrary to diaphyseal lesions with considerable cortical thinning. (Source: Strategies in Trauma and Limb Reconstruction)
Source: Strategies in Trauma and Limb Reconstruction - November 3, 2018 Category: Orthopaedics Source Type: research

Distally based anterolateral thigh flap: an underutilized option for peri-patellar wound coverage
In this report, both a single-centre experience using distally based anterolateral thigh (ALT) island flaps for supra-patellar wound coverage and the existing literature on this topic were reviewed. A systematic literature review was performed to assess the use of the ALT for peri-patellar wounds. Five patients with a mean age of 69 underwent a distally based ALT flap for coverage of peri-patellar defects. Four out of 5 flaps survived at the end of their respective follow-up. Based on this combined experience, the distally based reverse-flow anterolateral thigh island flap represents a useful but relatively underutilized o...
Source: Strategies in Trauma and Limb Reconstruction - October 1, 2018 Category: Orthopaedics Source Type: research

Use of flexible intramedullary nailing in combination with an external fixator for a postoperative defect and pseudarthrosis of femur in a girl with osteogenesis imperfecta type VIII: a case report
This article presents a case report of operative treatment in a 9-year-old girl affected with OI type VIII complicated with postoperative defect and pseudarthrosis of the femur causing functional impairment with loss of walking ability. A combination of intramedullary flexible nailing and minimal external fixation was applied for treatment of femoral defect-pseudarthrosis in a girl of 9  years with OI type VIII. Intramedullary and extramedullary nails with wrapping of titanium nickel mesh subperiosteally provided osteosynthesis and deformity correction of the tibia of a small intramedullary canal diameter. Upright sta...
Source: Strategies in Trauma and Limb Reconstruction - September 29, 2018 Category: Orthopaedics Source Type: research

Two consecutive limb lengthenings with the same PRECICE nail: a technical note
ConclusionThis technique utilizes the principles and advantages of lengthening over an magnetic lengthening nail, avoids the necessity of nail removal and minimizes the complication rates and the overall time for complete recovery.Level of evidenceLevel IV. (Source: Strategies in Trauma and Limb Reconstruction)
Source: Strategies in Trauma and Limb Reconstruction - September 19, 2018 Category: Orthopaedics Source Type: research

Effect of external fixation rod coupling in computed tomography
AbstractExternal fixation is a common tool in the treatment of complex fractures, correction of limb deformity, and salvage arthrodesis. These devices typically incorporate radio-opaque metal rods/struts connected at varying distances and orientations between rings. Whilst the predominant imaging modality is plain film radiology, computed tomography (CT) may be performed in order for the surgeon to make a more confident clinical decision (e.g. timing of frame removal, assessment of degree of arthrodesis). We used a fractured sheep leg to systematically assess CT imaging performance with a Discovery CT750 HD CT scanner (GE ...
Source: Strategies in Trauma and Limb Reconstruction - September 15, 2018 Category: Orthopaedics Source Type: research

Transverse debridement and acute shortening followed by distraction histogenesis in the treatment of open tibial fractures with bone and soft tissue loss
AbstractThis retrospective case series evaluates the technique of transverse debridement, acute shortening and subsequent distraction histogenesis in the management of open tibial fractures with bone and soft tissue loss, thereby avoiding the need for a soft tissue flap to cover the wound. Thirty-one patients with Gustilo grade III open tibial fractures between 2001 and 2011 were initially managed with transverse wound extensions, debridement and shortening to provide bony apposition and allowing primary wound closure without tension, or coverage with mobilization of soft tissue and split skin graft. Temporary monolateral ...
Source: Strategies in Trauma and Limb Reconstruction - September 11, 2018 Category: Orthopaedics Source Type: research

Rehabilitation post-distraction osteogenesis for brachymetacarpia: a case report
We present a case report describing the hand rehabilitation program of a 13-year-old girl with congenital brachymetacarpia who underwent distraction osteogenesis of the third metacarpal. Intense weekly hand therapy including desensitization, scar massage, range of motion exercises and splinting was essential up to 28  weeks postoperatively to address the progressive changes in the anatomical structures. At final follow-up, she had full active range of motion, no functional deficits in grasp or in-hand manipulation skills and resumed her participation in competitive baton twirling. Patient and family satisfactio n with...
Source: Strategies in Trauma and Limb Reconstruction - August 29, 2018 Category: Orthopaedics Source Type: research

Measurement of wire deflection on loading may indicate union in Ilizarov constructs, an in vitro model
This study aimed to test a method for assessing wire deflection within an Ilizarov frame. (1) To assess the repeatability of our novel measurement method in measuring wire deflection within an Ilizarov frame in vitro. (2) To compare the amount of wire deflection in an unstable model with that in an intact bone model. (3) To assess accuracy of this method by comparing wire deflection measured with overall machine extension. Tests were performed on clinical grade-tensioned fine wire 4-ring Ilizarov constructs stabilising a simulated fracture, with and without an unstable defect. Models were sequentially loaded to 700  N...
Source: Strategies in Trauma and Limb Reconstruction - August 1, 2018 Category: Orthopaedics Source Type: research

Role of ultrasound in detection of radiolucent foreign bodies in extremities
AbstractRemoval of foreign bodies from soft tissues in emergency is very challenging and becomes more problematic when it is radiolucent. Blind exploration is sometimes hazardous for patients especially when it is in proximity to a vessel or a nerve or an overlying tendon. The purpose of this study was to determine the accuracy of ultrasonography (USG) in detecting radiolucent soft tissue foreign bodies in the extremities. From January 2014 to January 2016, 120 patients with either a positive history or clinically suspected soft tissue foreign body and negative radiography were evaluated by USG with a high-frequency (13 &n...
Source: Strategies in Trauma and Limb Reconstruction - August 1, 2018 Category: Orthopaedics Source Type: research

The Resolution Axis Method (RAM) for lengthening of the femur with or without associated frontal plane deformity (a new method)
ConclusionThe Resolution Axis Method is a new and alternative method providing a solution for planning when lengthening the femur along the anatomical axis using an IM nail, whether a deformity is present or not. (Source: Strategies in Trauma and Limb Reconstruction)
Source: Strategies in Trauma and Limb Reconstruction - August 1, 2018 Category: Orthopaedics Source Type: research

Distraction arthroplasty compared to other cartilage preservation procedures in patients with post-traumatic arthritis: a systematic review
AbstractPost-traumatic arthritis (PTA) is characterized by the deterioration of articular cartilage temporally associated with an articular injury. With a paucity of literature comparing joint preservation techniques, we performed a systematic review of the literature intending to describe and summarize the results of ankle distraction arthroplasty as it compares with studies on tibio-talar microfracture, allograft, and autograft for ankle joint preservation in the post-traumatic population under 50  years of age. Research databases were searched and abstracts screened for relevance on our topic of interest. Abstracts...
Source: Strategies in Trauma and Limb Reconstruction - August 1, 2018 Category: Orthopaedics Source Type: research

Surgical reconstruction of the acromioclavicular joint: Can we identify the optimal approach?
AbstractInjuries to the acromioclavicular (AC) joint are common, tending to occur secondary to traumatic injuries. Rockwood grade IV, V and VI injuries involve complete dislocation of the joint and require surgical reconstruction, with inconclusive literature on whether grade III injuries should be surgically or conservatively managed. There are over one hundred reported surgical techniques which reconstruct the AC joint, with little indication of which methods achieve the best results. Techniques can generally be considered as: anatomical reduction; CC ligament reconstruction; and anatomical reconstruction. Techniques whi...
Source: Strategies in Trauma and Limb Reconstruction - August 1, 2018 Category: Orthopaedics Source Type: research

Cozen ’s deformity: resolved by guided growth
We present 19 patients who were successfully treated with guided growth, tethering the proximal medial physis. There were ten boys and nine girls, ranging in age from two to 13.6  years at the time of intervention. The mean follow-up from injury was 7.3 years. We documented the intermalleolar distance, mechanical axis deviation (by zone), medial proximal tibial angle (MPTA), and leg length discrepancy. Removal of the plate, or more recently, the metaphyseal screw, was unde rtaken upon normalization of the mechanical axis. Including the four patients who have undergone repeat tethering for recurrent valgus (one pa...
Source: Strategies in Trauma and Limb Reconstruction - August 1, 2018 Category: Orthopaedics Source Type: research

The tibial bayonet method of wound closure
AbstractManagement of open lower limb fractures with soft tissue defects can be a technically challenging orthopaedic problem. Limited availability of orthoplastic services means that alternatives to the fix and flap concept are required in order to prevent infected non-unions from developing. The proposed ‘bayonet apposition’ allows the surgeon to temporarily shorten the limb without angulating the limb or creating a bone defect and removing viable bone. The viable bone edges are overlapped in a bayonet-like manner in order to appose the wound and skin edges. The limb length is restored by gradua lly distracti...
Source: Strategies in Trauma and Limb Reconstruction - August 1, 2018 Category: Orthopaedics Source Type: research

Causes of peroneal neuropathy associated with orthopaedic leg lengthening in different canine models
AbstractPeroneal neuropathy is one of the complications of orthopaedic leg lengthening. Methods of treatment include slowing of distraction and decompression both of which may lead to additional complications. The purpose of this study was to analyse the changes in histologic peroneal nerve structure during experimental orthopaedic lengthening using various modes of manual or automatic distraction. The obtained data provide the basis for better understanding of peroneal neuropathy pathogenesis and refinement of prophylaxis and preventive treatment protocols. Four experimental models of canine leg lengthening using the Iliz...
Source: Strategies in Trauma and Limb Reconstruction - August 1, 2018 Category: Orthopaedics Source Type: research

Surgical reconstruction of the acromioclavicular joint: Can we identify the optimal approach?
AbstractInjuries to the acromioclavicular (AC) joint are common, tending to occur secondary to traumatic injuries. Rockwood grade IV, V and VI injuries involve complete dislocation of the joint and require surgical reconstruction, with inconclusive literature on whether grade III injuries should be surgically or conservatively managed. There are over one hundred reported surgical techniques which reconstruct the AC joint, with little indication of which methods achieve the best results. Techniques can generally be considered as: anatomical reduction; CC ligament reconstruction; and anatomical reconstruction. Techniques whi...
Source: Strategies in Trauma and Limb Reconstruction - July 5, 2018 Category: Orthopaedics Source Type: research

Causes of peroneal neuropathy associated with orthopaedic leg lengthening in different canine models
AbstractPeroneal neuropathy is one of the complications of orthopaedic leg lengthening. Methods of treatment include slowing of distraction and decompression both of which may lead to additional complications. The purpose of this study was to analyse the changes in histologic peroneal nerve structure during experimental orthopaedic lengthening using various modes of manual or automatic distraction. The obtained data provide the basis for better understanding of peroneal neuropathy pathogenesis and refinement of prophylaxis and preventive treatment protocols. Four experimental models of canine leg lengthening using the Iliz...
Source: Strategies in Trauma and Limb Reconstruction - May 25, 2018 Category: Orthopaedics Source Type: research

The Resolution Axis Method (RAM) for lengthening of the femur with or without associated frontal plane deformity (a new method)
ConclusionThe Resolution Axis Method is a new and alternative method providing a solution for planning when lengthening the femur along the anatomical axis using an IM nail, whether a deformity is present or not. (Source: Strategies in Trauma and Limb Reconstruction)
Source: Strategies in Trauma and Limb Reconstruction - May 24, 2018 Category: Orthopaedics Source Type: research

Acute femoral shortening for reconstruction of a complex lower extremity crush injury
We present the case of a patient who sustained a traumatic through-knee amputation ipsilateral to an open comminuted femoral fracture. Soft tissue injury prohibited initial primary closure over the distal femoral condyles. A functional residual limb was achieved with acute femoral shortening, maintenance of the femoral condyles and fracture stabilization with a short retrograde intramedullary nail. This approach allowed maintenance of muscular attachments to the femur, soft tissue closure and resulted in a residual limb of acceptable length with a broad weight-bearing surface that was fitted with a prosthesis successfully....
Source: Strategies in Trauma and Limb Reconstruction - May 23, 2018 Category: Orthopaedics Source Type: research

Open complete anterior dislocation of the sacro-iliac joint in a 4-year-old boy: a case report of a rare injury with 5-year follow-up
AbstractPelvic fractures are uncommon in children and account for between 0.3 and 7.5% of all pediatric injuries. Open pelvic fractures only account for up to 12.9% of all pediatric pelvic fractures. An unusual case of open complete anterior sacro-iliac joint dislocation in a 4-year-old boy is presented with a long-term follow-up. The multidisciplinary approach is reported with review of the current literature. A 4-year-old male presented to our institution in January 2012 after having been run over by a tractor. He presented with gross hemodynamical instability, MISS of 25, and an unstable lateral compression type III pel...
Source: Strategies in Trauma and Limb Reconstruction - April 1, 2018 Category: Orthopaedics Source Type: research

Dermotaxis v/s loop suture technique for closure of fasciotomy wounds: a study of 50 cases
We describe using dermotaxis for skin edge approximation that is done using inexpensive equipment available readily in any standard operating room. Twenty-five patients had fasciotomy wounds closed either by dermotaxis or a loop suture technique with the inclusion criteria being closed fractures, no concomitant skin loss, fracture-related compartment syndrome and fasciotomy performed within 36  h. The fasciotomy incision was closed in a single stage by loop suture technique or gradually by dermotaxis once the oedema had settled between 3 and 5 days. Results were graded as excellent if approximation could be achie...
Source: Strategies in Trauma and Limb Reconstruction - April 1, 2018 Category: Orthopaedics Source Type: research

Bridging hard callus at 48  days in an open femoral shaft fracture with segmental defect treated with a first-stage Masquelet technique: I wasn’t expecting that
AbstractThe Masquelet technique is a strategy for management of segmental bone defects. It is a two-stage procedure that involves inducing a synovial-like membrane that can be used for a bone graft. Segmental bone defects can occur following trauma and can accompany traumatic brain injury. There is a well-documented, albeit debated, association between traumatic brain injury and increased rate of new bone formation. Here, we present a case of unexpected callus formation in a segmental femoral fracture. The patient had a traumatic brain injury and was treated with the first stage of the Masquelet technique. Owing to the amo...
Source: Strategies in Trauma and Limb Reconstruction - April 1, 2018 Category: Orthopaedics Source Type: research

The Teramoto distal tibial oblique osteotomy (DTOO): surgical technique and applicability for ankle osteoarthritis with varus deformity
This report describes the surgical technique and its applicability. DTOO can be used for cases of varus ankle osteoarthritis with a range of the ankle joint movement of at least 10 ° or more. The osteotomy is obliquely directed cut across the distal tibia from proximal-medial to distal lateral and is of an opening-wedge type with the centre of rotation coincident with the centre of the tibiofibular joint. A laminar spreader instrument is inserted in the osteotomy to open the wedge until the lateral surface of the talar body is seen on X-ray to be in contact and congruent with medial articular surface of the lateral mal...
Source: Strategies in Trauma and Limb Reconstruction - April 1, 2018 Category: Orthopaedics Source Type: research

Treatment of extraarticular knee extension contracture secondary to prolonged external fixation by a modified Judet quadricepsplasty technique
AbstractThe goal of this study is to evaluate the functional results of the modified Judet quadricepsplasty for a knee extension contracture secondary to prolonged external fixation. This is a retrospective study of 31 patients with the diagnosis of an extraarticular knee extension contracture who had  prolonged external fixation of the femur. Functional assessment was conducted after a minimum follow-up of 1 year. After performing the functional assessment, according to the Judet scale, 51% of the 31 patients had good results and 19.35% (6 cases) showed excellent results. The improvement in m obility from p...
Source: Strategies in Trauma and Limb Reconstruction - April 1, 2018 Category: Orthopaedics Source Type: research

Extra-articular deformity correction using Taylor spatial frame prior to total knee arthroplasty
We describe our experience with staged correction of deformity using a Taylor Spatial Frame (TSF) followed by total knee arthroplasty in these patients and highlight the advantage of staged approach. The use of TSF fixator for deformity correction prior to a primary total knee arthroplasty has not been described in the literature. We describe three cases of secondary osteoarthritis of the knee associated with multiplanar tibial deformity treated effectively with a total knee arthroplasty following deformity correction and union using a TSF. All patients had an improved Knee Society score and Oxford Knee score postoperative...
Source: Strategies in Trauma and Limb Reconstruction - March 20, 2018 Category: Orthopaedics Source Type: research

Cozen ’s deformity: resolved by guided growth
We present 19 patients who were successfully treated with guided growth, tethering the proximal medial physis. There were ten boys and nine girls, ranging in age from two to 13.6  years at the time of intervention. The mean follow-up from injury was 7.3 years. We documented the intermalleolar distance, mechanical axis deviation (by zone), medial proximal tibial angle (MPTA), and leg length discrepancy. Removal of the plate, or more recently, the metaphyseal screw, was unde rtaken upon normalization of the mechanical axis. Including the four patients who have undergone repeat tethering for recurrent valgus (one pa...
Source: Strategies in Trauma and Limb Reconstruction - March 16, 2018 Category: Orthopaedics Source Type: research

Role of ultrasound in detection of radiolucent foreign bodies in extremities
AbstractRemoval of foreign bodies from soft tissues in emergency is very challenging and becomes more problematic when it is radiolucent. Blind exploration is sometimes hazardous for patients especially when it is in proximity to a vessel or a nerve or an overlying tendon. The purpose of this study was to determine the accuracy of ultrasonography (USG) in detecting radiolucent soft tissue foreign bodies in the extremities. From January 2014 to January 2016, 120 patients with either a positive history or clinically suspected soft tissue foreign body and negative radiography were evaluated by USG with a high-frequency (13 &n...
Source: Strategies in Trauma and Limb Reconstruction - February 9, 2018 Category: Orthopaedics Source Type: research

Measurement of wire deflection on loading may indicate union in Ilizarov constructs, an in vitro model
This study aimed to test a method for assessing wire deflection within an Ilizarov frame. (1) To assess the repeatability of our novel measurement method in measuring wire deflection within an Ilizarov frame in vitro. (2) To compare the amount of wire deflection in an unstable model with that in an intact bone model. (3) To assess accuracy of this method by comparing wire deflection measured with overall machine extension. Tests were performed on clinical grade-tensioned fine wire 4-ring Ilizarov constructs stabilising a simulated fracture, with and without an unstable defect. Models were sequentially loaded to 700  N...
Source: Strategies in Trauma and Limb Reconstruction - February 2, 2018 Category: Orthopaedics Source Type: research

A novel treatment approach to infected nonunion of long bones without systemic antibiotics
This study aims to assess the efficacy of local antibiotics used as a replacement to prolonged intravenous therapy. Thirteen patients with infected nonunion of long bones who failed at least one previous surgery were included. The infection was treated through extensive debridement, application of antibiotic-impregnated calcium sulphate pellets and the bone stabilized with external fixation. These patients were monitored for union and infection by clinical signs, laboratory values, and radiographs over a period of 24  months. The results support an eradication of infection and union in all patients with no antibiotic-...
Source: Strategies in Trauma and Limb Reconstruction - January 29, 2018 Category: Orthopaedics Source Type: research

The Teramoto distal tibial oblique osteotomy (DTOO): surgical technique and applicability for ankle osteoarthritis with varus deformity
This report describes the surgical technique and its applicability. DTOO can be used for cases of varus ankle osteoarthritis with a range of the ankle joint movement of at least 10 ° or more. The osteotomy is obliquely directed cut across the distal tibia from proximal-medial to distal lateral and is of an opening-wedge type with the centre of rotation coincident with the centre of the tibiofibular joint. A laminar spreader instrument is inserted in the osteotomy to open the wedge until the lateral surface of the talar body is seen on X-ray to be in contact and congruent with medial articular surface of the lateral mal...
Source: Strategies in Trauma and Limb Reconstruction - January 29, 2018 Category: Orthopaedics Source Type: research

The tibial bayonet method of wound closure
AbstractManagement of open lower limb fractures with soft tissue defects can be a technically challenging orthopaedic problem. Limited availability of orthoplastic services means that alternatives to the fix and flap concept are required in order to prevent infected non-unions from developing. The proposed ‘bayonet apposition’ allows the surgeon to temporarily shorten the limb without angulating the limb or creating a bone defect and removing viable bone. The viable bone edges are overlapped in a bayonet-like manner in order to appose the wound and skin edges. The limb length is restored by gradua lly distracti...
Source: Strategies in Trauma and Limb Reconstruction - January 24, 2018 Category: Orthopaedics Source Type: research

Distraction arthroplasty compared to other cartilage preservation procedures in patients with post-traumatic arthritis: a systematic review
AbstractPost-traumatic arthritis (PTA) is characterized by the deterioration of articular cartilage temporally associated with an articular injury. With a paucity of literature comparing joint preservation techniques, we performed a systematic review of the literature intending to describe and summarize the results of ankle distraction arthroplasty as it compares with studies on tibio-talar microfracture, allograft, and autograft for ankle joint preservation in the post-traumatic population under 50  years of age. Research databases were searched and abstracts screened for relevance on our topic of interest. Abstracts...
Source: Strategies in Trauma and Limb Reconstruction - January 23, 2018 Category: Orthopaedics Source Type: research

Treatment of extraarticular knee extension contracture secondary to prolonged external fixation by a modified Judet quadricepsplasty technique
AbstractThe goal of this study is to evaluate the functional results of the modified Judet quadricepsplasty for a knee extension contracture secondary to prolonged external fixation. This is a retrospective study of 31 patients with the diagnosis of an extraarticular knee extension contracture who had  prolonged external fixation of the femur. Functional assessment was conducted after a minimum follow-up of 1 year. After performing the functional assessment, according to the Judet scale, 51% of the 31 patients had good results and 19.35% (6 cases) showed excellent results. The improvement in m obility from p...
Source: Strategies in Trauma and Limb Reconstruction - December 16, 2017 Category: Orthopaedics Source Type: research

Bridging hard callus at 48  days in an open femoral shaft fracture with segmental defect treated with a first-stage Masquelet technique: I wasn’t expecting that
AbstractThe Masquelet technique is a strategy for management of segmental bone defects. It is a two-stage procedure that involves inducing a synovial-like membrane that can be used for a bone graft. Segmental bone defects can occur following trauma and can accompany traumatic brain injury. There is a well-documented, albeit debated, association between traumatic brain injury and increased rate of new bone formation. Here, we present a case of unexpected callus formation in a segmental femoral fracture. The patient had a traumatic brain injury and was treated with the first stage of the Masquelet technique. Owing to the amo...
Source: Strategies in Trauma and Limb Reconstruction - November 7, 2017 Category: Orthopaedics Source Type: research

Complex tibial fractures are associated with lower social classes and predict early exit from employment and worse patient-reported QOL: a prospective observational study of 46 complex tibial fractures treated with a ring fixator
This study indicates that at 12 months after frame removal there are poorer patient-reported QOL as when compared to reference populations. Furthermore, this study suggests that complex tibial fractures are associated with lower so cial classes and that only 27% of patients in this sample, who prior to injury were employed, had returned to employment at approximately 19 months after the injury. (Source: Strategies in Trauma and Limb Reconstruction)
Source: Strategies in Trauma and Limb Reconstruction - November 4, 2017 Category: Orthopaedics Source Type: research

Calcaneal fractures: Where are we now?
AbstractThis review article on the current management for calcaneal fractures discusses the advantages and disadvantages of different treatment options including the problems encountered. Controversies are described and the evidence reviewed. The management of some types of displaced intra-articular calcaneal fractures remains contentious; is there a preferred stabilisation method for each type of calcaneal fracture? How constant is the “constant fragment” in an intra-articular calcaneal fracture and what is the evidence for primary arthrodesis and what is its place in these fractures? (Source: Strategies in Tr...
Source: Strategies in Trauma and Limb Reconstruction - October 20, 2017 Category: Orthopaedics Source Type: research

Dermotaxis v/s loop suture technique for closure of fasciotomy wounds: a study of 50 cases
We describe using dermotaxis for skin edge approximation that is done using inexpensive equipment available readily in any standard operating room. Twenty-five patients had fasciotomy wounds closed either by dermotaxis or a loop suture technique with the inclusion criteria being closed fractures, no concomitant skin loss, fracture-related compartment syndrome and fasciotomy performed within 36  h. The fasciotomy incision was closed in a single stage by loop suture technique or gradually by dermotaxis once the oedema had settled between 3 and 5 days. Results were graded as excellent if approximation could be achie...
Source: Strategies in Trauma and Limb Reconstruction - October 16, 2017 Category: Orthopaedics Source Type: research

Distal femoral flexion deformity from growth disturbance treated with a two-level osteotomy and internal lengthening nail
AbstractSalter Harris fractures of the distal femur can lead to growth disturbance with resulting leg length inequality and knee deformity. We have looked at a case series (3) of patients who presented with a distal femur flexion malunion and shortening treated with a distal femoral osteotomy and plating and a proximal femoral osteotomy with a magnetic internal lengthening nail. Does a two-level osteotomy and internal fixation approach provide a reliable result both radiographically and functionally? The average knee extension loss was 12 °, LLD 47 mm, PDFA 65°, MAD 2 mm. The patients were treated with an...
Source: Strategies in Trauma and Limb Reconstruction - October 16, 2017 Category: Orthopaedics Source Type: research

The history, evolution and basic science of osteotomy techniques
AbstractOsteotomy techniques date back to Hippocrates circa 415 BC (Jones Hippocrates collected works I, Harvard University Press, Cambridge,2006; Brorson in Clin Orthop Relat Res 467(7):1907 –1914,2009). There is debate about the best way to divide the bone surgically and which technique yields the best bone regenerate in lengthening; ensuring predictable new bone formation and healing of the osteotomy are the primary goals. We review the history and techniques of the osteotomy and consider the evidence for optimum bone formation. Methods discussed include variants of the ‘drill and osteotome’ technique,...
Source: Strategies in Trauma and Limb Reconstruction - October 6, 2017 Category: Orthopaedics Source Type: research

Open complete anterior dislocation of the sacro-iliac joint in a 4-year-old boy: a case report of a rare injury with 5-year follow-up
AbstractPelvic fractures are uncommon in children and account for between 0.3 and 7.5% of all pediatric injuries. Open pelvic fractures only account for up to 12.9% of all pediatric pelvic fractures. An unusual case of open complete anterior sacro-iliac joint dislocation in a 4-year-old boy is presented with a long-term follow-up. The multidisciplinary approach is reported with review of the current literature. A 4-year-old male presented to our institution in January 2012 after having been run over by a tractor. He presented with gross hemodynamical instability, MISS of 25, and an unstable lateral compression type III pel...
Source: Strategies in Trauma and Limb Reconstruction - September 9, 2017 Category: Orthopaedics Source Type: research