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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 Trauma and...
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 achieved, goo...
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 acute, poster...
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, use of the ...
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

Midshaft clavicle fractures treatment: threaded Kirschner wire versus conservative approach
This study evaluated retrospectively all patients presented with a clavicle fracture at Emergency Department of our Institution, between January 2006 and December 2011. Fractures were classified according to Allman ’s radiographic classification system, modified by Nordqvist and Petersson. Patients were distinguished into two groups: one that underwent conservative treatment with a “figure-of-8” orthosis and one that underwent surgery with reduction in fracture and fixation with intramedullary threaded K irschner wire. Pin removal was performed after 4 weeks of rest in Gilchrist bandage, after clinical and radiograp...
Source: Strategies in Trauma and Limb Reconstruction - August 20, 2017 Category: Orthopaedics Source Type: research

Anterior hip dislocation with ipsilateral displaced fracture neck of femur treated by open reduction and internal fixation: case report and review of the literature
AbstractCombined fracture neck femur with anterior dislocation of the head of femur is a very rare injury with little resources available in the literature. This case report describes a case that was treated by open reduction and internal fixation with 2-year follow-up showing good radiological and functional outcome. Functional evaluation was done according to Merle d ’Aubigné score modified by Matta JM, which takes into account the presence of pain, ability to walk and joint range of motion. The measured functional score was 15 points out of a maximum of 18, signifying a good postoperative result. Early intervention (...
Source: Strategies in Trauma and Limb Reconstruction - August 7, 2017 Category: Orthopaedics Source Type: research

Shaped graft for aneurysmal bone cyst of upper limb bones
AbstractThe optimal treatment of aneurysmal bone cyst remains challenging. The aim of this prospective study was to evaluate the results of using bone grafts shaped to the defects caused by aneurysmal bone cysts of upper limb bones. Fifteen patients (12 males and 3 females) with an average age of 12  years (range 6–16 years) were treated for aneurysmal bone cysts of upper limb bones by intralesional resection, argon beam coagulation and shaped bone graft. The grafts were harvested from 14 patients (11 fibulas and 3 iliac bones) and from the mother of one patient (proximal fibula). Osteosynt hesis was required to stabil...
Source: Strategies in Trauma and Limb Reconstruction - July 15, 2017 Category: Orthopaedics Source Type: research

Guided growth for valgus deformity correction of knees in a girl with osteopetrosis: a case report
This article presents a case report of operative treatment of an 11-yea r-old girl affected with ADO, who underwent a simultaneous valgus knee deformity correction of both limbs with medial eight-plate epiphysiodesis. Simultaneous correction of valgus deformity on both limbs using an extraperiosteal tension plate technique for medial tibial hemiepiphysiodesis was perfor med in a girl of 11.5 years old with autosomal dominant osteopetrosis. The treatment duration from surgery to complete deformity correction and removal of plates was 18 months. The final aMPTA was 86° on the right side and 85° on the left side. The corre...
Source: Strategies in Trauma and Limb Reconstruction - June 7, 2017 Category: Orthopaedics Source Type: research

Accuracy in identifying the elbow rotation axis on simulated fluoroscopic images using a new anatomical landmark
AbstractExternal fixation of the elbow requires identification of the elbow rotation axis, but the accuracy of traditional landmarks (capitellum and trochlea) on fluoroscopy is limited. The relative distance (RD) of the humerus may be helpful as additional landmark. The first aim of this study was to determine the optimal RD that corresponds to an on-axis lateral image of the elbow. The second aim was to assess whether the use of the optimal RD improves the surgical accuracy to identify the elbow rotation axis on fluoroscopy. CT scans of elbows from five volunteers were used to simulate fluoroscopy; the actual rotation axi...
Source: Strategies in Trauma and Limb Reconstruction - June 7, 2017 Category: Orthopaedics Source Type: research

Repair of the pronator quadratus after volar plate fixation in distal radius fractures: a systematic review
AbstractTo position the volar plate on the distal radius fracture site, the pronator quadratus muscle needs to be detached from its distal and radial side and lifted for optimal exposure to the fracture site. Although the conventional approach involves repair of the pronator quadratus, controversy surrounds the merits of this repair. The purpose of this study was to compare the functional outcomes of patients with distal radius fractures treated with pronator quadratus repair after volar plate fixation versus no pronator quadratus repair. A systematic search was conducted in Medline, EMBASE and the Cochrane Central Registe...
Source: Strategies in Trauma and Limb Reconstruction - May 17, 2017 Category: Orthopaedics Source Type: research

The silhouette technique: improving post-operative radiographs for planning of correction with a hexapod external fixator
We describe a simple technique for obtaining adequate imaging, without the use of additional equipment. Introduction of the technique to our department has demonstrated an improvement in the adequacy of planning radiographs and a reduction in the requirement for repeat imaging. (Source: Strategies in Trauma and Limb Reconstruction)
Source: Strategies in Trauma and Limb Reconstruction - May 12, 2017 Category: Orthopaedics Source Type: research

Neglected hip dislocation: an unusual presentation, its management and review of the literature
AbstractNeglected traumatic posterior hip dislocation is not an uncommon condition seen in developing countries. Its treatment is fraught with great difficulties and controversies. Here we present a 31-year-old female patient presented to our hospital 2  years after sustaining an accident. She had gone through multiple treatments for her dislocated hip without any success. After arrival to our hospital, patient managed by constrained total hip replacement (THR). Her Harris hip score improved from 48 (preoperative) to 81 (postoperative). On follow- up she had a good range of movement of the hip with no pain, deformity and ...
Source: Strategies in Trauma and Limb Reconstruction - April 26, 2017 Category: Orthopaedics Source Type: research

Three-dimensional virtual planning of corrective osteotomies of distal radius malunions: a systematic review and meta-analysis
AbstractThe purpose of this study was to summarize and evaluate results of three-dimensional (3D-) planned corrective osteotomies of malunited distal radius fractures. 3D-planning techniques provide the possibility to address 3D-deformity that conventional planning methods might not address. We systematically searched PubMed, EMBASE and the Cochrane library for studies that performed a 3D-planned corrective osteotomy on patients with a malunited distal radius fracture. Fifteen studies with a total of 68 patients were included in the analysis. In 96% of cases, the preoperatively present palmar tilt, radial inclination and u...
Source: Strategies in Trauma and Limb Reconstruction - April 25, 2017 Category: Orthopaedics Source Type: research

Lengthening of the humerus with intramedullary lengthening nails —preliminary report
We report on the first intramedullary lengthening cases of the humerus with two different lengthening devices (FITBONE and PRECICE). Two different approaches and implantation techniques were used. We retrospectively reviewed clinical and radiographic data and pointed out results, pit falls and complications of the procedure. Four adult patients with relevant length discrepancy of the humerus were treated with fully implantable systems in two centers between 2012 and 2015. Three patients were treated with FITBONE by an antegrade approach; one patient had lengthening with a PRECIC E and a retrograde approach. Average nail le...
Source: Strategies in Trauma and Limb Reconstruction - April 24, 2017 Category: Orthopaedics Source Type: research