1/8. False aneurysm of the anterior tibial artery in lower leg fractures treated with the Ilizarov external fixator. Case report.A case of open segmental fracture of the right lower leg treated with an Ilizarov external fixator in emergency surgery is presented. Approximately two months after operation, swelling in the anterior compartment of the tibia and repeated episodes of bleeding from one of the Kirschner wire holes led the authors to perform an angiography, which revealed the presence of a false aneurysm of the anterior tibial artery. The intraoperative finding of a double lesion in the anterior tibial artery confirmed the iatrogenous nature of the injury.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/8. Global reconstruction of type IIIA open comminuted femoral shaft fracture with segmental bone loss in an 11-year-old girl.An 11-year-old girl with type IIIA open fracture of the femoral shaft and 4.5 cm bone loss, was treated by global reconstruction using a reamed, interlocking, intramedullary titanium nail, following meticulous primary debridement with pulsed lavage irrigation. The nail entry was carefully chosen at the lateral transtrochanteric point in order to avoid any vascular damage to the head of femur. The osteophilic nature of the titanium nail, in addition to the thick periosteum of the paediatric bone, helped satisfactory union despite a hostile environment. The child had 0-90 degrees flexion of the knee without any extensor lag at the last follow-up. To our knowledge, this is the first case described in the literature that proves the efficacy of nailing for such a fracture.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/8. Sonographic detection of occult bone fractures.Two infants of 24 and 20 months of age with painful local swelling at the femoral and clavicular regions were investigated by ultrasound after a negative radiographic study of the adjacent bones. In both children high resolution ultrasound clearly revealed the presence of bone fractures in addition to the soft tissue hematomas. These fractures were confirmed by a repeat radiographs performed 6 and 8 days later. Although sonography is not the method of choice for the detection of bone fractures, it may be worthwhile to examine the bone contour for a fracture when a painful swelling adjacent to bone is present. The method may be particularly rewarding in children due to its rapid non-invasive nature and to the small tissue thickness that has to be penetrated.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/8. Selection, evaluation and indications for electrical stimulation of ununited fractures.Management of nonunions requires careful and critical assessment of the true biologic status of the fracture. The mere radiographic persistence of a fracture line does not invariably indicate nonunion. Ten percent of fractures considered initially to be ununited in this series healed spontaneously without further treatment. The patient who has no pain with weight-bearing and no demonstrable motion on careful stress studies does not usually require further treatment, except for protection against reinjury. Intraosseous venography may be useful to distinguish the delayed from the nonunion in order to institute appropriate and early treatment. Percutaneous direct-current electrostimulation is proving to be a reliable and effective method of managing the most common nonunion of the tibia or distal femur. It appears less satisfactory for the more proximal femoral fractures and for fractures of the humerus. Electrical stimulation does not eliminate the need to stabilize the nonunion of either the femur or the upper limb. Electrical stimulation also does not eliminate the need for bone grafting in approximately 15% to 20% of nonunions. The fractures' biologic inability to respond may be identifiable by 99MTc diphosphonate bone scan. The implantable direct-current electrical stimulatory device proved ineffective in this series. Hopefully, further development of this technology may produce more consistent results in the future. The electromagnetic noninvasive stimulator appears to be a useful alternative method to the semi-invasive system. This, of course, should depend on the individual needs of the patient and the nature and location of the fracture. Continued technologic improvement in all electrical stimulatory methods should broaden their usefulness and applicability. However, the healing status of the fracture and the processes by which each fracture responds must be carefully assessed to appreciate what is being effected by electrical stimulation. Critical evaluation and clarification of indications are essential if the patient is to be offered the most effective therapy available.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/8. On the nature of stress fractures.It is felt that stress fractures are caused by excessive, repetitive muscle forces acting across the affected bone. These fractures should be suspected in participants of athletic endeavors who present with a history of persistent, focal, activity-related pain regardless of their stage of physical conditioning. Associated physical findings are localized tenderness and swelling without evidence of a generalized systemic response. Bone scans and serial roentgenograms including specialized views may be required for documentation. Limitation of the athletic activity is the hallmark of the treatment program.- - - - - - - - - - ranking = 4keywords = nature (Clic here for more details about this article) |
6/8. Variable prenatal appearance of osteogenesis imperfecta.osteogenesis imperfecta is a heterogeneous group of disorders of type I collagen with both lethal and nonlethal forms. Prenatal sonographic findings in affected fetuses are variable and depend on the severity of the disease. Six cases of osteogenesis imperfecta in which prenatal sonography had been performed were reviewed. Two cases of lethal type II osteogenesis imperfecta revealed short femurs at 16 to 17 weeks' gestation with development of bowing and fractures by 19 weeks' gestation. Four fetuses with the nonlethal type III or IV had femoral bowing with or without shortening in the late second or third trimester with grossly normal mineralization. Fractures in this latter group did not develop until 1 to 12 months after delivery. Understanding the progressive nature and variability of osteogenesis imperfecta is crucial in the prenatal diagnosis and management of this disease.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/8. Supracondylar femur fracture above a mature knee fusion treated with a long locked intramedullary rod.Fracture around a mature knee fusion has been reported in the orthopedic literature, but little has been written regarding treatment options. Closed long anterograde rodding with interlocking screws offers distinct advantages over other methods of reduction and fixation. The closed nature of the procedure avoids excessive soft-tissue stripping. In comparison with a short unlocked rod or plate, the long locked rod imparts more stability and prevents shortening and rotation. We present a case of a supracondylar femur fracture above a mature knee fusion treated in this manner. The literature on this injury is also reviewed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/8. Supracondylar femur fractures above an Insall-Burstein CCK total knee: a new method of intramedullary stem fixation.Supracondylar femur fracture above a well-fixed posterior cruciate substituting prosthesis may not allow the use of standard fixation methods because of the closed nature of the femoral box. The Insall-Burstein Constrained Condylar knee femoral prosthesis (Zimmer, Warsaw, IN) possesses a closed box and the capability of modular femoral stems. A retrieval device aids the utilization of the modular ability of the femoral prosthesis to gain intramedullary fixation of supracondylar femur fractures above a well-fixed femoral component allowing restoration of alignment, length, preinjury range of motion, and function.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |