1/31. Use of a reversed-flow vascularized pedicle fibular graft for treatment of nonunion of the tibia.Ten patients with nonunion of the lower tibia were treated with a vascularized ipsilateral fibular graft, that was transferred distally and based on retrograde peroneal vessel flow. Eight patients were treated for congenital pseudarthrosis of the tibia; one had a nonunion subsequent to infection, and another patient had bone and skin loss due to infection. A posterior approach was used to expose the tibia and to harvest the fibula. Bone union and full weight-bearing were achieved in all cases by 9 months. The patients were followed-up for a mean of 1.8 years (range: 1.5 to 3 years).- - - - - - - - - - ranking = 1keywords = lower (Clic here for more details about this article) |
2/31. Nonunion of fracture of the neck of the radius: a report of three cases.Nonunion of a radial neck fracture is uncommon. Our report of three cases aims to highlight the fact that this complication is possible following such a fracture in adults. Appropriate clinical and radiologic follow-up is necessary to make sure such nonunion not missed. Surgical fixation (when nonunion of radial neck fracture is suspected) or excision of the radial head may be necessary if the complication is symptomatic. When associated with an ulna fracture, the threshold for internal fixation of both fractures must be lower.- - - - - - - - - - ranking = 1keywords = lower (Clic here for more details about this article) |
3/31. A fractured mandible, from initial operation to removal of tantalum mesh. Report of a case.Report is made of a case of fracture of the angle of the mandible. Treatment was attempted with the Sampson pericortical bone clamp, but was unsuccessful. Routine use of intraosseous wire led to a localized osteomyelitis, without union of the fracture. Treatment then was made with a particulate marrow graft contained within a tantalum mesh screen. The screen was removed 30 months postoperatively.- - - - - - - - - - ranking = 220.87693285387keywords = mandible (Clic here for more details about this article) |
4/31. Intramedullary fibular allograft and nail for treatment of femoral shaft nonunion.We present a difficult case of hypertrophic nonunion associated with a large cavity in the lower third of the femur. The cavity had been created by a windshield-wiper effect after failure of fixation with a Schneider intramedullary rod in a patient weighing 450 pounds. Treatment consisted of exchanging the Schneider nail with a larger-diame-ter interlocking nail and using the intramedullary fibular allograft to fill the cavity. The fracture healed 4 months after the procedure. At 5-year follow-up, the patient had no complaint, and plain radiographs showed obliteration of the large cavity in the distal femur. Intramedullary fibular graft technique can be used as an adjunct to use of an intramedullary nail when the distal femur contains a large cavity or when the intramedullary rod does not provide adequate fixation stability.- - - - - - - - - - ranking = 1keywords = lower (Clic here for more details about this article) |
5/31. Use of an orthopaedic fixator for external fixation of the mandible.A patient presented with a chronically infected, non-united fracture of the mandible, with considerable bone loss. He was treated with a metacarpal fixator, the miniPennig external fixator. The fixator is stable and smaller than conventional mandibular fixators. It can be applied and removed under local anaesthesia, if necessary, requires little maintenance and produces minimal scarring. The successful outcome in this patient is encouraging and we commend the use of the fixator in similar difficult cases.- - - - - - - - - - ranking = 220.87693285387keywords = mandible (Clic here for more details about this article) |
6/31. Bipedicled fasciocutaneous flaps in the lower extremity.It is well known that a bipedicled skin flap permits survival of longer flaps due to the secondary recruitment of vascularity. Inclusion of the deep fascia with such a flap, obeying the principles of the single-pedicled fasciocutaneous flap, provides even greater security for the immediate transposition of yet larger or riskier flaps without the need for delay maneuvers. This variation is especially valuable for the management of difficult wounds encountered in the lower extremity when no other local options may be available. Thirteen local bipedicled fasciocutaneous flaps including both vertical and horizontal orientations, without isolation of any discrete fascial perforators, have been successfully used for soft tissue coverage in the distal leg and ankle with only three (23%) minor complications as untoward sequelae. Another major advantage of this bipedicled version of the fasciocutaneous flap was that the inclusion of a distal pedicle simultaneously may be designed to prevent bone or tendon exposure at the donor site that otherwise frequently is a concern with a unipedicled flap.- - - - - - - - - - ranking = 5keywords = lower (Clic here for more details about this article) |
7/31. chiropractic care of a patient with low back pain associated with subluxations and a Malgaigne-type pelvic fracture.OBJECTIVE: To describe the chiropractic care of a patient with a pelvic ring fracture and concomitant subluxations of multiple segments of the spinal column. CLINICAL FEATURES: A 23-year-old male, after falling down a flight of stairs, was initially hospitalized for fractures of the pelvis. Five weeks posthospitalization, the patient initiated chiropractic care with complaints of severe low back pain with lower extremity involvement. He also complained of neck pain and occipital headache. The patient had several positive low back orthopedic tests with bilaterally absent Achilles deep tendon reflexes. The anteroposterior radiographic view revealed ununited fractures at the left superior and inferior pubic ramus, noted as a type I Malgaigne fracture. Subluxations were detected at the left innominate (ie, fracture-subluxation) and at the patient's lumbar, thoracic, and cervical spine. INTERVENTION AND OUTCOME: The patient was cared for with contact-specific, high-velocity, low-amplitude adjustments to sites of vertebral and sacroiliac subluxations. The patient's response to care was positive, receiving great pain relief. Less than 3 months after initiating care, the patient returned to work on regular duty. CONCLUSION: There are indications that patients suffering from the injuries described above may derive benefits from chiropractic care. The practitioner must pay careful attention to issues of biomechanical and vascular stability and adjustment modifications in these types of patients.- - - - - - - - - - ranking = 1keywords = lower (Clic here for more details about this article) |
8/31. Callusmassage. A new treatment modality for non-unions of the irradiated mandible.Recent reports on orthopaedic surgery focus on mechanical stimulation of the regenerate during distraction therapy of non-unions in long-bone-surgery. In the field of maxillofacial surgery, callus stimulating techniques are rarely reported. The case of a 65-year-old man with a radiogenic mandibular non-union after ablative tumour therapy and pre-operative radiation therapy presented with a non-union. Vertical distraction in combination with subsequent repeated, stepwise compression and distraction (=massage) had a positive effect on the consolidation of the regenerate.- - - - - - - - - - ranking = 176.70154628309keywords = mandible (Clic here for more details about this article) |
9/31. The management of a plastic bullet injury to the mandible.A patient hit by a plastic bullet sustained severe facial contusion and a comminuted fracture of the mandible with bone loss. There was a non-union of the fracture. The injury and the restoration of the defect are described and the use of plastic bullets is discussed.- - - - - - - - - - ranking = 220.87693285387keywords = mandible (Clic here for more details about this article) |
10/31. A quantitative approach to radiography of the lower limb. Principles and applications.A method is described which provides standardised reproducible radiographic images of the lower limb. Anteroposterior and lateral radiographs are digitised and processed by computer to provide graphic/numeric displays of angles and linear measurements, relating the centre points of the hip, knee, and ankle. Two cases illustrate how surgical planning is facilitated when standardised data are available. These data confirm the close relationship between postoperative limb alignment and positioning of prosthetic elements.- - - - - - - - - - ranking = 5keywords = lower (Clic here for more details about this article) |
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