1/5. An introduction to the minimally invasive osteosynthesis of intra-articular calcaneal fractures.The approach to the treatment of intra-articular calcaneal fractures has often been the subject of discussion. The results achieved with both operative and non-operative management remain to some extent unpredictable. Minimally invasive osteosynthesis offers an alternative approach, especially in those cases in which open reduction would be hazardous and non-operative treatment inadequate. This technique requires minimal dissection and preserves subtalar motion almost completely. The authors believe that displaced intra-articular calcaneal fractures are best treated through operative intervention. Restoration of articular congruity is an integral, though not necessarily sufficient, component of a successful long-term outcome following calcaneal fracture. The extra-articular dimensions of the calcaneus must be restored in order to tolerate standard shoe-wear, maintain a functional range of talocalcaneal motion and avoid subsequent tibiotalar arthrosis. However, in certain circumstances open reduction may be associated with an unacceptably high complication rate. In these cases, the authors have found a "minimally invasive" osteosynthesis technique useful in dealing with competing goals. In our experience, this technique can, when used appropriately, result in a functional recovery of the patient suffering a calcaneal fracture.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/5. femoral fractures secondary to low velocity missiles: treatment with delayed intramedullary fixation.The literature is replete with descriptions of the advantages of intramedullary nailing in the treatment of femoral fractures. However, little has been reported about the use of this method in femoral fractures resulting from gunshot wounds. Often, the amount of bony comminution and retained metal fragments have discouraged attempts at operative intervention. We reviewed our experience with 26 patients who had sustained low velocity gunshot fractures of the femur that were treated operatively with intramedullary fixation. After injury, the patients were stabilized in the emergency room and placed in balanced skeletal traction. They also received local wound care. When the patients recovered from associated injuries and the bullet wounds were healing, a delayed closed intramedullary nailing was performed. Nineteen patients were followed to union. Seventeen had fractures that united at an average of 4.5 months. One patient had a delayed union, and one had a nonunion. There were no deep wound infections and no cases of osteomyelitis. Range of motion was within 10 degree of the unaffected side in all but one patient, and there were neither rotatory nor angular deformities.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
3/5. Internal fixation of an unstable open fracture of a distal phalanx with a Herbert screw.A 20-year-old patient was seen with an unstable, infected, open fracture of the distal phalanx of the long finger of the right dominant hand. The patient was treated by removal of the nail, debridement of the fracture site, and stabilization of the fracture with a Herbert screw. The Herbert screw compressed the fracture site and allowed early active motion of the distal inter-phalangeal (DIP) joint. The wound healed without incident, and the fracture was radiographically united 6 weeks after the procedure. The Herbert screw is useful in the treatment of unstable fractures of the distal phalanx, since the screw maintains reduction, compresses the fracture site, and allows early active motion of the DIP joint.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/5. Vascularised bone grafts in the treatment of long bone defects.Reconstruction of large bony defects of long bones was performed using vascularised fibular grafts in four patients at the Department of Orthopaedic Surgery of the University of Ioannina Medical School. Indications for grafting procedures in this small series had been the loss of bone due to the extensive resection of avascular and necrotic bone from septic pseudoarthrosis in three patients and congenital pseudarthrosis secondary to neurofibromatosis in a child. Primary skeletal union with graft hypertrophy occurred in three of the patients. The fourth patient had an asymptomatic nonunion at the proximal end of the graft. The result in each patient was the presence of a well-aligned limb that had normal or nearly normal motion and acceptable length.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
5/5. Open anterior dislocation of the shoulder.An open dislocation of the shoulder is a very uncommon and serious injury. The sequelae of open glenohumeral dislocation include infection, avascular necrosis, and limited motion. The patient with such complications will have serious compromise in shoulder function, as illustrated in this case report and reference to another report in the literature.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |