Showing papers in "Journal of Orthopaedic Trauma in 1997"
TL;DR: Quality triplanar fluoroscopic imaging of the accurately reduced posterior pelvic ring should allow for safe iliosacral screw insertions and the surgeon must understand the variability of sacral anatomy.
Abstract: Objective:To report on the early complications related to the percutaneous placement of iliosacral screws for the operative treatment of displaced posterior pelvic ring disruptions.Study Design:Prospective, consecutive.Setting:Level-one trauma center.Patients:One hundred seventy-seven consecutive pa
406 citations
TL;DR: Bicruciate ligament injuries are equivalent to knee dislocations with regard to mechanism of injury, severity of ligamentous injury, and frequency of major arterial injuries.
Abstract: Objective:To evaluate bicruciate knee injuries and determine whether they should be treated as knee dislocations, especially with regard to vascular injuries.Design:Retrospective.Setting:University hospital, level 1 trauma center.Patients:Fifty patients admitted between 1987 and 1994 who had sustain
314 citations
TL;DR: The results indicate that efforts at reducing one year mortality after hip fracture should be directed at the prevention of postoperative complications.
Abstract: Objective:To determine the one year mortality following hip fracture in an ambulatory, community dwelling, cognitively intact elderly population and to examine the role of specific type, number, and severity of associated medical comorbidities.Design:Prospective, consecutive.Methods:Six hundred twel
314 citations
TL;DR: Results indicate that unprotected individuals working twenty-four inches (70cm) or less from a fluoroscopic beam receive significant amounts of radiation, whereas those working thirty-six inches (91.4 cm) or greater from the beam receive an extremely low amount of radiation.
Abstract: Objectives:To correlate the amount of radiation exposure to members of the orthopaedic surgical team based on their relative positions during a simulated fluoroscopically assisted orthopaedic procedure.Design:Experimental study using commercially available fluoroscopic units and dosimetry badges des
267 citations
TL;DR: Anterior knee pain is a significant complication of intramedullary nailing of the tibia and there was considerable functional impairment with 91.8% of patients experiencing pain on kneeling and 33.7% having pain even at rest.
Abstract: Objectives To establish the incidence and clinical effects of anterior knee pain after intramedullary nailing of the tibia. Design A retrospective study. Setting The Royal Infirmary of Edinburgh, Scotland. Patients 169 patients who presented with a tibial diaphyseal fracture and were treated by intramedullary nailing. Intervention All patients were treated with a reamed Grosse Kempf tibial nail. Main outcome measurements Anterior knee pain was assessed with an analogue scale and functional outcome was examined using a series of routine daily activities. Results Anterior knee pain was found in 56.2% of patients. The only distinguishing feature between patients with and without pain was that the patients who had pain were significantly younger. Most patients had mild pain but there was considerable functional impairment with 91.8% of patients experiencing pain on kneeling and 33.7% having pain even at rest. Nail removal resolved or improved the symptoms in almost all cases. Conclusions Anterior knee pain is a significant complication of intramedullary nailing of the tibia.
257 citations
TL;DR: The incidence of early complications in operatively treated patella fractures is higher than previously reported and technical errors or patient noncompliance were identified as factors.
Abstract: Objective:To identify and review early complications in the operative treatment of patella fractures.Design:Retrospective review.Setting:Single tertiary care institution with multiple surgeons, including generalists and fellowship trained subspecialists.Patients:A consecutive series of eighty-seven
247 citations
TL;DR: Combining interfragmentary screw fixation with the tension band principle appears to provide improved stability over the modified tension band or screws alone for transverse patella fractures.
Abstract: Objective:To compare the mechanical effectiveness of three different techniques for stabilization of transverse fractures of the patella.Design:Cadaveric knees were used to model acute fractures of the patella. To test three treatment techniques in pairs of knees, specimen pairs were assigned random
238 citations
TL;DR: A parapatellar tendon incision for nail insertion, and nail removal for those patients with a painful knee are recommended based on a retrospective analysis of patients treated by tibial nailing.
Abstract: Objective:To determine the incidence and natural history of knee pain following tibial nailing.Design:A retrospective analysis of patients treated by tibial nailing evaluating a consecutive series of patients with isolated tibial shaft fractures.Setting:A level one trauma center in Vancouver, Britis
218 citations
TL;DR: Addition of CT scans to plain roentgenograms increases the interobserver and intraobserver agreement on treatment plan and fracture classification of tibial plateau fractures.
Abstract: Objective:To evaluate the interobserver and intraobserver agreement for both treatment plan and fracture classification of tibial plateau fractures using plain films alone and with computed tomography (CT) scansDesign:Prospective study to assess the impact of an advanced radiologic study on the agr
198 citations
TL;DR: Anterior elbow dislocations occur most often as a fracture-dislocation in which the distal humerus is driven through the olecranon, thereby causing a complex, comminuted fracture of the proximal ulna.
Abstract: Objective:To characterize the prevalence, morphology, and prognosis of anterior (transolecranon) fracture-dislocations of the elbow.Design:Retrospective case series.Setting:A consecutive series of thirteen patients from a single level-one trauma center, plus four patients from the practices of two o
195 citations
TL;DR: A condylar buttress plate with locked screws is a valid concept for improving fixation stability and proved significantly more stable in axial loading than the blade plate both before and after cycling.
Abstract: Objectives:This biomechanical cadaver study was performed to compare the fixation stability of a standard lateral condylar buttress plate with a similar condylar buttress plate with the distal screws locked to the plate. Then the study was repeated with six additional matched femoral pairs to compar
TL;DR: The described fixation technique for transverse patella fractures had clinical results equivalent to reports of patellA fractures fixed with modified tension band wiring, which included a low-profile construct that caused lesser degrees of implant irritation to local soft tissue structures.
Abstract: Objective:To evaluate the clinical results of transverse patella fracture fixation with a tensioned anterior figure-eight wire placed through parallel cannulated screwsDesign:Prospective, clinicalPatients:Ten patients with displaced transverse patella fractures were managed with a standardized reh
TL;DR: Twelve of 14 proximal third tibial shaft fractures were successfully treated with a new technique for intramedullary nailing of these fractures, dependent on neutralizing the primary factors causing malreduction.
Abstract: Twelve of 14 proximal third tibial shaft fractures were successfully treated with a new technique for intramedullary nailing of these fractures. The average anterior displacement was 3.0 mm (range 0-17). The average coronal plane alignment was 2.0 degrees valgus (range 2 degrees varus to 12 degrees valgus). There was one nonunion. The technique's success is dependent on neutralizing the primary factors causing malreduction: wide effective diameters of tibial nails, narrow diameter of the medial tibial metaphysis, and a posteriorly directed sagittal plane entrance angle.
TL;DR: Norian SRS proved to be clinically safe and effective as a cancellous bone cement to maintain fracture reduction of unstable extraarticular distal radius fractures.
Abstract: Objective:The purpose of the study was to evaluate the feasibility of Norian SRS bone cement injected percutaneously into a distal radius following reduction in both preventing loss of reduction as well as safety.Design:The study was a prospective clinical study with an established protocol.Setting:
TL;DR: The AO/ASIF classification for fractures of the distal tibia has good observer agreement at the type level, but poor agreement atThe group level, and the kappa coefficient of agreement was calculated and used to compare the interobserver reliability and intraobserver reproducibility of the classification systems.
Abstract: Objectives:The purpose of this study was to assess the interobserver reliability and intraobserver reproducibility of the AO/ASIF and Ruedi and Allgower classifications for fractures of the distal tibia, and to determine the benefit of a computed tomography (CT) scan and experience on observer agree
TL;DR: Significant and possibly irreversible articular cartilage damage occurs after a single high-energy impact load.
Abstract: Objectives:To investigate the biological and mechanical effects of a single-impact load on articular cartilage.Design:An in vitro laboratory study was performed using mature bovine cartilage and bone, and isolated cartilage explants. Each specimen was impacted with a single load applied with a speci
TL;DR: Avoiding the risk zone in which the infrapatellar branch of saphenous nerve would probably be located and performing a blind puncture or an arthrotomy within the safety zone may decrease the incidence of IPBSN injury.
Abstract: Objectives:To describe the course of the infrapatellar branch of saphenous nerve (IPBSN) and define a risk zone in which the nerve would probably be located.Design and Materials:The course of the IPBSN was studied in twenty-eight cadaver specimens (fifteen male and thirteen female) chosen haphazardl
TL;DR: The results support the use of an SHS and DHS composite compared with three cancellous screws in the treatment of unstable basicervical femoral neck fractures.
Abstract: Objectives:The optimal method of internal fixation of basicervical femoral neck fractures is controversial. This area represents a transition zone between the intracapsular femoral neck fracture, usually fixed with multiple cancellous screws, and the extracapsular intertrochanteric fracture, fixed w
TL;DR: It was found that pelvic trauma negatively affected the genitourinary and reproductive function of female patients and the increased rate of cesarean section in women after pelvic trauma may be multifactorial in origin and warrants further investigation.
Abstract: Objectives/Hypothesis: To evaluate the impact of a pelvic fracture on a woman's physical, sexual, and reproductive functioning. Design: Retrospective review. Setting: Level one trauma center. Patients: Two groups of female multitrauma patients: those with pelvic fractures (subjects) and those with extremity fractures but no pelvic fracture (controls). Main Outcome Measurements: Of the 302 women eligible for participation in this study, 255 (80%; 123 subjects, 118 controls) were interviewed by blinded professional interviewers regarding genitourinary symptoms, sexual function, and reproductive history. Results: Urinary complaints occurred significantly more frequently in subjects than in controls (21 versus 7%, respectively; p = 0.003), in subjects with residual pelvic fracture displacement ≥ 5 mm than in those without displacement (33 versus 14%, respectively; p = 0.018), and in subjects with residual lateral (60%) or vertical (67%) displacement than in those with medially displaced fractures (21.4%) (p = 0.04). Although both groups reported increased rates of cesarean section, this increase was statistically significant only in the subject group: 14.5% preinjury versus 48% pastinjury (p < 0.0001). Adjusting for previous cesarean sections, cesarean section was significantly more frequent in subjects with fractures initially displaced ≥ 5mm (80%) than in those with fractures initially displaced < 5mm (15%) (p = 0.02). There was no difference in the incidence of miscarriage or infertility between the groups. Problems with physiologic arousal or orgasm were rare. Pain during sex (dyspareunia)was more common in subjects with fractures displaced ≥ 5mm than in those with nondisplaced fractures (43 versus 25%, respectively; p = 0.04). Conclusions: We found that pelvic trauma negatively affected the genitourinary and reproductive function of female patients. The increased rate of cesarean section in women after pelvic trauma may be multifactorial in origin and warrants further investigation.
TL;DR: Rabbit control and fractured ribs, after healing for three, six, and twelve hours and daily for seven days, were evaluated by light and electron microscopy to document early histological and ultrastructural changes in periosteal fracture callus blood vessels.
Abstract: Objective:To document early histological and ultrastructural changes in periosteal fracture callus blood vessels.Design:Rabbit control and fractured ribs, after healing for three, six, and twelve hours and daily for seven days, were evaluated by light and electron microscopy.Results:Control perioste
TL;DR: Determination of fracture types alone (type A, B, or C) would seem to be sufficient for clinical research where fracture severity should be reported as a variable, similar to others reported for interobserver agreement with the AO/OTA fracture classification and other classification systems.
Abstract: Objectives: To evaluate the interobserver variation for the AO/OTA fracture classification system: region forty-three-pilon fractures. Methods: One senior attending, two fellows (one trauma, one foot and ankle), one junior orthopaedic resident, and one experienced research coordinator independently classified eighty-four sets of radiographs. The evaluator was blinded as to treatment and functional outcome. The radiographs initially used to manage the patients were evaluated; no special radiographs or standardized radiographic techniques were used. The kappa statistic, Williams index, and SAV statistic were calculated. Results: Using the SAV statistic to quantify rater agreement beyond that expected by chance alone, the average chance-adjusted agreement among the raters was 0.57 for fracture type, 0.43 for group, and 0.41 for subgroup. This is equivalent to moderate agreement (0.41 to 0.60). The kappa statistic was used to determine whether there was difficulty with any specific category of the AO type classification among raters for selecting fracture type (A, B, C). Kappa values were 0.49 for type A, 0.58 for type B, 0.57 for type C, all of which were considered adequate. Conclusion: These data are similar to others reported for interobserver agreement with the AO/OTA fracture classification and other classification systems. The issue of individual judgment in taking a continuous variable (fracture pattern) and compartmentalizing it into a dichotomous variable (fracture classification system) is highlighted by these data. Determination of fracture types alone (type A, B, or C) would seem to be sufficient for clinical research where fracture severity should be reported as a variable.
TL;DR: Geriatric hip fracture patients who receive allogeneic red blood cell transfusions are at higher risk for developing a postoperative urinary tract infection than are those patients who are not transfused.
Abstract: Objective:To determine whether allogeneic red blood cell transfusion is a predictor for developing an in-hospital postoperative urinary tract, respiratory, or wound infectionStudy Design:Prospective, consecutiveMethods:Six hundred eighty-seven community-dwelling, ambulatory, geriatric hip fracture
TL;DR: The indications for intramedullary nailing of unstable diaphyseal tibia fractures may be extended to include certain fractures with distal extension into the ankle joint, as well in a tibial shaft fracture occurring in combination with a noncontiguous ipsilateral ankle fracture.
Abstract: Objective: To evaluate the efficacy of intramedullary nailing in diaphyseal tibia fractures with distal intraarticular involvement. Design: Retrospective. Setting: Henry Ford Hospital, a level I trauma center. Patients/Participants: Twenty patients with twenty fractures at an average of twenty-two months of follow-up were evaluated. There were fifteen closed and five open fractures. Intervention: All fractures were stabilized with lag screw fixation (with or without supplemental plates) of the intraarticular-fracture extension or ankle fracture, and intramedullary nailing of the diaphyseal tibia fracture. Main Outcome Measurements: Time to bony union, malunion, knee and ankle range of motion, early arthrosis, and any complications of treatment were assessed. Results: Nineteen fractures healed, with an average time to bony union of seventeen weeks. One nonunion after a grade IIIB open fracture required exchange nailing and healed after sixty-two weeks. Nineteen fractures had excellent alignment after healing. There were no infections. Conclusions: The indications for intramedullary nailing of unstable diaphyseal tibia fractures may be extended to include certain fractures with distal extension into the ankle joint, as well in a tibial shaft fracture occurring in combination with a noncontiguous ipsilateral ankle fracture.
TL;DR: In transverse noncomminuted olecranon fractures, fixation with monofilament wire is superior with Kirschner wire placement into the anterior ulnar cortex with intramedullary KirSchner wires, and fixation using braided cable is significantly improved over that with mon ofilament Wire.
Abstract: Objectives/Hypothesis: Our null hypothesis was that no difference in fracture displacement would be detected between traditional monofilament wire and Kirschner wire placement versus three modified tension-band techniques for transverse olecranon fractures. Study Design: A nested form of the repeated measures design with twenty-two paired embalmed elbows (subjects grouped by sex and nested within the fracture method). Methods: Transverse osteotomies were created at the olecranon and stabilized with four techniques. One hundred cycles of loading were applied to achieve a peak flexion bending moment at the fracture of nine newton-meters. At the onset of testing, the triceps tendon was anchored at an initial elbow flexion angle of 70 degrees. Results: When using a monofilament figure-eight loop, oblique Kirschner wire placement into the anterior ulnar cortex provided greater resistance to tensile force than intramedullary Kirschner wires (p = 0.04). With intramedullary Kirschner wire placement, 1.6-millimeter-diameter braided cable in both figure-eight (p < 0.0001) and circular loop (p < 0.0001) designs allowed less fracture displacement than did the 1.0-millimeter-diameter monofilament wire. There was no difference between figure-eight and circular loop configurations when using braided cable (p = 0.98). Conclusions: In transverse noncomminuted olecranon fractures, fixation with monofilament wire is superior with Kirschner wire placement into the anterior ulnar cortex. With intramedullary Kirschner wires, fixation using braided cable is significantly improved over that with monofilament wire. When using braided cable, figure-eight and circular loop designs allow similar displacements. Braided cable or anterior cortical Kirschner wire purchase increases the stability of fixation over that achieved with the traditional method.
TL;DR: Complications associated with total hip replacement in patients with previous proximal femoral fracture fixation occurred more frequently than in patients who had not had undergone previous fracture fixation; in addition, intraoperative surgical difficulty was significantly greater in those patients whoHad undergone previous surgery for hip fracture.
Abstract: Objectives: To determine problems associated with and to present the results of secondary total hip replacement for complications of proximal femoral fractures. Setting: An acute care hospital with a prospectively entered database for primary total hip arthroplasty. Patients and Participants: The prospective database was reviewed to extract all patients undergoing primary total hip replacement for complications of treatment of proximal femoral fractures. These fifty-three patients were then compared with fifty-three patients from the same data bank matched for age, sex, weight, prosthesis type, and length of follow-up but who had not sustained a proximal femoral fracture before total hip replacement. Intervention: Primary total hip arthroplasty for complications of proximal femoral fractures. After the surgical procedure, patients were seen at follow-up intervals of three months and six months and, thereafter, yearly. Main Outcome Measurements: Patients were evaluated using the St. Michael's hip rating scale, which is a scale measuring pain, motion, and function specifically designed for evaluation of total hip arthroplasty. Routine radiographs were obtained at each patient visit. Results: The complications associated with total hip replacement in patients with previous proximal femoral fracture fixation occurred more frequently than in patients who had not had undergone previous fracture fixation; in addition, intraoperative surgical difficulty was significantly greater in those patients who had undergone previous surgery for hip fracture. However, the final hip score at ≥ 2 years after total hip arthroplasty was not statistically different between the two patient groups. Conclusion: Total hip replacement is a satisfactory salvage procedure for failed fracture treatment despite the increased incidence of operative difficulty and increased incidence of complication.
TL;DR: Reamed canal preparation led to faster healing of distal fractures treated with statically locked intramedullary nails, and blood loss was greater in the reamed group but this did not translate into increased transfusion requirements.
Abstract: Objective: To compare operative and postoperative variables in the treatment of femur fractures using interlocked intramedullary nails with and without reaming Design: Prospective and randomized Methods: 81 consecutive patients with femur fractures treated with a stainless steel statically locked intramedullary nail Whether or not reaming was done was randomized There were 42 nails placed without reaming and 39 placed with reaming There were no demographic differences between the two groups Intraoperative and postoperative variables were studied Interval healing was assessed by one observer on bimonthly radiographs Results: There were more intraoperative technical complications in the group without reaming There was no statistical difference in operative time, transfusion requirement, or time to union between the groups In the reamed group callus formation occurred faster and there was slightly more blood loss (247cc vs 396cc) (p < 005) However, when distal fractures were analyzed separately, the time to union was faster in the reamed group ( < 005) Two patients in the unreamed group and none in the reamed group developed delayed unions Pulmonary complications occurred in two patients, one in each group and did not appear to be related to the nailing Conclusion: Reamed canal preparation led to faster healing of distal fractures treated with statically locked intramedullary nails Blood loss was greater in the reamed group but this did not translate into increased transfusion requirements In this series, there was no advantage to nail insertion without reaming
TL;DR: This biomechanical study showed that the IM device provided a stronger, more stable, and durable fixation option than did PP fixation for large-fragment multipart proximal humeral fractures with minimal comminution.
Abstract: Objectives: The purpose of this study was to investigate the mechanical strength and durability of intramedullary nailing (IM) and percutaneous pinning (PP) for fixation of three-part proximal humeral fractures using a cadaveric model. Design: Three-part surgical neck fractures were created in paired embalmed cadaveric humeri. Fractures were fixed with IM and PP fixation. The fixation stiffness and durability was assessed under cyclic rotational loading (infraspinatus) ramping from 0.1 to 1.25 Newton-meters for 10,000 cycles. The specimen were then torsionally loaded to failure. Setting: Mechanical testing was performed using a servohydraulic test system (MTS, Minneapolis, MN, U.S.A.). Intervention: PP fixations were accomplished using standard multiplane techniques. IM fixation was attained using an 11.0-millimeter-diameter curved rod interlocked proximally with three splayed 5.0-millimeter cancellous screws and distally with three 3.5-millimeter cortical screws. Main Outcome Measurements: During cyclic loading the reconstruction stiffness, angular migration, and angular displacement per cycle were measured and compared between fixation methods. The ultimate torque at failure, absolute angular migration, and reconstruction stiffness during failure were recorded and compared between fixation methods during destructive testing. Results: The intramedullary device had greater stiffness and less angular displacement of fragments during cyclic loading. When loading the reconstructions to failure, the intramedullary device proved to have greater failure torques, stiffness, energy absorbed, and angular displacement before failure. Conclusions: This biomechanical study showed that the IM device provided a stronger, more stable, and durable fixation option than did PP fixation for large-fragment multipart proximal humeral fractures with minimal comminution.
TL;DR: Pain, limp and weakness are common following insertion of a femoral intramedullary nail and agluteal retracting approach may minimize abductor weakness.
Abstract: OBJECTIVES: To assess hip abductor function, strength and complaints following insertion of a femoral intramedullary nail. DESIGN: Retrospective clinical review. SETTING: Department of Orthopaedics, Adelaide Women's and Children's Hospital, Adelaide. Department of Orthopaedic Surgery and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia. PATIENTS: 1. 32 of 37 patients who had an intramedullary nail inserted for an isolated femoral shaft fracture at the Royal Adelaide Hospital between 1987 and 1990. 2. 14 of 18 patients who had closed femoral shortening for leg length discrepancy, at the Adelaide Women's and Children's Hospital between 1985 and 1987. Patients with pathology involving the abductor mechanism were excluded. 3. 40 asymptomatic controls. INTERVENTION: Intramedullary fixation for femoral shaft fractures or as part of closed femoral shortening. All procedures were performed on a traction table via a gluteal splitting approach with reamed nails. MAIN OUTCOME MEASUREMENTS: Complaints included, pain, stiffness, limp and diminished walking distance. Examination of abductor function and measurement of abductor strength. Radiological assessment at followup. RESULTS: Complaints included trochanteric pain (40%, 40%), thigh pain (10%, 8%) and limp (13%, 42%) in the femoral fracture and closed femoral shortening groups respectively. There was significant difference in the abduction strength (p < 0.01) and abduction ratio (p < 0.01) between the control and each treatment group. Abductor weakness correlated (r = 0.30) with the incidence of complaints. CONCLUSION: Pain, limp and weakness are common following insertion of a femoral intramedullary nail. Agluteal retracting approach may minimize abductor weakness.