1/13. [Primary Ilizarov ankle fusion for nonreconstructable tibial plafond fractures]OBJECTIVE: ankle arthrodesis in a plantigrade position. In high-energy open injuries with segmental bone loss: proximal tibial metaphyseal corticotomy with distal Ilizarov bone transport for compensation of leg length discrepancy. INDICATIONS: Posttraumatic loss of the tibial plafond, usually resulting from open fracture type IIIC. CONTRAINDICATIONS: Ipsilateral foot injuries impairing ambulation after fusion. Severe injury to the posterior tibial nerve with absent plantar sensation. Soft-tissue injury not manageable surgically. Inadequate patient compliance. Advanced age. Severe osteoporosis. Acute infection. SURGICAL TECHNIQUE: Standard technique: anteromedial longitudinal incision. Removal of remaining articular cartilage. Passing of Ilizarov wires through the distal fibula, talar neck and body. Placement of 5-mm half-pins through stab incisions, perpendicular to the medial face of the tibial shaft. A lateral to medial 1.8-mm Ilizarov wire in the proximal tibial metaphysis is optional. Callus distraction/Ilizarov bone transport: exposure through an anteromedial incision or transverse traumatic wound. Removal of small residual segment of tibial plafond blocking transport. Retain small vascularized bone fragments not blocking transport. For Ilizarov external fixation, two rings in the proximal tibial region. Drill osteoclasis of the tibial metaphysis 1 cm distal to the tibial tuberosity and complete with Ilizarov osteotome. Secure the Ilizarov threaded rods or clickers. Weight bearing as tolerated. Begin distraction 14 days after corticotomy at a rate of 0.5-1 mm per day depending on patient's age. After docking: Ilizarov ankle arthrodesis. RESULTS: Between January 1993 and September 1996, four patients (two men, two women) with severe, nonreconstructable fractures of the tibial plafond were treated. Callus distraction and Ilizarov bone transport in three patients. Age range 19-68 years (average age 45.7 years). Mean follow-up 6.6 years (4 years 9 months to 7 years 4 months). Average duration of the entire treatment in external fixation 54.4 days/cm for the three bone distraction patients. Mean transport 6 cm (4.5-8.5 cm). One patient required repeat ankle arthrodesis.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
2/13. Description of Mycobacterium conceptionense sp. nov., a mycobacterium fortuitum group organism isolated from a posttraumatic osteitis inflammation.A nonpigmented rapidly growing mycobacterium was isolated from wound liquid outflow, bone tissue biopsy, and excised skin tissue from a 31-year-old woman who suffered an accidental open right tibia fracture and prolonged stay in a river. The three isolates grew in 3 days at 24 to 37 degrees C. 16S rRNA sequence analyses over 1,483 bp showed that they were identical and shared 99.7% (4-bp difference) sequence similarity with that of Mycobacterium porcinum, the most closely related species. Partial rpoB (723 bp) sequence analyses showed that the isolates shared 97.0% sequence similarity with that of M. porcinum. Further polyphasic approaches, including biochemical tests, antimicrobial susceptibility analyses, and hsp65, sodA, and recA gene sequence analysis, as well as % G C determination and cell wall fatty acid composition analysis supported the evidence that these isolates were representative of a new species. Phylogenetic analyses showed the close relationship with M. porcinum in the mycobacterium fortuitum group. The isolates were susceptible to most antibiotics and exhibited evidence for penicillinase activity, in contrast to M. porcinum. We propose the name Mycobacterium conceptionense sp. nov. for this new species associated with posttraumatic osteitis. The type strain is D16(T) (equivalent to CIP 108544(T) and CCUG 50187(T)).- - - - - - - - - - ranking = 0.16666666666667keywords = fracture (Clic here for more details about this article) |
3/13. Supracondylar-intercondylar fractures of the femur. Treatment by internal fixation.The records on fifty-two supracondylar-intercondylar fractures of the femur were reviewed twenty to 120 months after injury. More than one-third of the fractures had been open. All of the fractures were treated in a single trauma center, using: (1) a single lateral incision, (2) internal fixation with ASIF interfragmentary screws and plates, (3) bone-grafting of comminuted metaphyseal segments, (4) impaction of comminuted metaphyseal segments in osteoporotic elderly patients, and (5) repair of any associated torn ligaments and patellar fractures. Postoperatively, early active motion of the knee was encouraged, and for selected patients a brace was used only to protect the repair of associated disruptions of ligaments or of the extensor mechanism. The fractures were classified by the ASIF system, with C1 being a simple Y pattern, C2 having additional supracondylar comminution, and C3 having intra-articular comminution. The final results were rated using the system that was described by Neer et al. for fractures of the distal end of the femur. The average time between the operation and full weight-bearing (healing) was 13.6 weeks and ranged from 12.3 weeks for C1 fractures (as graded using the ASIF classification) to 15.4 weeks for C3 fractures. The average final arc of motion of the knee was 107 degrees, ranging from 113 degrees for C1 fractures to 99 degrees for C3 fractures. C1 fractures had a better outcome (92 per cent excellent and good results) than did C2 and C3 fractures (77 per cent excellent and good results). Two amputations and one arthrodesis were done to treat infection, and infection accounted for three of the four poor results. Age did not influence the final results, although elderly patients had a longer period of hospitalization. Supracondylar-intercondylar fractures of the femur should be analyzed separately from other fractures of the distal end of the femur because of their intra-articular involvement and associated ligamentous injuries and patellar fractures. Rigid internal fixation permits early functional rehabilitation of the patient and decreases the incidence of malunion, non-union, and loss of fixation.- - - - - - - - - - ranking = 3.1666666666667keywords = fracture (Clic here for more details about this article) |
4/13. Immediate internal fixation of open fractures of the diaphysis of the forearm.Between 1975 and 1983, fifty-seven patients were treated at Sunnybrook and Harborview Medical Centers with immediate internal plate fixation of an open diaphyseal fracture of the forearm. Fifty patients were available for follow-up, which ranged from one to nine years and averaged three years. The injuries were classified on the basis of the extent of soft-tissue injury as defined by Gustilo and Anderson, and consisted of twenty Type-I injuries, nineteen Type-II injuries, and eleven Type-III injuries. The complications included deep infection in two patients and non-union in six. The functional results were excellent or good in 85 per cent of the series. This study demonstrates that immediate stable plate fixation is a beneficial method of treatment of open fractures of the forearm. The results are related to the severity of the initial soft-tissue injury and the surgical technique. Autogenous cancellous bone-grafting at the time of closure of the wound in comminuted fractures in which interfragmental compression cannot be obtained is recommended.- - - - - - - - - - ranking = 1.1666666666667keywords = fracture (Clic here for more details about this article) |
5/13. Musculoskeletal lesions in yaws.yaws, a spirochetal infection that is endemic in certain tropical countries, including malaysia, may present with various orthopedic problems. As the condition is relatively unknown, diagnosis is often missed, which leads to poor management. There are initial, early, and late phases of the disease process. By involving skin, bone, and joints, yaws can produce deep ulcerations, joint deformities, and bone destruction. Within a ten-year period in malaysia, 14 cases of serologically proven yaws have been treated for chronic ulcers, gross joint deformities, and pathologic fractures.- - - - - - - - - - ranking = 0.16666666666667keywords = fracture (Clic here for more details about this article) |
6/13. Differential diagnosis of brown tumor vs. cystic osteitis by arteriography and computed tomography.An expansile lytic lesion of bone can be either a brown tumor or a cyst when the patient has hyperparathyroidism. If weight-bearing bones are involved, the diagnosis must be made prior to parathyroidectomy in order to avert a possible pathological fracture. In the authors' patient, arteriography and computed tomography both demonstrated that the lesion in question was a brown tumor, which is hypervascular and clearly separable from a fluid-filled cyst; however, CT has the advantage of being a noninvasive procedure.- - - - - - - - - - ranking = 0.16666666666667keywords = fracture (Clic here for more details about this article) |
7/13. Isolated pathological fracture of the capitate bone. A case report.Isolated fracture of the capitate bone is rare, but an isolated pathological fracture due to leprosy has not been previously reported. Although varying degrees of trauma is implied to be associated with fractures, this case illustrates a pathological fracture of the capitate apparently due solely to a specific disease. Fracture has occurred without a history of trauma and there has been no displacement of the fragments on x-rays over a period exceeding ten years even though it has been subjected to unrestricted activities by the patient who has clinically inactive disease.- - - - - - - - - - ranking = 1.3333333333333keywords = fracture (Clic here for more details about this article) |
8/13. Traumatic osteitis pubis: the gracilis syndrome.The "gracilis syndrome," a fatigue fracture of traumatic etiology involving the bony origin of the gracilis muscle at the pubic symphysis, is akin to traumatic osteitis pubis and injuries of the adductor longus muscle origin. It is a well-recognized and reported injury in European athletes, but has received less attention in north america. This paper describes a case of this syndrome in a 23-year-old male athlete with a 2-year history of groin, perineal and medial thigh pain, of gradual onset, associated with his participation in rather violent contact sports. The only positive finding on examination was the belated appearance of local tenderness over the symphysis pubis. Radiographically, a bony fragment, including the inferior corner of his left pubis at the symphysis, could be identified. This lesion was surgically excised, and the patient was relieved of his symptoms. The histopathological features of the fragment revealed both viable and nonviable bony trabeculae embedded in fibrous tissue, suggesting that the lesion is an avulsion type of fatigue fracture with the avulsion related to the directional pull of the gracilis muscle.- - - - - - - - - - ranking = 0.33333333333333keywords = fracture (Clic here for more details about this article) |
9/13. Microvascular osteocutaneous groin flap in the treatment of an ununited tibial fracture with chronic osteitis. A case report.A 37-year-old man with an ununited tibial fracture combined with a significant skin defect underwent a microvascular transfer of an island osteocutaneous flap of groin skin and iliac crest bone. The bone component of the flap was shown to be a living transplant by the observation of brisk cancellous bone bleeding when the flap was isolated on its vascular stalk; by rapid fracture healing (weight-bearing 15 weeks postoperatively); and sequential bone scan investigations. Various aspects of the flap blood supply, particularly to bone, are discussed, and reference is made to the use of a more suitable vessel system.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
10/13. The treatment of osteitis complicating tibial fractures.A six-part scheme for the treatment of osteitis complicating tibial fractures is presented: (1) wound excision; (2) external fixation; (3) open irrigation drainage; (4) cancellous bone grafting; (5) split skin grafting; (6) full weight bearing in a plaster cast. Of 20 cases, 14 of which were ununited, remission of the infection was achieved in 17 with in 27 months (mean 10.8 months). All 14 ununited fractures went on to union within 20 months (mean 9.5 months).- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
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