1/48. Chronic clostridium septicum infection of a tibial fracture: a case report.An open transverse fracture of the mid-shaft of the tibia of a professional footballer became infected by clostridium septicum and, after early compression plating, required surgical intervention on three further occasions and extensive antibiotic treatment before healing occurred. Clostridial infection is a recognized complication of open fractures contaminated with soil, and the necrotizing toxins produced by the C. septicum were probably responsible for the persistence of this infection. Infection occurred in less than 1 per cent of our series of 215 operations of compression plating of fresh fractures of the tibial shaft. Infection by clostridium species is a serious complication of open fractures. This patient did not show the spreading inflammation and necrosis, or the marked systemic upset, characteristic of acute clostridial infection, but persistent local infection necessitated prolonged surgical and antibiotic treatment.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
2/48. Delayed onset of generalized tonic-clonic seizures as a complication of halo orthosis. Case report.The authors report on the case of a 29-year-old man who presented with new-onset, generalized tonic-clonic seizures 11 years after being treated with a halo orthosis for a neurologically intact C-7 fracture. neuroimaging and surgical findings indicated that the epileptic focus was scar tissue, which developed secondary to halo pin penetration of the skull. This complication of halo orthosis has not yet been reported in the literature.- - - - - - - - - - ranking = 0.125keywords = fracture (Clic here for more details about this article) |
3/48. rotation of the clavicular portion of the pectoralis major for soft-tissue coverage of the clavicle. An anatomical study and case report.BACKGROUND: The purposes of this study were to describe the anatomical features of a rotational flap consisting of the clavicular portion of the pectoralis major and to report the surgical technique and the outcome of use of this flap in a patient with poor soft-tissue coverage following multiple operations for a clavicular fracture complicated by nonunion and infection. methods: Ten shoulders from five cadavera were dissected to isolate the clavicular portion of the pectoralis major. The vascular pedicle, thoracoacromial artery, and axillary artery were identified, and the length of the vascular pedicle from the axillary artery to the muscle was measured. The angle of rotation of the flap about its intact clavicular origin was measured before and after division of the acromial branch of the thoracoacromial artery. The clavicular origin was then incised, and the overall length, width, and thickness of the muscle as well as the distance from each end of the muscle to the vascular pedicle were measured. RESULTS: The average length of the vascular pedicle from the axillary artery to the pectoralis muscle belly was 5.3 centimeters (range, 3.7 to 6.5 centimeters). The average maximum angle of rotation with the clavicular origin intact was 60 degrees (range, 55 to 67 degrees) before division of the acromial branch and 73 degrees (range, 65 to 82 degrees) after division. The average total length of the clavicular head was 20.2 centimeters (range, 18.0 to 23.0 centimeters). The average width of the clavicular head was 2.9 centimeters (range, 2.0 to 4.0 centimeters), and the average thickness was 0.5 centimeter (range, 0.2 to 0.7 centimeter). The vascular pedicle entered the muscle an average of 8.7 centimeters (range, 5.2 to 10.7 centimeters) lateral to the most medial extent of the muscle and an average of 11.5 centimeters (range, 9.5 to 14.0 centimeters) medial to the most lateral extent of the muscle. The rotational flap was successfully used clinically to provide soft-tissue coverage after bone-grafting and internal fixation of a clavicular nonunion that had been complicated by infection. CONCLUSIONS: The clavicular head of the pectoralis major may be used as a local rotational flap to cover soft-tissue deficiencies over the clavicle. It can be harvested with relative ease without damaging the sternocostal head.- - - - - - - - - - ranking = 0.125keywords = fracture (Clic here for more details about this article) |
4/48. 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 = fracture (Clic here for more details about this article) |
5/48. Treatment of traumatic mandibular nonunion.BACKGROUND AND OBJECTIVES: Nonunion is a complication in mandibular fractures. The causative factors include delay in treatment, infection, inadequate immobilization, and improper internal fixation; concomitant infection may be present. pain, mobility of the fracture segments, and radiographic evidence of radiolucency did in diagnosis. methods AND MATERIALS: Three clinical cases are used to present the methods of treatment to manage nonunion following a gunshot wound, assault with a blunt object, and a fall. Treatment included antimicrobial therapy, fracture site debridement, segment immobilization, and bone grafting. Maxillomandibular fixation, debridement, and placement of a reconstruction plate were used in the first case; reconstruction plate, autogenous bone graft in a polyglactin resorbable mesh, and screw buttons in the second; and custom reconstruction plate and iliac crest bone graft in the third. RESULTS AND/OR CONCLUSIONS: All cases healed uneventfully. Due to rapid revascularization, use of autogenous cancellous bone grafts is preferred to cortical bone. Custom-molded polyglactin mesh provides control of the loose cancellous bone graft.- - - - - - - - - - ranking = 0.375keywords = fracture (Clic here for more details about this article) |
6/48. Fatal necrotizing fasciitis following a mandibular fracture.Necrotizing fasciitis of the head and neck is an uncommon, insidious infection that usually occurs secondarily to odontogenic infections, although blunt and penetrating trauma can be another cause. Of 65 total reported cases of necrotizing fasciitis, 10 (15.4%) have been fatal. This article presents a case of a mandibular fracture in a severely immunocompromised elderly patient in whom delayed treatment proved fatal. The clinician must remain suspicious of any infection refractory to antibiotic therapy alone, since necrotizing fasciitis is a rapidly progressing condition with high morbidity and potential for mortality. Rapid diagnosis, surgical treatment, antibiotic therapy, medical management, nutritional support, and early detection and treatment of complications are critical elements in the management of necrotizing fasciitis.- - - - - - - - - - ranking = 0.625keywords = fracture (Clic here for more details about this article) |
7/48. Kuntscher intramedullary reaming and nail fixation for nonunion of the forearm.Twenty cases of nonunion of forearm fractures were treated by the Kuntscher method of intramedullary reaming and nailing. Fifteen fractures healed per primam; 2 required renailing; 2 did not heal but the patients benefited from the stabilizing effect of the nail; 1 was lost to follow-up. Even infected cases could be treated successfully by this method, but extensive experience with all the details of the surgical technique may constitute the difference between catastrophic failure and success. Excision of sinus tracts and sequestrectomy were done as a preliminary procedure.- - - - - - - - - - ranking = 0.25keywords = fracture (Clic here for more details about this article) |
8/48. review of the management of open fractures.This article presents a literature review of the evaluation and management of open fractures. A case report of a patient having sustained a type II open fracture of the hallux is presented. debridement, tetanus prophylaxis, reduction and stabilization, and intravenous antibiosis are the hallmarks for prompt and appropriate treatment.- - - - - - - - - - ranking = 0.75keywords = fracture (Clic here for more details about this article) |
9/48. wound infection due to absidia corymbifera and candida albicans with fatal outcome.A case of a mixed infection due to candida albicans and the zygomycete absidia corymbifera in a 38-year-old, previously healthy, Caucasian male is presented. The infection developed following serial rib fractures, and ruptures of kidney, liver and biliary tract as well as a pancreatic contusion resulting from a traffic accident. During intensive care treatment the patient underwent several surgical procedures but subsequently experienced multi-organ failure and sepsis. Some weeks later, fungal growth was observed macroscopically on the patient's skin and wounds. From wound swabs C. albicans and A. corymbifera were grown. Histopathology of abdominal tissue yielded pseudohyphae and coenocytic hyphae. Although surgical debridement and antifungal treatment with amphotericin b and 5-flucytosine were started immediately, the patient died in therapy-refractory septic multi-organ failure.- - - - - - - - - - ranking = 0.125keywords = fracture (Clic here for more details about this article) |
10/48. Rigid internal fixation for the treatment of infected mandibular fractures.A review of the literature is presented that shows that treatment of infected fractures by rigid internal fixation is biologically sound. A protocol for managing infected mandibular fractures with plate and screw fixation was developed and used on 11 patients. All patients had osseous union of the fracture and none required removal of the bone plate. This protocol is recommended as a viable option in the treatment of infected mandibular fractures.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
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