Cases reported "Fractures, Comminuted"

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1/37. Sideswipe elbow fractures.

    A retrospective review of all cases of sideswipe elbow fractures (SSEFs) treated at two community hospitals from 1982 to 1992 was conducted to determine the functional outcome of the operative treatment of SSEFs. All five injuries involved the left elbow, and they included open fractures of the olecranon, the radius and ulna, the ulna and humerus, the humerus, and traumatic amputation of the arm. Concomitant injuries included three radial nerve palsies and two injuries each to the median nerve, ulnar nerve, and brachial artery. Treatment included irrigation, debridement (repeated if necessary), open reduction and internal fixation, external fixation (one case), and delayed amputation (one case). An average of 130/-10 degrees elbow flexion/extension, and 60/60 degrees supination/pronation was obtained for the three of four patients with reconstructions who returned for follow-up.
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ranking = 1
keywords = operative
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2/37. Combined talar body and tibial plafond fracture: a case report.

    We report a case of a crush fracture of the body of the talus associated with an anterior tibial plafond fracture. This injury is a rare variant of talar body fracture which merits special attention. The bony injury in this type of fracture is associated with multiple loose fragments involving both weightbearing surfaces of the ankle joint. After appropriate imaging to allow preoperative planning, we utilized a two-incision approach which was necessary to achieve adequate exposure and fixation. We used basic fracture management principles to deal with a previously undocumented fracture pattern.
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ranking = 1
keywords = operative
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3/37. Comminuted pelvic ring disruption in toddlers: management of a rare injury.

    Pediatric pelvic fractures are rare injuries. The clinical management, classification, and operative treatment of this type of injury was presented in two toddlers ranging in age from 1 to 3 years. The CT examination proved to be the most reliable diagnostic tool for the assessment of the fracture morphology. The findings of the CT examination provide the possibility for an exact classification and operative planning. The surgical treatment was performed with the AO instrumentation for small fragments by using the approved standard approaches of adult surgery. The postoperative management has to be adapted to the physiology of the children. It is important to remove the osteosynthesis material in due time to avoid the risk of epiphysiodesis at the pelvis. To detect late sequelae of the trauma, follow-up should be performed regularly until growth is completed.
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ranking = 3
keywords = operative
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4/37. Intraoperative imaging of the tibial plafond fracture: a potential pitfall.

    STUDY DESIGN: Human tibial plafond cadaveric specimens were coronally sectioned and imaged to assess the accuracy of evaluation of ankle joint line congruity using anteroposterior radiography. Two interesting representative clinical cases are discussed. OBJECTIVES: To evaluate the validity of the routine use of anteroposterior radiographs to evaluate intra-operative ankle joint line congruity in circumstances where lateral radiographs are infeasible due to obscuring internal or external hardware. methods: Eleven frozen human cadaveric lower extremity specimens were used in this study. At the level of the tibial plafond, the specimens were sequentially sliced into 0.5cm sections in the coronal plane. True anteroposterior radiographs were taken with the specimen en bloc. Sequentially, the posterior slices were removed one by one, with an image taken after removing each section. The process was then repeated by removing the anterior sections sequentially with intervening radiographs. Each series of anteroposterior radiographs was then evaluated to characterize which portion of the joint line on the whole specimen view had been contributed by each of the sections. This then allowed us to make inferences about the evaluation of the joint line if it had been derived solely by anteroposterior radiography. Two poignant clinical cases demonstrating the clinical relevance of this information are discussed. RESULTS: By sequentially imaging after removing coronal sections of the tibial plafond we were able to accurately characterize the contribution of each portion of the plafond to the overall anteroposterior view. By primarily imaging the anterior portions of the plafond, with the posterior portions removed, the joint line image was virtually unchanged from the en bloc anteroposterior radiograph. However, removal of the anterior coronal sections caused large variation in the joint line image. These observations demonstrate that the anteroposterior radiograph of the tibial plafond characterizes the anterior portion of the joint well, while it represents a poor assessment of the posterior portion of the joint. This was well illustrated in our clinical case presentations. CONCLUSION: In severe fractures of the tibial plafond multiple forms of internal and external devices are frequently used for fixation. In these circumstances hardware may obscure the lateral view making it impossible to obtain adequate lateral radiographs to assess fracture reduction and joint line congruity. In this scenario, the anteroposterior radiograph is frequently relied upon to confirm the anatomic relationship of the displaced fragments. However, this view fails to accurately characterize reduction in the entire joint line and, intra-operatively, may mislead the surgeon to accept a reduction as anatomic when intra-articular incongruity still exists. Strict attention to pre-operative radiographs and the use of additional rotated views may aid the surgeon in this setting to assess fracture reduction and joint line congruence.
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ranking = 7
keywords = operative
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5/37. Immediate tibiocalcaneal arthrodesis with interposition fibular autograft for salvage after talus fracture: a case report.

    Treatment goals in the operative management of talus fractures include prompt, anatomic, open reduction with rigid internal fixation; functional outcome is measured by degree of arthrosis, pain, range of motion, limb length, cosmesis, and return to premorbid activities. If restoration of the articular surfaces is precluded secondary to comminution, immediate and/or staged reconstructive salvage procedures must be considered. This report describes an immediate reconstructive procedure for salvage after a comminuted talus fracture with an ipsilateral tibia fracture. A standard antegrade tibial nail extending into the calcaneus was selected to stabilize both fracture sites. The technique of tibiocalcaneal arthrodesis using interposition fibular autograft and intramedullary fixation is presented as a unique treatment option.
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ranking = 1
keywords = operative
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6/37. Comminuted fracture-dislocations of the elbow treated with an AO wrist fusion plate.

    Comminuted fracture-dislocations of the elbow are complex injuries that can result in significant postoperative loss of motion. Rigid anatomic fixation with early range of motion is the required treatment. Because of the local anatomy of the proximal ulna, it often is difficult to achieve a rigid fixation construct. A fixation technique of a dorsally applied AO limited contact-dynamic compression wrist fusion plate contoured to fit the anatomy of the proximal ulna is presented. Advantages of the AO wrist fusion plate in comminuted olecranon fractures include the ease of contouring, a low profile, and the use of variable screw hole sizing to achieve stable fixation. The hybrid design allows for rigid 3.5-mm plate fixation distally while providing low profile 2.7-mm plate fixation over the subcutaneous olecranon. The technical and biomechanical features of this plate make it an ideal alternative for fixation of these complex injuries.
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ranking = 1
keywords = operative
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7/37. Trimalleolar fracture with a double fragment of the posterior malleolus: a case report and modified operative approach to internal fixation.

    Fractures of the medial and lateral malleoli are frequently associated with fractures of the posterior malleolus, comprising trimalleolar fractures. The posterior fragment may be posteromedial or posterolateral and its size determines the necessity for surgical or non-surgical treatment. The authors describe a case of trimalleolar fracture with double involvement of the posterior malleolus, both a posteromedial and posterolateral fragment. A modified transmalleolar operative approach for internal fixation is recommended when dealing with such complex trimalleolar fractures of the ankle.
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ranking = 5
keywords = operative
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8/37. titanium mesh repair of the severely comminuted frontal sinus fracture.

    BACKGROUND: Severely comminuted frontal sinus fractures are difficult to contour and immobilize. Frequently, plates or wires are inadequate in fixating all fragments together, resulting in less than optimal outcomes. Advancements in the development of biomaterials have now made titanium mesh a new option for the repair of severely comminuted fractures. methods: Fourteen patients with severely comminuted frontal sinus fractures were treated with titanium mesh from 1994 to 1999. The fractures were reduced and immobilized using a simple algorithm: (1) Isolated anterior table fractures were repaired with reduced bony fragments attached to titanium mesh. (2) Anterior table fractures with nasofrontal duct involvement were repaired by sinus obliteration and anterior wall reconstruction with reduced bony fragments attached to titanium mesh. (3) Anterior and posterior table fractures with cerebrospinal fluid leak or displacement were treated with the cranialization of the sinus and anterior wall reconstruction with reduced bony fragments attached to titanium mesh. RESULTS: Of the 14 patients treated, 12 were available for postoperative evaluation. Parameters such as nasal function, cranial nerve V and VII function, cosmesis, and complications (hardware extrusions, sinusitis, meningitis, osteomyelitis, mucopyocele, brain abscess, pneumocephalus, and cerebrospinal fluid leak) were evaluated. All patients had good function of the superior division of cranial nerves V and VII. Two patients (16%) had minor wound infections, which resolved under treatment with antibiotics. All had excellent cosmetic results as measured by postreduction radiographs and personal and family perceptions of forehead contour. CONCLUSION: titanium mesh reconstruction of severely comminuted frontal sinus fractures has few complications while providing excellent forehead contour and cosmesis.
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ranking = 1
keywords = operative
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9/37. Coronal split fracture of the proximal tibia epiphysis through a partially closed physis: a new fracture pattern.

    SUMMARY: A comminuted coronal split fracture of the proximal tibial epiphysis is an uncommon injury in children. The authors evaluated and treated two patients who sustained an epiphyseal fracture through a partially closed proximal tibial epiphysis. Plain radiography and computed tomography with three-dimensional reconstruction showed a comminuted coronal split fracture of the proximal tibial epiphysis. Each patient underwent definitive operative fixation of the fracture and was followed at least 1 year after clinical union. A mechanism consisting of three-point bending on the tibial plateau is proposed.
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ranking = 1
keywords = operative
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10/37. Orbital deformity after craniofacial fracture repair: avoidance and treatment.

    BACKGROUND AND OBJECTIVES: To achieve the optimal preoperative appearance following craniofacial fracture repair, the surgeon must be facile in the most sophisticated reconstructive techniques and able to determine their application. The purpose of this article is to describe the common deformities following such repairs, outline a strategy to avoid them, and review the surgical techniques to correct them. methods AND MATERIALS: The deformities are categorized by the anatomic zones of the orbit, i.e., zygomatic, frontal, and nasoethmoidal, affected by low-, middle-, and high-energy impact. The common types of deformity and acute and late treatments are discussed for each category. RESULTS AND/OR CONCLUSIONS: The optimal time to correct posttraumatic orbital deformities is during the acute phase. Extended open reduction and rigid fixation techniques have their own morbidity, which must not outweigh the deformity of an untreated or partially treated injury. The results of late reconstruction are always limited by scarring of the overlaying soft tissue envelope.
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ranking = 1
keywords = operative
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