Cases reported "Fractures, Open"

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1/56. 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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2/56. Is there a place for external fixation in humeral shaft fractures?

    There is a good indication for unilateral axial dynamic external fixation in fractures of the humeral shaft when the fracture appears in the distal third or in cases of bilateral fractures. A non-union or a posttraumatic paralysis of the radial nerve may be indications for external fixation as well as fractures associated with multiple injuries. Further indications include osteitis, infected non-union and comminuted fracture. There is maximum protection of the soft tissue with this method of treatment. External fixation combines the advantages of conservative and operative treatment by influencing callus formation by dynamizing, distraction or compression. Minimizing soft tissue damage facilitates the decision for early exploration of the radial nerve in cases of palsy. A safer positioning technique of the distal screws of the fixator is described.
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keywords = operative
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3/56. Successful free flap transfer following venous thrombectomy in recipient vessel.

    We report the case of a 53-year-old male patient who suffered a high velocity multiple trauma with bilateral open tibial fractures. At definitive orthopaedic and plastic surgical reconstruction 5 days post initial trauma, he was found peroperatively to have an existing deep venous thrombosis in his popliteal vein on one side. He underwent venous thrombectomy and had subsequent successful latissimus dorsi flap transfer using the unblocked popliteal vein as a recipient vessel.
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keywords = operative
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4/56. Treatment of infection and non-union after bilateral complicated proximal tibial fracture.

    BACKGROUND AND AIMS: Complicated tibial fractures form a great challenge for orthopaedic surgeons. Non-unions and infections are more common in complicated than in closed fractures. In the present study, we describe a patient case treated for non-union combined to chronic osteomyelitis after bilateral open proximal tibial fractures. MATERIAL AND methods: A female patient born in 1946 was multi-traumatised, when a car hit her as a pedestrian. She went through multiple operations of both tibias due to bilateral complicated proximal fractures. Fractures were stabilised at first with internal fixation, which had to be changed to external fixation due to infection of both sides. During the last operative step a commercial bone graft based on hydroxyapatite and bovine type I fibrillar collagen/tricalcium phosphate ceramic (Collagraft) mixed with autogenous bone marrow was applied. RESULTS: Fractures united after 28 (right tibia) and 22 (left tibia) months of follow-up. At the final follow-up visit 55 months after the initial accident patient walked without any aid and showed no signs of an infection. CONCLUSIONS: The use of commercial mixed xeno-/autogenous-bone graft may provide a feasible alternative in complicated chronic non-unions of the tibia even when an infection is present, especially when autogenous bone is not easily available after previous attempts of bone grafting.
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keywords = operative
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5/56. Free tissue transfer in pregnancy: guidelines for perioperative management.

    A successful free tissue transfer of serratus anterior muscle, to provide coverage for an open ankle defect in a pregnant patient, is described. Microvascular surgery in the presence of a viable pregnancy demands considerations unique to this situation. Although rarely possible, an attempt should be made to plan surgery to coincide with the second trimester, to lessen the risk of anesthesia to the fetus. Maternal positioning, fluid balance, and aspiration precautions need to be critically addressed. Close perioperative monitoring by an obstetrician is essential. The condition of pregnancy results in a hypercoagulable state that may lead to an increased risk of anastomotic failure. The use of anticoagulants results in increased risk of bleeding, not only for the patient but also for the fetus, as well as risk of teratogenic effects. Closely monitored heparin is considered safe in pregnancy as is low-molecular-weight dextran and low-dose aspirin. Additional considerations include the use of narcotics and sedatives for comfort postoperatively, as well as antibiotic choices, if indicated.
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ranking = 6
keywords = operative
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6/56. Open iliac wing fracture caused by penetrating injury from a bicycle handlebar.

    Bicycle accidents have been documented as one of the most common mechanisms of accidents in children. Several reports describe intra-abdominal injury secondary to bicycle handlebars. Reported injuries include liver and spleen trauma, bowel perforation, and pancreatitis. However, there are few reports of penetrating handlebar injuries. We report a case of a penetrating bicycle handlebar producing an open iliac wing fracture. A number of reports have stressed the dichotomy between the benign external appearance and the potential severity of the intra-abdominal injury after a bicycle handlebar injury. Thus, a high index of suspicion must be maintained when evaluating a child after such an injury. All patients with a significant mechanism should have a thorough and complete evaluation, including radiographs. As with all traumatic injuries, a multidisciplinary approach is often required to efficiently manage these injuries. Although uncommon, open pelvic injuries in children do occur. The principles of management are the same in children as they are in adults. All children with open pelvic fractures require emergent operative debridement and, if indicated, stabilization. Special attention should be given to ensure that the gastrointestinal and genitourinary tracts do not communicate with the fracture. With attention to these fundamental principles, severe pelvic injuries in children can be managed with few long-term sequelae.
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keywords = operative
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7/56. The simple and effective choice for treatment of chronic calcaneal osteomyelitis: neurocutaneous flaps.

    The authors describe their experience with the use of distally based saphenous and sural neurofasciocutaneous flaps for the treatment of calcaneal osteomyelitis in nine cases. Aggressive debridement of all nonviable and poorly vascularized tissue and coverage with a distally based neurofasciocutaneous flap were coupled with a thorough antibiotic course in all cases. The deepithelized peripheral parts of all flaps were buried in the bone cavities after bone debridement. Follow-up periods ranged from 15 to 27 months. All flaps survived completely. All of the wounds except one healed completely. These flaps have adequate blood flow for the management of chronic bone infections. They also have many advantages, such as easy quick elevation, short operative time, and acceptable donor-site morbidity. Moreover, patients treated with neurocutaneous flaps do not require debulking procedures or special shoes. Reconstruction with neurocutaneous flaps after radical debridement is a versatile alternative to the use of local or distant muscle flaps and calcanectomy procedures for patients with osteomyelitis of the os calcis.
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ranking = 1
keywords = operative
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8/56. Tibio-talo-calcaneal fusion with a free vascularized fibular graft in comminuted open fractures of the talus and the calcaneus.

    An operation is described in which a free vascularized fibular graft with a peroneal cutaneous flap is used for tibio-talo-calcaneal fusion and simultaneous skin coverage in treatment of comminuted open fractures of the talus and the calcaneus involving large skin loss. Nine months postoperatively, the tibio-talo-calcaneal arthrodesis was successful, with good coverage of the skin defect on the medial aspect of the sole. One year 7 months postoperatively, the patient is free of pain and able to walk with full weightbearing on the foot.
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ranking = 2
keywords = operative
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9/56. Total extrusion of the talus: a case report.

    Total extrusion of the talus without recovery of the bone is a very unusual injury. The authors present a case of a 25-year-old man who sustained an open total enucleation of the talus in a motorcycle accident. The talus was not recovered at the scene of the accident. An immediate tibiocalcaneal stabilization was performed by using an external fixator. In the postoperative period, a polymicrobic infection was observed and treated with parenteral antibiotics. Nine months after injury, the patient developed an infection of both the empty space and the distal third of the tibia. A wound debridement with tibial sequestrectomy and insertion of gentamicin-impregnated polymethylmethacrylate beads was performed. Three months later, after multiple negative bacteriologic examinations, a tibiocalcaneal arthrodesis with staples and autogenous bone graft was performed. Because of a pseudoarthrosis, the patient underwent a revision of the arthrodesis by retrograde tibiocalcaneal nailing, achieving clinical and radiographic success. The definitive treatment of total enucleation of the talus is still controversial because of its rarity and the high rate of complications, such as avascular necrosis, osteomyelitis, and ankle stiffness. In this case, without recovery of the talus, retrograde nailing afforded good stability by bypassing the bone defects.
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ranking = 1
keywords = operative
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10/56. tibial fractures. The Ilizarov alternative.

    Between February 1988 and May 1989, 17 consecutive patients with 18 tibial fractures were treated using the Ilizarov method and apparatus. Injuries included four closed fractures and 14 open fractures. There were three Grade I open, four Grade II open, and seven Grade III open tibial fractures. Indications for application of the Ilizarov frame included fractures that were determined to need surgical management primarily, or fractures that had failed to heal by other treatment methods, either operative or nonoperative. patients averaged 17.7 months of follow-up treatment. One patient was lost to follow-up treatment after the fracture healed and the device was removed. To date, all fractures are healed. There was one delayed union, which subsequently healed with a second application of the device. Complications included two late wound infections, both in Grade III open fractures. These occurred after removal of the Ilizarov apparatus. The average time from application of the device to complete fracture healing was 5.6 months, with a range of 3.25 to 13 months. This compares favorably with the results described for other treatment modalities. These results indicate that the Ilizarov method is indeed a useful adjunct in the orthopedic armamentarium for the treatment of either open or closed tibial fractures. No practical contraindications to the use of the Ilizarov device in the management of tibial fractures were encountered.
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ranking = 2
keywords = operative
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