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Strategies in Trauma and Limb Reconstruction

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https://www.readbyqxmd.com/read/30232655/two-consecutive-limb-lengthenings-with-the-same-precice-nail-a-technical-note
#1
André Couto, Joana Freitas, Nuno Alegrete, Jorge Coutinho, Gilberto Costa
PURPOSE: The most significant advance in our time about limb lengthening is the magnetic lengthening nail, as the first reports appeared to show good results with accurate lengthening rates and good regenerate bone formation. The described complication rate is generally low. They avoid external fixation elements, and are activated transcutaneously, so the patient's pain and discomfort are reduced and the rehabilitation is faster and more effective. The aim of authors is to describe a special technical issue of the PRECICE system: the nail can be extended inside the patient limb (after the osteotomy), but it also can be retracted inside the limb after achieving the bone union...
September 19, 2018: Strategies in Trauma and Limb Reconstruction
https://www.readbyqxmd.com/read/30220005/effect-of-external-fixation-rod-coupling-in-computed-tomography
#2
Carlos A Peña-Solórzano, Matthew R Dimmock, David W Albrecht, David M Paganin, Richard B Bassed, Mitzi Klein, Peter C Harris
External fixation is a common tool in the treatment of complex fractures, correction of limb deformity, and salvage arthrodesis. These devices typically incorporate radio-opaque metal rods/struts connected at varying distances and orientations between rings. Whilst the predominant imaging modality is plain film radiology, computed tomography (CT) may be performed in order for the surgeon to make a more confident clinical decision (e.g. timing of frame removal, assessment of degree of arthrodesis). We used a fractured sheep leg to systematically assess CT imaging performance with a Discovery CT750 HD CT scanner (GE Healthcare) to show how rod coupling in both traditional Ilizarov and hexapod frames distorts images...
September 15, 2018: Strategies in Trauma and Limb Reconstruction
https://www.readbyqxmd.com/read/30203142/transverse-debridement-and-acute-shortening-followed-by-distraction-histogenesis-in-the-treatment-of-open-tibial-fractures-with-bone-and-soft-tissue-loss
#3
Saif Salih, Edward Mills, Jonathan McGregor-Riley, Mick Dennison, Simon Royston
This retrospective case series evaluates the technique of transverse debridement, acute shortening and subsequent distraction histogenesis in the management of open tibial fractures with bone and soft tissue loss, thereby avoiding the need for a soft tissue flap to cover the wound. Thirty-one patients with Gustilo grade III open tibial fractures between 2001 and 2011 were initially managed with transverse wound extensions, debridement and shortening to provide bony apposition and allowing primary wound closure without tension, or coverage with mobilization of soft tissue and split skin graft...
September 11, 2018: Strategies in Trauma and Limb Reconstruction
https://www.readbyqxmd.com/read/30159719/rehabilitation-post-distraction-osteogenesis-for-brachymetacarpia-a-case-report
#4
Emily S Ho, Catharine S Bradley, Gregory H Borschel, Simon P Kelley
Distraction osteogenesis for brachymetacarpia has been described in several small case series and single case reports, but the rehabilitation required to optimize outcomes has not been reported. We present a case report describing the hand rehabilitation program of a 13-year-old girl with congenital brachymetacarpia who underwent distraction osteogenesis of the third metacarpal. Intense weekly hand therapy including desensitization, scar massage, range of motion exercises and splinting was essential up to 28 weeks postoperatively to address the progressive changes in the anatomical structures...
August 29, 2018: Strategies in Trauma and Limb Reconstruction
https://www.readbyqxmd.com/read/29978445/surgical-reconstruction-of-the-acromioclavicular-joint-can-we-identify-the-optimal-approach
#5
REVIEW
Alexander S North, Tracey Wilkinson
Injuries to the acromioclavicular (AC) joint are common, tending to occur secondary to traumatic injuries. Rockwood grade IV, V and VI injuries involve complete dislocation of the joint and require surgical reconstruction, with inconclusive literature on whether grade III injuries should be surgically or conservatively managed. There are over one hundred reported surgical techniques which reconstruct the AC joint, with little indication of which methods achieve the best results. Techniques can generally be considered as: anatomical reduction; CC ligament reconstruction; and anatomical reconstruction...
August 2018: Strategies in Trauma and Limb Reconstruction
https://www.readbyqxmd.com/read/29802558/causes-of-peroneal-neuropathy-associated-with-orthopaedic-leg-lengthening-in-different-canine-models
#6
Natalia A Shchudlo, Tatyana N Varsegova, Mikhail M Shchudlo, Mikhail A Stepanov, Andrey A Yemanov
Peroneal neuropathy is one of the complications of orthopaedic leg lengthening. Methods of treatment include slowing of distraction and decompression both of which may lead to additional complications. The purpose of this study was to analyse the changes in histologic peroneal nerve structure during experimental orthopaedic lengthening using various modes of manual or automatic distraction. The obtained data provide the basis for better understanding of peroneal neuropathy pathogenesis and refinement of prophylaxis and preventive treatment protocols...
August 2018: Strategies in Trauma and Limb Reconstruction
https://www.readbyqxmd.com/read/29797157/the-resolution-axis-method-ram-for-lengthening-of-the-femur-with-or-without-associated-frontal-plane-deformity-a-new-method
#7
Sherif Galal
INTRODUCTION: Femoral lengthening with or along intramedullary (IM) nails will occur along the axis of the nail coincident with the anatomical axis of the bone. In the femur particularly, such lengthening often creates lateral mechanical axis deviation as the knee is driven medially. In cases where shortening is associated with frontal plane deformity the surgeon needs to correct the deformity intra-operatively, however, subsequent lengthening along the anatomical axis will create deformity...
August 2018: Strategies in Trauma and Limb Reconstruction
https://www.readbyqxmd.com/read/29549568/cozen-s-deformity-resolved-by-guided-growth
#8
Matthew Morin, Joshua Klatt, Peter M Stevens
Proximal tibial metaphyseal fractures in children can lead to progressive and symptomatic tibial valgus. Corrective osteotomy has been abandoned, due to frequent complications, including recurrent valgus deformity. While spontaneous remodelling has been reported, this is not predictable. For children with persistent deformities, we have resorted to guided growth of the tibia. We present 19 patients who were successfully treated with guided growth, tethering the proximal medial physis. There were ten boys and nine girls, ranging in age from two to 13...
August 2018: Strategies in Trauma and Limb Reconstruction
https://www.readbyqxmd.com/read/29426979/role-of-ultrasound-in-detection-of-radiolucent-foreign-bodies-in-extremities
#9
Mehraj D Tantray, Asim Rather, Qazi Manaan, Irfan Andleeb, Mir Mohammad, Yasmeena Gull
Removal of foreign bodies from soft tissues in emergency is very challenging and becomes more problematic when it is radiolucent. Blind exploration is sometimes hazardous for patients especially when it is in proximity to a vessel or a nerve or an overlying tendon. The purpose of this study was to determine the accuracy of ultrasonography (USG) in detecting radiolucent soft tissue foreign bodies in the extremities. From January 2014 to January 2016, 120 patients with either a positive history or clinically suspected soft tissue foreign body and negative radiography were evaluated by USG with a high-frequency (13-6 MHz) linear-array transducer...
August 2018: Strategies in Trauma and Limb Reconstruction
https://www.readbyqxmd.com/read/29396686/measurement-of-wire-deflection-on-loading-may-indicate-union-in-ilizarov-constructs-an-in-vitro-model
#10
Beth Lineham, Todd Stewart, Paul Harwood
No entirely reliable method exists for assessing union during Ilizarov treatment. Premature removal results in potential treatment failure; hence, alternative methods warrant investigation. Wire deflection might provide an indication of fracture site deformation on weight bearing, indicating progress towards union. This study aimed to test a method for assessing wire deflection within an Ilizarov frame. (1) To assess the repeatability of our novel measurement method in measuring wire deflection within an Ilizarov frame in vitro...
August 2018: Strategies in Trauma and Limb Reconstruction
https://www.readbyqxmd.com/read/29363013/the-tibial-bayonet-method-of-wound-closure
#11
Peter O'Farrell, Annette-Christi Barnard, Franz Birkholtz
Management of open lower limb fractures with soft tissue defects can be a technically challenging orthopaedic problem. Limited availability of orthoplastic services means that alternatives to the fix and flap concept are required in order to prevent infected non-unions from developing. The proposed 'bayonet apposition' allows the surgeon to temporarily shorten the limb without angulating the limb or creating a bone defect and removing viable bone. The viable bone edges are overlapped in a bayonet-like manner in order to appose the wound and skin edges...
August 2018: Strategies in Trauma and Limb Reconstruction
https://www.readbyqxmd.com/read/29363012/distraction-arthroplasty-compared-to-other-cartilage-preservation-procedures-in-patients-with-post-traumatic-arthritis-a-systematic-review
#12
REVIEW
Jessica C Rivera, Jason A Beachler
Post-traumatic arthritis (PTA) is characterized by the deterioration of articular cartilage temporally associated with an articular injury. With a paucity of literature comparing joint preservation techniques, we performed a systematic review of the literature intending to describe and summarize the results of ankle distraction arthroplasty as it compares with studies on tibio-talar microfracture, allograft, and autograft for ankle joint preservation in the post-traumatic population under 50 years of age. Research databases were searched and abstracts screened for relevance on our topic of interest...
August 2018: Strategies in Trauma and Limb Reconstruction
https://www.readbyqxmd.com/read/29796861/acute-femoral-shortening-for-reconstruction-of-a-complex-lower-extremity-crush-injury
#13
Philip K Lim, Bharat Sampathi, Nathan M Moroski, John A Scolaro
Traumatic through-knee or transfemoral amputations with concomitant ipsilateral femoral fractures are extremely rare injuries. The initial goal of management is patient resuscitation and stabilization. Subsequent interventions focus on limb salvage and the creation of a residual limb that can be fitted successfully for a functional lower extremity prosthesis. We present the case of a patient who sustained a traumatic through-knee amputation ipsilateral to an open comminuted femoral fracture. Soft tissue injury prohibited initial primary closure over the distal femoral condyles...
May 23, 2018: Strategies in Trauma and Limb Reconstruction
https://www.readbyqxmd.com/read/29380256/a-novel-treatment-approach-to-infected-nonunion-of-long-bones-without-systemic-antibiotics
#14
Karim Z Masrouha, Michael E Raad, Said S Saghieh
Infected nonunion of long bones may require intravenous antibiotics over a lengthy period which may result in a high rate of complications. This study aims to assess the efficacy of local antibiotics used as a replacement to prolonged intravenous therapy. Thirteen patients with infected nonunion of long bones who failed at least one previous surgery were included. The infection was treated through extensive debridement, application of antibiotic-impregnated calcium sulphate pellets and the bone stabilized with external fixation...
April 2018: Strategies in Trauma and Limb Reconstruction
https://www.readbyqxmd.com/read/29380255/the-teramoto-distal-tibial-oblique-osteotomy-dtoo-surgical-technique-and-applicability-for-ankle-osteoarthritis-with-varus-deformity
#15
Tsukasa Teramoto, Shota Harada, Motoyuki Takaki, Tomohiko Asahara, Narutaka Kato, Nobuyuki Takenaka, Takasi Matsushita, Yosiaki Makino, Kouitiro Tasiro, Ootuka Kazutaka, Yukinobu Nishi, Kiyoto Kinugsa
We have devised a medial peri-articular osteotomy, the distal tibial oblique osteotomy (DTOO), and have used this technique since 1994 for ankle osteoarthritis of advanced and late stages associated with varus inclination. This report describes the surgical technique and its applicability. DTOO can be used for cases of varus ankle osteoarthritis with a range of the ankle joint movement of at least 10° or more. The osteotomy is obliquely directed cut across the distal tibia from proximal-medial to distal lateral and is of an opening-wedge type with the centre of rotation coincident with the centre of the tibiofibular joint...
April 2018: Strategies in Trauma and Limb Reconstruction
https://www.readbyqxmd.com/read/29248977/treatment-of-extraarticular-knee-extension-contracture-secondary-to-prolonged-external-fixation-by-a-modified-judet-quadricepsplasty-technique
#16
Federico Persico, Oscar Vargas, Gabriel Fletscher, Mauricio Zuluaga
The goal of this study is to evaluate the functional results of the modified Judet quadricepsplasty for a knee extension contracture secondary to prolonged external fixation. This is a retrospective study of 31 patients with the diagnosis of an extraarticular knee extension contracture who had prolonged external fixation of the femur. Functional assessment was conducted after a minimum follow-up of 1 year. After performing the functional assessment, according to the Judet scale, 51% of the 31 patients had good results and 19...
April 2018: Strategies in Trauma and Limb Reconstruction
https://www.readbyqxmd.com/read/29116576/bridging-hard-callus-at-48-days-in-an-open-femoral-shaft-fracture-with-segmental-defect-treated-with-a-first-stage-masquelet-technique-i-wasn-t-expecting-that
#17
Andrew James Hotchen, Lynne V Barr, Matija Krkovic
The Masquelet technique is a strategy for management of segmental bone defects. It is a two-stage procedure that involves inducing a synovial-like membrane that can be used for a bone graft. Segmental bone defects can occur following trauma and can accompany traumatic brain injury. There is a well-documented, albeit debated, association between traumatic brain injury and increased rate of new bone formation. Here, we present a case of unexpected callus formation in a segmental femoral fracture. The patient had a traumatic brain injury and was treated with the first stage of the Masquelet technique...
April 2018: Strategies in Trauma and Limb Reconstruction
https://www.readbyqxmd.com/read/29103207/complex-tibial-fractures-are-associated-with-lower-social-classes-and-predict-early-exit-from-employment-and-worse-patient-reported-qol-a-prospective-observational-study-of-46-complex-tibial-fractures-treated-with-a-ring-fixator
#18
Rasmus Elsoe, Peter Larsen, Juozas Petruskevicius, Søren Kold
The long-term outcomes following complex fractures of the tibia are reported to carry a risk of knee pain, malalignment, articular injury and post-traumatic osteoarthritis. The main objective of this study was to account for the patient-reported quality of life (QOL) 12 months after ring fixator removal in patients with a complex tibial fracture. Secondary objectives included a review of the socio-economic characteristics of the patient group and the rate of return to work in the study period. A prospective follow-up study was conducted of 60 patients with complex fractures of the tibia treated with ring external fixation...
April 2018: Strategies in Trauma and Limb Reconstruction
https://www.readbyqxmd.com/read/29052080/calcaneal-fractures-where-are-we-now
#19
REVIEW
Aisha Razik, Mark Harris, Alex Trompeter
This review article on the current management for calcaneal fractures discusses the advantages and disadvantages of different treatment options including the problems encountered. Controversies are described and the evidence reviewed. The management of some types of displaced intra-articular calcaneal fractures remains contentious; is there a preferred stabilisation method for each type of calcaneal fracture? How constant is the "constant fragment" in an intra-articular calcaneal fracture and what is the evidence for primary arthrodesis and what is its place in these fractures?...
April 2018: Strategies in Trauma and Limb Reconstruction
https://www.readbyqxmd.com/read/29039127/dermotaxis-v-s-loop-suture-technique-for-closure-of-fasciotomy-wounds-a-study-of-50-cases
#20
Naveen Mittal, Robin Bohat, Jagandeep Singh Virk, Payal Mittal
Fasciotomy incisions lead to large, unsightly, chronic wounds after surgical intervention. Classic management was to use split-thickness skin grafts, but this leads to insensate skin with reports that as many as 23% of patients are dissatisfied by the appearance of the wound. Since no skin loss has occurred with the fasciotomy incision, utilizing the dermal properties of creep, stress relaxation and load cycling, closure can be achieved in a better way. We describe using dermotaxis for skin edge approximation that is done using inexpensive equipment available readily in any standard operating room...
April 2018: Strategies in Trauma and Limb Reconstruction
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