Non-operative management of acetabular fractures. The use of dynamic stress views.
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To assess the stability of the hip after acetabular fracture, dynamic fluoroscopic stress views were taken of 41 acetabular fractures that met the criteria for non-operative management. These included roof arcs of 45 degrees, a subchondral CT arc of 10 mm, displacement of less than 50% of the posterior wall, and congruence on the AP and Judet views of the hip. There were three unstable hips which were treated by open reduction and internal fixation. The remaining 38 fractures were treated non-operatively with early mobilisation and delayed weight-bearing. At a mean follow-up of 2.7 years, the results were good or excellent in 91% of the cases. Three fair results were ascribed to the patients' other injuries. Dynamic stress views can identify subtle instability in patients who would normally be considered for non-operative treatment. (+info)
Fractures of the tibia. Can their outcome be predicted?
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We have carried out a prospective study to determine whether the basic descriptive criteria and classifications of diaphyseal fractures of the tibia determine prognosis, as is widely believed. A number of systems which are readily available were used, with outcome being determined by standard measurements including fracture union, the need for secondary surgery and the incidence of infection. Many validated functional outcomes were also used. The Tscherne classification of closed fractures proved to be slightly more predictive of outcome than the others, but our findings indicate that such systems have little predictive value. (+info)
The effect of using a tourniquet on the intensity of postoperative pain in forearm fractures. A randomized study in 32 surgically treated patients.
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We have analysed the relationship between the intensity of postoperative pain and the use of a pneumatic tourniquet in procedures for operative fixation of fractures of the forearm. Thirty-two patients were divided randomly into two groups as a control (NT) and tourniquet (T). The pain scores in the NT group were significantly lower. Patients over the age of 30 had notably more pain than those younger after the use of a tourniquet. Avoidance of the tourniquet gave better postoperative analgesia in male patients and in those with comminuted fractures. When a tourniquet was used the best results were obtained if it was kept inflated for less than one hour. (+info)
Subtalar arthrodesis with correction of deformity after fractures of the os calcis.
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We have reviewed the long-term results of 22 patients (23 fusions) with fractures of the os calcis, who had subtalar arthrodesis with correction of the deformity between 1975 and 1991. The mean follow-up was nine years (5 to 20). All patients were evaluated according to a modified foot score. A radiological assessment was used in which linear and angular variables were measured including the fibulocalcaneal abutment, the height of the heel and fat pad, the angle of the arch and the lateral talocalcaneal and the lateral talar declination angles. The technique used restores the normal relationship between the hindfoot and midfoot and corrects the height of the heel. This leads to better biomechanical balance of the neighbouring joints and gives a favourable clinical outcome. The modified foot score showed a good or excellent result in 51% of the feet. Residual complaints were mostly due to problems with the soft tissues. Subjectively, an excellent or good score was achieved in 78% of the cases. After statistical analysis, except for the height of the heel and the degenerative changes in the calcaneocuboid joint, no significant difference was found in the measured variables between the operated and the contralateral side. (+info)
Avulsion fracture of the anterior half of the foramen magnum involving the bilateral occipital condyles and the inferior clivus--case report.
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A 38-year-old male presented with an avulsion fracture of the anterior half of the foramen magnum due to a traffic accident. He had palsy of the bilateral VI, left IX, and left X cranial nerves, weakness of his left upper extremity, and crossed sensory loss. He was treated conservatively and placed in a halo brace for 16 weeks. After immobilization, swallowing, hoarseness, and left upper extremity weakness improved. Hyperextension with a rotatory component probably resulted in strain in the tectorial membrane and alar ligaments, resulting in avulsion fracture at the sites of attachment, the bilateral occipital condyles and the inferior portion of the clivus. Conservative treatment is probably optimum even for this unusual and severe type of occipital condyle fracture. (+info)
Closed tibial shaft fractures: management and treatment complications. A review of the prospective literature.
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OBJECTIVE: To compare the results and complications of the various modalities for treating closed fractures of the tibial shaft described in the prospective literature. DATA SOURCES: A MEDLINE search of the English language literature from 1966 to 1999 was conducted using the MeSH heading "tibial fractures." Studies pertaining to the management of closed tibial shaft fractures were reviewed, and their reference lists were searched for additional articles. STUDY SELECTION: An analysis of the relevant prospective, randomized controlled trials was performed. Studies including confounding data on open fractures or fractures in children were excluded. The 13 remaining studies were reviewed. DATA EXTRACTION: Raw data were extracted and pooled for each method of treatment. DATA SYNTHESIS: The 13 studies described 895 tibial shaft fractures treated by application of a plaster cast, fixation with plate and screws, and reamed or unreamed intramedullary nailing. Although definitions varied, the combined incidence of delayed and nonunion was lower with operative treatment (2.6% with plate fixation, 8.0% with reamed nailing and 16.7% with unreamed nailing) than with closed treatment (17.2%). The incidence of malunion was similarly lower with operative treatment (0% with plate fixation, 3.2% with reamed nailing and 11.8% with unreamed nailing) than with closed treatment (31.7%). Superficial infection was most common with plate fixation (9.0%) compared with 2.9% for reamed nailing, 0.5% for unreamed nailing and 0% for closed treatment. The incidence of osteomyelitis was similar for all groups. Rates of reoperation ranged from 4.7% to 23.1%. CONCLUSIONS: All forms of treatment for tibial shaft fractures are associated with complications. A knowledge of the incidence of each complication facilitates the consent process. To fully resolve the controversy as to the best method of treatment, a large, randomized, controlled trial is required. This review more precisely predicts the expected incidence of complications, allowing the numbers of required patients to be more accurately determined for future randomized controlled studies. (+info)
Closed pelvic fractures: characteristics and outcomes in older patients admitted to medical and geriatric wards.
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OBJECTIVE: To investigate the characteristics and outcomes of older patients with pelvic fracture admitted to medical and geriatric wards. METHODS: All patients admitted to medical and geriatric wards with a pelvic fracture over a four year period were identified using the hospital clinical coding database. Data were collected from casenotes, hospital and Family Health Services Authority databases. Where available, pelvic radiographs were graded according to the Singh index. RESULTS: The casenotes of 148 patients (126 women) were studied; 83% (n=123) of patients suffered a pelvic fracture in low energy trauma. Mean (SD) length of hospital stay was 21.3 (17.6) days. Single breaks of the pubic rami accounted for 47.2% (n=68) of all fractures. Inpatient mortality was 7.6% and at one year was 27%. There was a marked adverse effect on the mobility of survivors with all patients using at least a walking stick at discharge and 51.1% (n=70) needing assistance for mobility. Although 70.9% (n=83) of patients admitted from home (or warden aided accommodation) were able to return there, 84.3% (n=70) of them required extra community support. Rates of institutionalisation rose from 20.9% (n=31) at admission to 35.8% (49/137) of survivors at discharge. Altogether 93% (n=107) of 115 patients, in whom adequate quality pelvic radiographs were available, were assigned a Singh index grade of 4 or less indicating the presence of osteoporosis. CONCLUSIONS: Pelvic fractures are often the result of low energy trauma. They are associated with appreciable inpatient and considerable one year mortality. They also have marked negative effects on mobility in the short term. They result in increased levels of dependency in terms of higher levels of community support and rates of institutionalisation. On the evidence of Singh index grading, pelvic fractures are associated with low bone density. (+info)
Long-term quadriceps femoris functional deficits following intramedullary nailing of isolated tibial fractures.
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This retrospective study assessed 5 male and 5 female patients, age 35.1+/-16 years, height 171.8+/-12 cm, and weight 75.5+/-18 kg (mean+/-SD) who were more than 1 year post isolated tibial fracture (18+/-6 months) and had been treated with an intramedullary tibial nail. Subjects completed a 12-question visual analog scale, a physical symptom and activity of daily living survey, and were also tested for bilateral isokinetic (60 degrees/s) quadriceps femoris and hamstring strength. Knee pain during activity, stiffness, swelling, and buckling were the primary symptomatic complaints. Perceived functional task deficits were greatest for climbing or descending stairs, pivoting, squatting, and walking on uneven surfaces. Involved lower extremity knee extensor and flexor torque production deficits were 25% and 17%, respectively. Early rehabilitation focuses on maintaining adequate operative site bony fixation while providing controlled, progressive, and regular biomechanical loading to restore functionally competent tissue. Following adequate fracture healing, greater emphasis should be placed on lower extremity functional recovery including commonly performed activities of daily living and other functional tasks that are relevant to the patient's disability level. A cyclic rehabilitation program that progresses the weight-bearing environment to facilitate bone and soft tissue healing and neuromuscular re-education is proposed. (+info)