Delayed open reduction and internal fixation of a displaced radiocapitellar fracture.
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Biomechanical Phenomena↗
Biomedical subjects
C M Reinert
Publications and source records attributed to C M Reinert.
Treatment of unstable tibial diaphyseal fractures with minimal internal and external fixation.
We prospectively studied 20 patients whose selected unstable tibial diaphyseal fractures were treated with the combined techniques of minimal internal fixation and external fixation. Five fractures were closed and 15 were open (six Grades I and II, nine Grade III). Seventeen were due to high-energy injuries. The minimum followup was 2 years. All fractures healed, one with malalignment. Time to union averaged 12 weeks in closed fractures and 19 weeks in open fractures. All high-energy fractures underwent bone grafting. The external fixation was removed by dynamization. Thirteen complications occurred in nine patients, all with open fractures. Three of 120 pins became infected (2.5%). Early bone grafting and dynamization of the external fixation prevented the malunions and nonunions reported previously with this technique.
Adolescent↗
Excision of posterolateral talar dome lesions through a medial transmalleolar approach.
Posterolateral osteochondral fractures of the talus are rare. Although arthroscopy is becoming an increasingly important method of evaluating and treating lesions of the ankle, these techniques may not always be feasible, especially for posterolateral lesions. Classic treatment of displaced or symptomatic chronic lesions is excision, usually with a distal fibular osteotomy and turndown procedure. Subsequent removal of the syndesmosis screw is required. The surgical dissection of the distal fibula is extensive and devascularizing. An alternate technique for debriding posterolateral talar dome lesions through a medial transmalleolar approach is described. Exposure of the lateral talar dome is sufficient to allow debridement and curettage of the lesion. Anatomic rigid fixation of the medial malleolus allows for rapid healing of the osteotomy site and immediate ankle rehabilitation. For those ankle lesions that are not accessible to arthroscopy or an anterolateral arthrotomy, this approach is preferable to the distal fibular osteotomy and turndown.
Adult↗
A technique for removing a fractured interlocking tibial nail.
The reported incidence of implant failure following reamed intramedullary tibial fixation is low. When necessary, retrieval of failed tibial nail segments is best performed in a closed fashion in order to avoid the delayed healing and increased risk of infection that may result from exposure of the tibial fracture site. A method to facilitate closed removal of the distal segment of a failed tibial nail is described.
Adult↗
Preoperative angiographic assessment of the superior gluteal artery in acetabular fractures requiring extensile surgical exposures.
Extensile exposures used for complex acetabular fracture reconstructive surgery often create abductor muscle flaps pedicled on the superior gluteal artery. Preoperative arteriograms were performed in eight patients who required extended iliofemoral or modified extended iliofemoral surgical approaches to assess the integrity of the superior gluteal artery. All of the patients had complex acetabular fractures, with significant displacement of the fracture into the sciatic notch. Abnormalities of the superior gluteal artery were found in three patients. One patient demonstrated a complete laceration of the superior gluteal artery, one patient a complete arterial occlusion, and one patient had a compressive entrapment of the artery at the fracture site. Preoperative angiographic evaluation of the superior gluteal artery is suggested for patients with acetabular fractures that are displaced into the sciatic notch and who will require an extensile surgical exposure creating an abductor muscle flap supplied by the superior gluteal artery.
Acetabulum↗
Heterotopic ossification as a complication of acetabular fracture. Prophylaxis with low-dose irradiation.
In a retrospective review of thirty-seven patients who had operative treatment for thirty-eight complex acetabular fractures, postoperative low-dose irradiation was administered to seventeen patients (eighteen fractures) to suppress heterotopic ossification. All of the patients had been operated on through either an extended iliofemoral incision or a modified extended iliofemoral incision. The prophylactic radiation was administered using a low-dose protocol; most of the patients received 1,000 rads in 200-rad increments, starting on the third post-operative day. The incidence of heterotopic ossification in the eighteen irradiated limbs was much lower than in the twenty patients who comprised the control group (50 per cent compared with 90 per cent). Only two of the irradiated limbs had Class-3 heterotopic ossification as described by Brooker et al., and no patient had Class-4 (ankylosis of the hip). Of the twenty control-group patients, ten had severe heterotopic ossification: Class 3 in seven and Class 4 in three. The difference in the incidence of severe (Class-3 or 4) heterotopic ossification between the two groups of patients was significant (p less than 0.01).
Acetabulum↗
A modified extensile exposure for the treatment of complex or malunited acetabular fractures.
A modification of the extended iliofemoral incision of Letournel and Judet facilitates the operative exposure of T-type, complex transverse, and both-column acetabular fractures and malunions. The modification includes the utilization of a T-shaped skin incision with large flaps, and osteotomies of the iliac crest, greater trochanter, and anterior superior iliac spine. The iliotibial band is transected and the abductor muscle mass is rotated posteriorly, hinged on the superior gluteal neurovascular bundle. Twenty patients had open reduction and internal fixation of a complex acetabular fracture using this surgical approach. Excellent surgical exposure allowed good or excellent reduction of the acetabulum in all patients. No flap necrosis developed, and all fractures healed. One non-union of a trochanteric osteotomy needed revision. This approach provides increased exposure of the posterior column and visualization of the entire surface of the joint and it allows fixation of the fracture from both sides of the iliac wing. The T-shaped skin incision allows utilization of a standard posterior approach with conversion to the extensile exposure if necessary. Options for late reconstruction are not compromised. Lagscrew fixation of the osteotomies allows aggressive rehabilitation of the joint.
Acetabulum↗
Bacterial meningitis following Pantopaque myelography. A case report and literature review.
A case of acute bacterial meningitis following Pantopaque myelography is reported, and the literature reviewed pertaining to this uncommon but potentially fatal complication. A positive Gram's stain is most helpful in differentiating bacterial from chemical meningitis. Treatment of the meningitis before and after determination of its cause is described. Preventive steps include removal of Pantopaque from the subarachnoid space immediately at the conclusion of fluoroscopy, and observance of strict sterile technique during myelography, including use of face masks.
Acute Disease↗
Surgical stabilization of thoracic and lumbar spine fractures: a retrospective study in a military population.
Twenty-two patients underwent surgical stabilization of thoracic and lumbar spine fractures. Twenty patients were operated on within 4 weeks of the injury and two patients more than 1 year following injury. Harrington rods were used in 21 and Dwyer instrumentation in one. The presenting neurological deficits were: four complete, five incomplete, and 13 intact. Clinical failure was noted in four patients, two of whom underwent posterior instrumentation more than 1 year following the initial injury. The most important contributing factor to failure was use of instrumentation in deviation from standard practice. The aim of operative treatment to maintain fracture reduction, decompress neural elements, promote fracture healing, and shorten hospitalization was achieved.
Adult↗
The use of epidural morphine to decrease postoperative pain in patients undergoing lumbar laminectomy.
In a double-blind study of fifty patients that was done to test the ability of epidural morphine to decrease the discomfort after lumbar laminectomy, we found that during the first postoperative day the patient's pain was lessened appreciably but that the total dose of morphine received postoperatively was not diminished. We used a three-milligram dose of epidural morphine, and there were no problems with respiratory depression. The addition of epinephrine to the morphine solution had no beneficial effect.
Adult↗