Abstract:
OBJECTIVE:To determine whether multiple approaches pose an increased risk to fracture healing when compared with a standard single approach in the treatment of pilon (OTA 43C) fractures. DESIGN:Retrospective review of a prospective database. SETTING:Level I academic trauma center and level II community trauma center. METHODS:From January 1, 2005 to December 31, 2011, all records of patients treated for OTA 43C fractures of the distal tibia were reviewed. Patients were grouped according to multiple (posterior-anterior) and single (anterior-alone) approaches. Medical charts and surgical documentation were reviewed and postoperative computed tomography (CT) scans were examined for residual articular displacement and quantified. Ultimate union rate was correlated with approach strategy. Articular reduction was subdivided into 3 groups (<1, 1-2, and >2 mm). RESULTS:A total of 116 patients were identified as having had 43C fractures treated surgically with postoperative CT scans completed. Twenty-six fractures presented as an open injury. Of these 116 patients, 35 underwent staged fixation of the posterior malleolar component at an average of 2 days postinjury, followed by delayed anterior fixation at an average of 14 days postinjury. The remaining 81 patients underwent anterior fixation alone, on average 17 days postinjury. Twenty-one patients were lost to follow-up before 12 months. Of the 95 patients with sufficient follow-up (≥12 months), there were 24 nonunions. There was a statistically significant association of nonunion with staged posterior approach (40% vs. 19%, P = 0.015). CT reduction for staged posterior versus anterior-alone approach was not significantly different for any of the 3 categories (63% vs. 57% <1 mm, 31% vs. 26% 1-2 mm, and 6% vs. 17% >2 mm). CONCLUSIONS:In this series, there was no statistically proven benefit to combined surgical approaches to tibial pilon fractures with regard to the quality of articular reduction. It appears from this investigation that there may be a significantly higher risk of nonunion associated with the addition of the staged posterior approach. Although articular reduction is of paramount importance, multiple approaches for direct reduction and fixation of all fragments may lead to further complications. LEVEL OF EVIDENCE:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
journal_name
J Orthop Traumajournal_title
Journal of orthopaedic traumaauthors
Chan DS,Balthrop PM,White B,Glassman D,Sanders RWdoi
10.1097/BOT.0000000000000728subject
Has Abstractpub_date
2017-02-01 00:00:00pages
90-94issue
2eissn
0890-5339issn
1531-2291journal_volume
31pub_type
杂志文章abstract::Many of the current techniques of internal fixation of proximal humerus fractures use tension band wires to achieve secure fixation, allowing immediate postoperative exercise of the affected limb. In addition, the use of a cancellous lag screw placed from the humeral shaft into the humeral head may have several advant...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199402000-00006
更新日期:1994-01-01 00:00:00
abstract:OBJECTIVES:We studied the safety of immediate weight bearing as tolerated (IWBAT) and immediate range of motion (IROM) following open reduction internal fixation (ORIF) of selected malleolar ankle fractures (defined as involving bony or ligamentous disruption of two or more of the malleoli or syndesmosis without articu...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000002003
更新日期:2020-11-09 00:00:00
abstract:OBJECTIVES:To determine the angular rotation that maximizes screw tension without sacrificing screw pullout force yet minimizing loss of screw purchase. METHODS:Three pairs of human humeri in each of the 3 groups (osteopenic, osteoporotic, and normal) underwent screw tension and pullout protocols. For screw tension, 3...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/01.bot.0000435631.71393.60
更新日期:2014-04-01 00:00:00
abstract:BACKGROUND:Calcaneal fractures comprise 1 to 2 percent of all fractures. Approximately 75% of calcaneal fractures are intra-articular. The management of intra-articular calcaneal fractures remains controversial. Nonoperative treatment options include elevation, ice, early mobilization, and cyclic compression of the pla...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,评审
doi:
更新日期:2005-05-01 00:00:00
abstract::A case of a complex distal humeral fracture is presented. The patient lacked sufficient bony architecture to allow for conventional reconstruction. A technique is described using an intramedullary plate to obtain bony stabilization and permit early range of motion exercises. ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-200205000-00011
更新日期:2002-05-01 00:00:00
abstract:OBJECTIVE:This study was conducted to categorize barefoot stubbing injuries to the great toe in children by injury mechanism to differentiate benign stubbing injuries from more complex injuries necessitating surgery. DESIGN:Prospective clinical series of consecutively treated patients. SETTING:Tertiary university hos...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e31828e5d39
更新日期:2013-11-01 00:00:00
abstract:OBJECTIVE:To determine whether the practice of overlapping surgery influenced patient safety after open reduction internal fixation (ORIF) for ankle fractures. DESIGN:Retrospective case-control. SETTING:Level 1 Academic Midwest trauma center. PATIENTS:All patients who underwent ankle fracture ORIF by a single surgeo...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001757
更新日期:2020-08-01 00:00:00
abstract:OBJECTIVE:To test the hypothesis that oblique screws at the ends of a plate provide increased strength of fixation as compared to standard screw insertion. DESIGN:Biomechanical laboratory study in synthetic bone test medium. METHODS:Narrow 4.5-mm stainless steel low-contoured dynamic compression plates were anchored ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-200410000-00006
更新日期:2004-10-01 00:00:00
abstract::Patella fractures are challenging orthopaedic injuries. Many commonly used fixation techniques can be ineffective and lead to poor clinical outcomes even with satisfactory reductions and fracture healing. In this investigation, we present the technique of cage plate fixation of patella fractures and the clinical outco...
journal_title:Journal of orthopaedic trauma
pub_type: 临床试验,杂志文章
doi:10.1097/BOT.0000000000000415
更新日期:2015-12-01 00:00:00
abstract:OBJECTIVE:To evaluate the cost-effectiveness of screw fixation versus hemiarthroplasty for nondisplaced femoral neck fractures in low-demand elderly patients. METHODS:We constructed a Markov decision model using a low-demand, 80-year-old patient as the base case. Costs, health-state utilities, mortality rates, and tra...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001747
更新日期:2020-07-01 00:00:00
abstract::Opening an abdominal window in a hip spica type of cast can be a troubling maneuver for both orthopaedic surgeon and patient. We present a simple device to create an abdominal window more easily. ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-200307000-00009
更新日期:2003-07-01 00:00:00
abstract:OBJECTIVE:To observe and report the clinical results of indirect plating techniques in the treatment of femoral shaft nonunions originally treated with intramedullary nailing. DESIGN:Prospective consecutive. SETTING:Regional trauma center. PATIENTS:A consecutive series of twenty-three patients with nonunion of femor...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-200105000-00004
更新日期:2001-05-01 00:00:00
abstract::Traumatic spinal cord injuries have a tremendous impact on individuals, families, and society as a whole. Substantial heterogeneity in the patient population, their presentation and underlying pathophysiology has sparked debates along the care spectrum from initial assessment to definitive treatment. This article revi...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,评审
doi:10.1097/BOT.0000000000000943
更新日期:2017-09-01 00:00:00
abstract:OBJECTIVES:To compare the abductor muscle function and trochanteric tenderness in patients operated with hemiarthroplasty using the direct lateral (DL) or posterolateral (PL) approach for displaced femoral neck fracture. DESIGN:Prospective cohort study. SETTING:A secondary teaching hospital. PARTICIPANTS:We enrolled...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000532
更新日期:2016-06-01 00:00:00
abstract::Immediate (within 24 h) open reduction and internal fixation of 103 open fractures of one or both bones of the forearm was accomplished in 69 patients between 1980 and 1989. Fifty-four of the 103 patients were reevaluated 1 to 7 years postinjury (average 2.5 years) to determine the efficacy of this treatment. Forty-fi...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,评审
doi:
更新日期:1992-01-01 00:00:00
abstract::From 1998 to 2006, 578 patients who were skeletally immature with proximal humerus fractures were treated at our institution. During that time period, 4 patients (0.7%) had associated brachial plexus and major peripheral nerve palsies. Average age at the time of injury was 12.3 years (range 10-14 years). Two fractures...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e31816b7898
更新日期:2008-04-01 00:00:00
abstract:OBJECTIVE:To compare the efficacy of anesthetic type on clinical outcomes after operative treatment of distal radius fractures. DESIGN:Retrospective review of prospectively collected data. SETTING:Academic medical center. PATIENTS:One hundred eighty-seven patients with a distal radius fracture (OTA type 23) were ide...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e318238becb
更新日期:2012-09-01 00:00:00
abstract:OBJECTIVES:The purpose of this study was to compare rates of surgical site infection (SSI) in patients with type 3 open fractures who had received cefazolin plus gentamicin versus piperacillin/tazobactam for antibiotic prophylaxis. DESIGN:Retrospective cohort study. SETTING:Level 1 trauma center. PATIENTS:Seven hund...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000554
更新日期:2016-08-01 00:00:00
abstract:OBJECTIVES:Comparison of the effect of stainless steel and titanium low-contact dynamic compression plate application on the vascularity and mechanical properties of cortical bone after fracture. DESIGN:Randomized, prospective. SETTING:Orthopaedic research laboratory. ANIMALS:Ten large (greater than twenty-five kilo...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199710000-00006
更新日期:1997-10-01 00:00:00
abstract:OBJECTIVE:To evaluate objectively the effectiveness of current surgical management of displaced acetabular fractures. To provide insight into how these evaluation methods can be used to identify areas in which improvements in surgery and rehabilitation can be pursued to improve patient outcomes. DESIGN:Consecutive cas...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-200202000-00001
更新日期:2002-02-01 00:00:00
abstract:OBJECTIVES:We developed a protocol to determine the timing of definitive fracture care based on the adequacy of resuscitation. Inception of this project required a multidisciplinary group, including physicians from anesthesiology, general trauma and critical care, neurosurgery, orthopaedic spine, and orthopaedic trauma...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000383
更新日期:2015-11-01 00:00:00
abstract:OBJECTIVES:To compare the results between a new intramedullary Gamma nail and a compression hip screw in the treatment of trochanteric fractures. DESIGN:Prospective randomized. SETTING:Level 1 trauma center. PATIENTS:Two hundred ten consecutive patients older than 65 years with trochanteric femoral fractures. INTER...
journal_title:Journal of orthopaedic trauma
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/01.bot.0000151819.95075.ad
更新日期:2005-04-01 00:00:00
abstract:OBJECTIVES:To compare reports of implant fatigue failure submitted to the FDA of 2 commonly used cephalomedullary nails. METHODS:In total, 2724 medical device reports from the FDA's MAUDE database from Jan 2015 to Oct 2019 were reviewed for the Trochanteric Femoral Nail-Advanced (TFNa) and Gamma 3 implants. RESULTS:D...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001864
更新日期:2021-02-01 00:00:00
abstract:OBJECTIVES:Report the technical aspects, radiographic results, and complications after minimum 1-year follow up of the anterior intra-pelvic (AIP or modified Rives-Stoppa) approach as an alternative to the ilioinguinal approach for the treatment of acetabular fractures. DESIGN:Retrospective review. SETTING:Level I tr...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e3181dd0b84
更新日期:2010-05-01 00:00:00
abstract::We reviewed 21 cases of humeral nonunion following the failure of "locking" humeral nails. The nails had been inserted as the primary operative procedure following humeral fracture in fifteen cases or after the failure of closed treatment in six cases. Reconstruction after the failure of these implants was complicated...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199610000-00008
更新日期:1996-01-01 00:00:00
abstract:OBJECTIVE:To determine whether using nothing stronger than codeine and tramadol provides adequate pain alleviation in people recovering from fixation of a fracture of the femur or tibia shaft. DESIGN:Retrospective case series. SETTING:Level 1 trauma center in the United States. PATIENTS:All adult patients from Octob...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001683
更新日期:2020-02-01 00:00:00
abstract:OBJECTIVES:Posttraumatic invasive fungal infections threaten critically injured combat-related injuries and require a combination of extensive surgery and systemic antifungal therapy, along with topical antimicrobials used adjunctively to control the infection. We evaluated the in vitro activity of topical agents in va...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e3182830bf9
更新日期:2013-08-01 00:00:00
abstract::Pediatric femoral shaft fractures present many challenging patient care decisions. Nonoperative treatment approaches still dominate care of the youngest age groups while surgical intervention is commonplace in virtually all older children. Treatment is determined primarily by patient age as modified by clinical factor...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001016
更新日期:2017-11-01 00:00:00
abstract:OBJECTIVES:To describe the technique and to determine the outcome of operatively treated displaced scapular body or glenoid neck fractures using minifragment fixation through a modified Judet approach. DESIGN:Retrospective review of scapular or glenoid fractures. SETTING:Level 1 teaching trauma center. PATIENTS:All ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e3181a18216
更新日期:2009-09-01 00:00:00
abstract::The effect of ultrasound (US) on the rate of fibula osteotomy healing in 139 mature New Zealand white rabbits was assessed in this study. Bilateral midshaft fibular osteotomies were made using a 1-mm Gigli saw. US was noninvasively applied to one limb for 20 minutes daily, while the contralateral limb served as a cont...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199004030-00002
更新日期:1990-01-01 00:00:00