摘要:

Summary:Unreamed intramedullary nailing of tibial and femoral fractures can achieve union rates comparable to those of other techniques, including reamed nailing, and may avoid some of the potential hazards of reamed nailing, such as infection, disruption of the endosteal blood supply, and increased risk of pulmonary emboli. Operative time, fluoroscopy time, and blood loss also are decreased. However, the unreamed technique requires the use of smaller implants, and the possibility of hardware failure should be considered. Careful attention to operative technique is mandatory to prevent angular and rotational deformities. Secondary procedures, such as dynamization and exchange nailing, should be carefully planned if delayed union occurs.

ISSN:0885-9698    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:Reamed intramedullary nailing has been demonstrated to be the optimal treatment for open and closed femoral fractures. Recent clinical trials now suggest that not only is it an excellent method for the primary management of tibial diaphyseal fractures but it has considerable use in the treatment of infection and aseptic nonunion.

ISSN:0885-9698    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:The results are reviewed of the treatment of 30 tibial fractures with significant bone loss in 29 patients treated in the Edinburgh Orthopaedic Trauma Unit. A protocol of early aggressive soft tissue and bony debridement followed by primary locked intramedullary nailing was used. Subsequently, definitive closure was obtained, usually with a soft-tissue flap within the first 48 h after injury, followed by elective bone-grafting procedures, which were delayed for 6 weeks after primary surgery. The times to fracture union and subsequent functional outcome were largely dependent on the severity and extent of bone loss, which we have classified. Twenty-nine fractures eventually achieved full bony union at a mean of 53.4 weeks, with delayed amputation required in only one patient. Poor functional outcome and complications of treatment were usually attributable to a departure from the standard treatment protocol in the primary management. We conclude that the protocol produces reliably satisfactory results in the management of these difficult fractures, and we consider that the use of intramedullary nailing offers considerable practical advantages over other methods of primary bone stabilization.

ISSN:0885-9698    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:Total hip arthroplasty is occasionally accompanied by a syndrome of hypotension, hypoxemia, tachycardia, and rarely cardiac arrest. The etiology of this remains somewhat obscure, although clinical and animal research have strongly implicated embolism of marrow contents to the pulmonary vascular bed as a potential cause for this syndrome. The author and a number of anesthesia and surgical colleagues made a step-wise search to confirm pulmonary fat embolism as a cause for this event. By using an established and by now well-recognized canine model for pulmonary fat embolism, we confirmed that marrow content is capable of causing all of the changes seen in this syndrome in the clinical situation. The vasoactive factors actually responsible for the changes have not yet been identified.

ISSN:0885-9698    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0885-9698    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0885-9698    

出版商:OVID    

年代:1996

数据来源: OVID