摘要:

Plain film radiography remains the cornerstone in the assessment of joint fractures. Optimal technique permits visualization of soft tissue abnormalities as well as bone injury. The need for orthogonal and oblique views is discussed, along with specialized projections, postreduction films, and stress views.Preoperative planning represents the primary role of sectional radiography. Scintigraphy is of value in the diagnosis of occult fractures, stress fractures, myositis, ossificans, and post-traumatic avascular necrosis.Arthrography is most commonly used to study internal derangements of the knee, particularly meniscal pathology. However, it is also commonly combined with tomography or computed tomography in the diagnosis of shoulder instability.Following trauma, angiography is indicated for the assessment of diminished or absent pulses in an extremity, especially in younger patients.CT of spinal, pelvic, acetabular and hindfoot fractures is accepted practice in many trauma centers. In the future, magnetic resonance imaging may also become useful in the diagnosis of articular injuries.

ISSN:0885-9698    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Osteosynthesis can be divided into seven steps:1. incision;2. preparation of the bone ends;3. reduction;4. temporary fixation;5. permanent fixation;6. closure;7. dressing.Systematic planning for fracture fixation using these steps improves the operation.

ISSN:0885-9698    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Post-traumatic arthritis is the primary clinical problem following displaced acetabulum fractures. Disruption of the acetabulum leads to alteration of the normal cartilage pressure distribution and subsequent destruction of articular cartilage. Initial AP and 45° oblique views of the pelvis as well as CT scanning lead to the proper fracture classification and nonoperative versus operative decision making. A trial of closed reduction is not usually an integral part of the evaluation. Fractures chosen for nonoperative treatment are expected to have a satisfactory clinical result despite articular displacement. Included in this category are fractures involving only inferior areas of the acetabulum and both column fractures with secondary congruence. The majority of displaced fractures do not meet the criteria for closed treatment and should be treated by open reduction and internal fixation. No one surgical approach is appropriate for all fractures, so an accurate preoperative radiographic interpretation is essential. The most effective surgical approaches are the Kocher-Langenbeck, extended iliofemoral, and ilioinguinal approaches.

ISSN:0885-9698    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Anterior dislocation of the hip may have associated fractures of the femoral head which involve the weight-bearing surface. The impression fracture involves the superolateral portion of the head, and the osteochondral fracture involves the anterosuperior portion. CT scan, arthrograms, and tomograms may be used to further assess the status of the femoral head. If CT scan or other diagnostic studies show no osteochondral fracture, no significant impression fracture, and no fragments within the joint, the hip is treated nonsurgically. Small osteochondral fragments not large enough for internal fixation are excised. Larger osteochondral fragments are treated with open reduction and internal fixation. Impression fractures of the femoral head deeper than 2 mm on CT scan or open inspection are treated by elevation of the defect, bone grafting, and internal fixation. All treatment modalities include the use of continuous passive motion in the postoperative phase.

ISSN:0885-9698    

出版商:OVID    

年代:1986

数据来源: OVID

ISSN:0885-9698    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Supracondylar fractures of the femur, particularly those with intracondylar extension, represent some of the most challenging fractures. They do almost universally poorly when treated nonoperatively but do even less well when operated on using inadequate technique.We use the AO technique and supracondylar blade plate for fixation of these fractures. The standard technique and instruments are well described in the AO manual and are not repeated here.Preoperative preparation is directed at assessing and managing the fracture and the associated injuries which these patients often have. Management of the fracture requires the assembly of adequate x-rays, equipment, and personnel.In all these fractures the key to good reduction and fixation is excellent placement of the blade in the condyles. In fractures with intracondylar extension the condyles must be reconstructed and rigidly fixed first. In those fractures with bone loss, excellent placement of the blade allows the plate to act as guide to both alignment and rotation.With good reduction and stable fixation of their fractures, these patients do well even if they have quite comminuted fractures.

ISSN:0885-9698    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Twenty-three patients with displaced supracondylar intercondylar fractures of the humerus have been treated using open reduction and internal fixation with a specifically designed contoured plate. One half of the fractures had significant comminution, and one third were open. At the time of review all fractures had united. There was an average 10° loss of extension and a 60° loss of flexion as compared with the opposite elbow. Two patients demonstrated loss of fixation on follow-up radiographs. In both cases, comminuted fractures in elderly patients were treated with continuous passive motion following internal fixation. Early operation with rigid fixation of comminuted supracondylar and intercondylar fractures of the humerus will yield satisfactory results. Poor results are associated with delay in surgery, significant associated injury to the same limb, and too early motion in patients with inadequate fixation.

ISSN:0885-9698    

出版商:OVID    

年代:1986

数据来源: OVID

ISSN:0885-9698    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Olecranon fractures in the adult are a common upper extremity injury. The fractures can be classified into three groups based on the lateral radiograph. Undisplaced fractures can be treated nonoperatively. Type I fractures can be treated by excision or interfragmentary compression with screws. Type II fractures are best treated by tension band wiring. Type III fractures, because of their configuration, are best treated by interfragmentary compression and a neutralization plate.

ISSN:0885-9698    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Lower limb trauma that results in soft tissue loss and exposure of the knee joint provides a unique challenge. To facilitate soft tissue coverage, knee joint defects are classified as medial, lateral, anterior, posterior, or complex where more than one surface is involved. Soft tissue coverage is provided by a variety of flaps taken usually from the lower limb, from below the knee, or occasionally from the thigh. These may include muscle flaps, myocutaneous flaps, fasciocutaneous flaps, or free flaps. Flap choice depends on the anatomic site of the defect and its extent. Careful consideration of the anatomic situation of the exposed knee joint and an understanding of the exact anatomy and vasculature to the lower limb muscles will allow correct planning to facilitate adequate coverage of the exposed joint. Technical considerations and flap elevation, transposition and closure will enable even the most complex defects to be closed in one stage. Early closure of open knee joint injuries will prevent dessication of exposed articular cartilage and allow early restoration of knee joint function.

ISSN:0885-9698    

出版商:OVID    

年代:1986

数据来源: OVID