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Biomedical subjects

P Tornetta

Publications and source records attributed to P Tornetta.

At least 55 records · Page 3Linked to original sources
PubMed1997

Anatomy of the posterior interosseous nerve in relation to fixation of the radial head.

The relationship of the posterior interosseous nerve to the radial neck as it relates to internal fixation of radial head fractures was studied in 50 fresh anatomic specimen arms. After a standard posterolateral approach, blind subperiosteal dissection was performed distally until a 4-cm minifragment plate could be placed on the shaft of the radius. Dissection of the radial nerve was performed under loupe magnification. In only one (2%) arm did the posterior interosseous nerve lie directly on the radius. The average distance from the posterior interosseous nerve to the plate was 5 +/- 1.2 mm. The nerve was not damaged by placement of the plate in any case. In two (4%) cases the nerve play on top of the distal portion of the plate within the supinator with the forearm in neutral rotation. The average distance from the radial head to the origin of the posterior interosseous nerve was 1.2 +/- 1.9 mm, with the takeoff being proximal to the radial head in 31 cases. The muscular branch to the extensor carpi radialis longus was located 7.1 +/- 1.8 mm from the radial head. These findings suggest that pronation of the forearm with blind subperiosteal dissection for plate placement does not place the posterior interosseous nerve at significant risk for structural injury. However, as with any approach done in the region of the nerve, caution should be used to avoid tension on the nerve that could lead to physiologic injury.

Bone Plates↗
PubMed1996

Axial computed tomography of pilon fractures.

Computed tomography (CT) is used in the preoperative planning of many fractures. It is particularly helpful in anatomic regions with complex anatomy and in fractures with complicated patterns. The authors evaluated the use of CT scans in the preoperative planning of pilon fractures. Twenty-two patients were studied with plain radiographs and with CT scans. The fracture pattern, number of fragments, comminution, impaction, and location of the major fracture line were recorded. The CT scan revealed an increased number of fragments in 12 patients, increased impaction in 6 patients, and increased comminution in 11 patients. The operative plan was changed in 14 (64%) patients, and additional information was gained in 18 (82%) patients.

Fractures, Closed↗
PubMed1996

Semiextended position of intramedullary nailing of the proximal tibia.

Over a 24 month period, 30 patients with proximal tibia fractures who were reviewed consecutively were treated by nonreamed, statically locked, intramedullary nailing. There were 16 open, 13 segmental, and 7 comminuted fractures (Winquist III, IV). The average distance from the fracture to the proximal locking screws was 24 mm (range, 0-65 mm). All procedures were performed while the patient's affected leg was on a radiolucent table without traction. The last 25 fractures were nailed using a partial (2/3) medial parapatellar incision while the leg was semiextended. This approach allowed the patella to be subluxed laterally availing the trochlear groove for use as a conduit for nail placement. Using only 15 degrees knee flexion eliminated the extension force of the quadriceps on the proximal fragment, which otherwise would have tended to cause anterior angulation at the fracture site. In the first 5 patients, the average anterior angulation was 8 degrees (range, 5 degrees-15 degrees). Of the 25 patients who were treated while in the semiextended position, none had more than 5 degrees anterior angulation and 19 had no anterior angulation. Fractures of 3 of the 25 patients had greater than 5 degrees angulation in the coronal plane, 2 of which were nailed in the semiextended position. This technique greatly facilitates intramedullary nailing of proximal tibia fractures.

Adolescent↗
PubMed1996

Radiologic evaluation of the pelvis.

Careful radiographic assessment is essential in the diagnosis of pelvic fractures. The standard radiographic assessment of the pelvis includes the anteroposterior, inlet, outlet, Judet views, and axial computed tomography images. The different radiographic projections of the pelvis and their corresponding anatomic landmarks and the anatomy of the pelvis and the different anterior and posterior pelvic lesions are discussed. Description of the proper views and their uses are included.

Bone Screws↗
PubMed1996

Angiographic findings in pelvic fractures.

Pelvic fractures are high energy injuries indicative of significant trauma. Hypotension and significant blood loss is common in skeletally unstable pelvic fractures. Potential sites of intrapelvic bleeding include fractured bone edges, venous injuries and/or arterial vascular injuries. In an attempt to define the relationship of fracture pattern to arterial injury, a specific subset of 39 patients with pelvic fractures who underwent angiography for hemodynamic instability or ongoing blood loss were reviewed retrospectively. In 35 patients with definable arterial injuries, 20 (57%) had multiple bleeding sites. Posterior arterial bleeding (internal iliac or its posterior branches) was statistically more common in patients with unstable posterior pelvic fractures, and anterior arterial bleeding (pudendal or obturator) was more common in patients with lateral compression injuries. The pudendal artery was the most commonly injured vessel in this series. The superior gluteal artery was the most commonly injured vessel associated with posterior pelvic fractures. There was no correlation between fracture pattern and survival. The injury severity score however, did indirectly correlate to survival. In addition, the presence of hypotension (systolic blood pressure < or = 90) at the time of arrival to the trauma center was found to significantly increase mortality.

Adolescent↗
PubMed1996

Internal fixation of unstable pelvic ring injuries.

One hundred and seven unstable pelvic fractures were treated operatively. Reductions were graded by the maximal displacement measured on the 3 standard views of the pelvis. Criteria were: excellent 4 mm or less, good 5 to 10 mm, fair 10 to 20 mm, and poor more than 20 mm. Overall there were 72 excellent, 30 good, 4 fair, and 1 poor reduction. Ninety-five percent of all reductions were excellent or good. Open reduction and internal fixation within 21 days were associated with a higher percentage of excellent reductions than in reductions performed after 21 days (70% versus 55%). These differences were not statistically significant, however. Complications were infrequent using the techniques described.

Fracture Fixation, Internal↗
PubMed1996

Outcome of rotationally unstable pelvic ring injuries treated operatively.

Twenty-nine patients with unstable rotational injuries treated operatively were observed for an average of 39 months. There were 24 associated orthopaedic injuries. Twenty-seven patients had symphysis disruption (4 with rami fractures) and 2 had rami fractures associated with an acetabular fracture. Followup evaluation of those who could be evaluated in each category revealed that 96% had no pain or pain only on strenuous activity, ambulated without assistance or limitations, and returned to work. Open reduction and internal fixation of rotationally unstable pelvic fractures results in a high functional success rate.

Adolescent↗
PubMed1996

Outcome of operatively treated unstable posterior pelvic ring disruptions.

Forty-six patients with 48 operatively fixed unstable posterior pelvic ring disruptions were observed for an average of 44 months. Two thirds of the patients returned to their original jobs and 16% changed jobs because of an associated injury. Sixty-three percent of the patients had no pain or pain only on strenuous activity and ambulated without limitation. However, 35% of the patients had significant neurologic injuries that compromised their final result. Properly performed open reduction and internal fixation of unstable posterior pelvic ring injuries may he expected to yield good functional results in the majority of patients. Associated injuries continue to be a major source of disability.

Adult↗
PubMed1996

Open reduction and internal fixation of the calcaneus using minifragment plates.

During a 4-year period, 35 nonconsecutive intraarticular fractures of the calcaneus were fixed with 2.7-mm minifragment plates and 3.5-mm small fragment screws through an extended lateral approach. There were 25 type II and 10 type III fractures by the classification system of Sanders. The reduction of the facet was anatomic in 91%. The reduction of the tuberosity was acceptable (< or = 5 degrees of angulation) in all cases. Early motion was begun in the ankle, subtalar, and midfoot joints in all cases. Two patients had minor edge necrosis amenable to local treatment. There were no deep infections. Using the Maryland foot score, there were 77% good or excellent results. The small size of the minifragment plates allows for their application to a wide variety of fracture patterns. They are also low profile and are therefore easy to cover. Multiple plates were used in many cases without steric interference. They provided rigid enough fixation to allow aggressive early motion exercises without loss of reduction or hardware failure in any case. Minifragment plates with small fragment screws are effective for the fixation of intraarticular calcaneus fractures through an extended lateral approach.

Adolescent↗
PubMed1996

Corona mortis. Incidence and location.

Fifty cadaver halves were dissected to determine the occurrence and location of the corona mortis. Anastomoses between the obturator and external iliac systems occurred in 84% of the specimens. Thirty-four percent had an arterial connection, 70% had a venous connection, and 20% had both. The distance from the symphysis to the anastomotic vessels averaged 6.2 cm (range, 3-9 cm).

Arteries↗
PubMed1995

Femoral torsion after interlocked nailing of unstable femoral fractures.

OBJECTIVE: The determination of rotation of the femur during intramedullary nailing procedures can be difficult, particularly when the fracture pattern does not lend itself to interdigitation. We studied 22 patients who had isolated femur fractures treated by closed intramedullary nailing to determine the degree of malrotation introduced at the time of surgery. DESIGN AND METHODS: Anteversion of the affected and normal femora was determined by a standard computed tomography (CT) torsion study. The range of motion of the hip was measured in the prone position. Foot progression angles (FPAs) were measured in 14 patients who were fully ambulatory for at least 6 months. MAIN RESULTS: The average malrotation of the fractured femur was 16 degrees (4 to 61 degrees). The median malrotation was 14 degrees. The differences in CT-measured anteversion (delta A), FPA (delta FPA), internal rotation (delta IR), and external rotation (delta ER) between the affected and normal sides were determined. Linear regression was used to analyze delta A with delta FPA, delta IR, and delta ER. Changes in internal and external rotation as determined by physical exam had a stronger correlation with delta A than did delta FPA. This indicates that malrotation of the femur is accommodated for during gait. CONCLUSIONS: Based on this data, we found that anteversion of the normal femur can be determined in the operating room using the image intensifier and can be duplicated on the fractured side using the described technique in cases where comminution prevents fragmentational alignment. This method has been used for 12 patients in a prospective trial, and malrotation has been kept to under 10 degrees in all cases.

Adult↗
PubMed1995

Intramedullary nailing after external fixation of the tibia.

Intramedullary nailing after external fixation of fractures of the tibia has high complication rates including nonunion and infection. The authors review the literature regarding this technique and refine the indications for secondary IM nailing. The report distinguishes between sequential secondary nailing and reconstructive secondary nailing. Sequential secondary nailing, as defined, is done by protocol and is planned from the onset of treatment. The technique includes only a short period in the external fixator, a planned interval between removal of the frame and placement of the IM nail, and specific exclusion criteria. This technique essentially uses the external fixator as a temporary traction device while the soft tissue envelope is reconstructed. Reconstructive procedures, as defined, are not done by protocol and not planned from the onset of treatment. Patients are usually in the external fixator for extended periods of time. The indications are variable and include delayed union, nonunion, malunion, and infected nonunion. The authors conclude that when done by protocol sequential IM nailing is safe and effective. Reconstructive IM nailing, however, has strict contraindications that include: a history of or an active infection of the pin tract, wound, or bone; the presence of an open wound or pin tract; and the presence of a ring or halo sequestrum. Yet reconstructive secondary procedures can be effective in healthy individuals if the soft tissue envelope is completely reestablished, if antibiotics are administered preoperatively, and the nail is placed without reaming.

Adult↗
PubMed1994

Anterograde interlocked nailing of distal femoral fractures after gunshot wounds.

Standard treatment for distal femoral fractures has been with blade plate or condylar screw plate devices. Excellent fixation is obtained, but bone grafting is required and the procedure exposes the fracture site. More recently, indirect methods of reduction have been initiated to limit the devascularization of the fracture site. Anterograde interlocked nailing has the advantage of using an incision far from the fracture site, and the technique is familiar to most surgeons. It can be performed regardless of the degree or length of comminution. Thirty-eight patients 16-50 years of age who underwent anterograde interlocked nailing for fractures of the distal femur were retrospectively studied. Follow-up averaged 24 months. All patients sustained their injury from a gunshot wound (GSW). Thirty-one had angiograms. The distance from the fracture to the distal screws was < 5 cm in all cases. There were five Winquist 2, eight Winquist 3, and 25 Winquist 4 type fractures. In five patients the rod tip was cut off to place the screw holes more distally, and in four patients only three corticies were obtained by the distal locking screws. Early motion was obtained in all patients. Fractures healed at an average of 8.6 weeks. No primary or secondary bone grafts were performed. Three of the six patients positioned laterally had 5 degrees or more of valgus angulation, and five of the 34 patients positioned supine had > or = 5 degrees of posterior angulation. A method of using smooth Steinman pins as joysticks to control the distal fragment is presented. Anterograde interlocked intramedullary (IM) nailing is an effective means of fixation for distal femur fractures.

Adolescent↗
PubMed1994

Treatment of grade-IIIb open tibial fractures. A prospective randomised comparison of external fixation and non-reamed locked nailing.

Severe open fractures of the tibia have a high incidence of complications and a poor outcome. The most usual method of stabilisation is by external fixation, but the advent of small diameter locking intramedullary nails has introduced a new option. We report the early results of a randomised, prospective study comparing external fixation with non-reamed locked nails in grade-IIIb open tibial fractures. Of 29 patients, 15 were treated by nails and 14 by external fixation. Both groups had the same initial management, soft-tissue procedures, and early bone grafting. All 29 fractures healed within nine months, but the nailed group had slightly better motion and less final angulation. Complications included one deep infection and two pin-track infections in the external fixator group and one deep infection and one vascular problem in the nailed group. Although the differences in healing and range of motion were not statistically significant, we found that the nailed fractures were consistently easier to manage, especially in terms of soft-tissue procedures and bone grafting. It is the treatment preferred by patients and does not require the same high level of patient compliance as external fixation. The only factors against nailing are the longer operating time and the greater need for fluoroscopy. We consider that locked non-reamed nailing is the treatment of choice for grade-IIIb open tibial fractures.

Adult↗
PubMed1993

Pilon fractures: treatment with combined internal and external fixation.

The purpose of this study was to prospectively evaluate the use of limited internal fixation and the application of a hybrid external fixator (tensioned wires distally and 5.0 mm half pins proximally attached to a semicircular frame without crossing the ankle joint) in the treatment of severe distal tibia fractures. This technique involves accurate reduction and fixation of the intraarticular component through an incision based over a fracture site followed by stabilization of the metaphysis with the hybrid external fixator. We studied 26 patients 15-55 years of age who were followed for 8-36 months. All fractures were within 5 cm of the joint. Seventeen fractures were intraarticular, nine extraarticular, and six open. Eleven patients required bone grafting. The average time to healing was 4.2 months. Using clinically based criteria, there were 81% good and excellent results overall, 70.5% for the 17 intraarticular fractures, and 69% for Ruedi type III fractures. Complications included one superficial and one deep infection, one 10 degrees varus malunion, and three pin tract infections. This method yielded results comparable with previous studies while reducing the amount of soft tissue dissection necessary for the placement of large plates. Soft tissue complications were infrequent and the goals of early motion and fracture stability were not sacrificed.

Adolescent↗
PubMed1993

Femur fractures caused by gunshots: treatment by immediate reamed intramedullary nailing.

Fractures of the femur caused by gunshots are increasingly common. There is no standard treatment of these fractures since there are no clear guidelines relating these injuries to open fracture classification. We reviewed our experience with such fractures, which included 65 patients who had an immediate reamed intramedullary nail placed as treatment. The soft-tissue injury, vascular injury, missile velocity, and length of hospital stay were evaluated. We found that all patients healed with no infections. The overall morbidity and average hospital stay were decreased compared with studies advocating delayed intramedullary nailing and prolonged intravenous antibiotics. We recommend that patients with fractures of the femur caused by gunshots are candidates for immediate reamed intramedullary nailing providing that there is only mild to moderate soft-tissue contamination and no evidence of major devitalization.

Adolescent↗
PubMed1993

Luxatio erecta: persistent displacement of the greater tuberosity after reduction.

The case of a 36-year-old man who sustained a luxatio erecta dislocation of his shoulder is reported. He had persistent displacement of a fracture of the greater tuberosity after closed reduction of the shoulder. The two-part fracture required operative treatment. This is the first occurrence of this complication reported in the literature.

Adult↗