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At least 703 records · Page 39Linked to original sources
PubMed1988

Reconstruction of post-traumatic deformity of the distal radius and ulna.

Proper patient selection, meticulous preoperative planning, and precise surgical technique are all necessary for a successful outcome following osteotomy of the distal radius. The patients should be young, manually active, and motivated. Radiocarpal post-traumatic arthritis or dystrophy are contraindications to this procedure.

Adolescent↗
PubMed1988

Intra-articular fractures of the basilar joint of the thumb.

This article on intra-articular fractures of the basilar joint of the thumb discusses the biomechanical and treatment complexities of fractures involving the thumb carpometacarpal joint. This review focuses on the treatment of thumb carpometacarpal fractures and dislocations, consolidating current philosophy and rationale regarding operative and nonoperative treatment. Treatment recommendations are based upon principles established in previous clinical and biomechanical studies emphasizing fracture-specific modalities. Emphasis is placed on maintenance of articular congruity, fracture stability, early motion, and maximum return of function.

Biomechanical Phenomena↗
PubMed1988

Non-union of fractures of the distal end of the humerus.

The records of twenty patients who had been treated for a non-union of the distal end of the humerus at the Massachusetts General Hospital from 1968 to 1984 were reviewed. Thirteen of the fractures were extra-articular and seven were intra-articular. Seven fractures had been open and nine had been associated with multiple trauma. Eight had been initially treated by open reduction and internal fixation; five, by closed reduction and immobilization; four, by skeletal traction; two, by external fixation; and one, by débridement and immobilization. The average time from the original fracture to the treatment of the non-union was twenty months (range, three to 120 months). All but one patient had pain and instability, and fifteen (75 per cent) had limited motion of the elbow. Radiographically, eleven were considered to have a reactive non-union and nine, a non-reactive non-union. Seventeen (94 per cent) of the eighteen non-unions ultimately united. Two patients underwent excision of the distal end of the humerus and replacement with an allograft. At follow-up (average, 3.6 years), function in one patient was rated as excellent; in six, as good; in seven, as fair; and in six, as poor. The patients who had an extra-articular supracondylar non-union had the best over-all results, while those who had a non-union that was associated with an intra-articular component or severe soft-tissue trauma did less well. It should be emphasized, however, that most of the patients in this study continued to have a major long-term disability, despite the fact that union was successful.

Adult↗
PubMed1988

Radial head fractures with acute distal radioulnar dislocation. Essex-Lopresti revisited.

Seven adults with displaced radial head fractures had concurrent dislocation of the distal radioulnar joint. Because support of the radius was lost at both the elbow and wrist, proximal migration of the radius from 5 to 10 mm occurred. Different types of fractures were classified to designate the best method of restoring radial length to prevent chronic wrist pain and stiffness. Type I fractures had large displaced radial head fragments with minimal or no comminution and amenable to interfragmentary fixation. Type II fractures had severe comminution requiring radial head excision and prosthetic replacement. Type III were old injuries with irreducible proximal migration of the radius managed by ulnar shortening and radial head prosthetic replacement. There were three Type I, two Type II, and two Type III fractures. Results of treatment were graded as 3, excellent; 2, good; 1, fair; and 1, poor. The three excellent results were in patients in which restoration of radial length was achieved within one week of injury. Suboptimal results occurred in the remaining four patients when definitive surgery was delayed four to ten weeks. The poor result was in a patient treated only by radial head excision and who refused further surgery. Recommendations include meticulous clinical and roentgenographic examination of the distal radioulnar joint in all patients with displaced radial head fractures. Preservation of the radial head with anatomic reduction and rigid internal fixation is preferred, but radial head replacement may be necessary in cases with extensive comminution. Radial head excision alone, though contraindicated, may be restructured by ulnar shortening and radial head prosthetic replacement.

Adult↗
PubMed1987

Non-union of the clavicle. Associated complications and surgical management.

Twenty-three patients who had a clavicular non-union were treated operatively at the Massachusetts General Hospital from 1974 to 1985. Twenty-one non-unions were the result of fracture and two, secondary to osteotomy. Twenty non-unions were located in the middle third of the clavicle, while three were in the lateral third. Radiographically, eighteen non-unions were atrophic and three, hypertrophic. Two non-unions resembled pseudarthrosis. Of the etiological factors that were reviewed the extent of displacement of the original fracture was the most significant. Associated complications of the non-union included limited mobility of the shoulder in fourteen, neurological symptoms in eight, thoracic outlet syndrome in four, and arterial ischemia in one. Of the nineteen patients who were treated to obtain union, seventeen had a successful result at an average length of follow-up of 23.8 months. In sixteen (93.7 per cent) of the seventeen patients union was achieved by fixation with a plate; one patient required two procedures. Ancillary bone graft was used in eighteen patients, with three requiring a sculptured bicortical graft from the iliac crest to span a defect. Of the four other patients three were treated with a partial clavicular resection and one, with complete clavicectomy.

Adult↗
PubMed1986

Intra-articular fractures of the distal end of the radius in young adults.

Intra-articular fractures of the distal part of the radius in young adults comprise a distinct subgroup of fractures that are difficult to manage and are associated with a high frequency of post-traumatic arthritis. The effect of residual radiocarpal incongruity after this fracture has not been investigated previously. A retrospective study of forty-three fractures in forty young adults (mean age, 27.6 years) was done to determine the components that are critical to the outcome. Treatment included application of a cast alone in twenty-one fractures, insertion of pins and application of a plaster cast in seventeen, external fixation in two fractures, and open reduction and internal fixation in three fractures. At a mean follow-up of 6.7 years, 26 per cent were rated as excellent; 35 per cent, as good; 33 per cent, as fair; and 6 per cent, as poor. There was radiographic evidence of post-traumatic arthritis in twenty-eight (65 per cent) of the fractures. Accurate articular restoration was the most critical factor in achieving a successful result. Of the twenty-four fractures that healed with residual incongruity of the radiocarpal joint, arthritis was noted in 91 per cent, whereas of the nineteen fractures that healed with a congruous joint, arthritis developed in only 11 per cent. A depressed articular surface (a so-called die-punch fragment) was reduced anatomically by closed means in only 49 per cent and was responsible for residual incongruity in 75 per cent of the incongruous joints at late follow-up. Non-union of the ulnar styloid process adversely affected the results. Restoration and maintenance (extra-articular reduction) of the dorsal tilt and radial length did not prove critical except when severe radial shortening occurred.

Adult↗
PubMed1987

Tension wire fixation of avulsion fractures in the hand.

Tension band wiring is a simple, predictable method of internal fixation for avulsion fracture in the hand. These fractures include the bony gamekeeper, bony mallet, and fractures associated with proximal interphalangeal joint trauma. By the placement of a small gauge wire through the insertion of the ligament or tendon onto the fracture fragment, the tension wire technique avoids many of the pitfalls of internal fixation and also takes advantage of its physiologic and biomechanical position.

Bone Wires↗
PubMed1987

The reconstruction of defects in the femoral shaft with vascularized transfers of fibular bone.

Seven major reconstructions of the femoral shaft using a vascularized graft of bone from the fibula were performed at the Massachusetts General Hospital from 1981 to 1984. Three patients had a post-traumatic infected non-union; one, extensive osteomyelitis of the femoral shaft; one, a fractured allograft; one, an atrophic non-union associated with radiation therapy; and one, post-traumatic loss of a ten-centimeter segment of bone. Six of the seven patients had a skeletal femoral defect, ranging from seven to fifteen centimeters in length. The average length of fibula that was used for reconstruction was 19.6 centimeters. Primary skeletal union occurred in five of the seven patients. Two patients had healing only at the distal junction and required a conventional bone graft and supplementary internal fixation of the proximal junction. At an average length of follow-up of thirty-four months, all of the patients were able to walk. Only two patients, both of whom had an extreme limb-length discrepancy, required additional support.

Adolescent↗
PubMed1985

Intercondylar fractures of the humerus. An operative approach.

In this paper we review a series of thirty-four intercondylar fractures of the distal end of the humerus that were treated by open reduction over a ten-year period. The fracture patterns were classified according to the system of Müller et al. and a strict rating scale incorporating subjective data, objective motion, and the functional status of the involved elbow was used for the results. At a mean follow-up of 5.8 years, thirteen results were rated as excellent; fourteen, as good; four, as fair; and three, as poor. Complications included postoperative neuritis in five patients; three non-unions; and refracture, heterotopic bone, and deep sepsis in one patient each.

Adolescent↗
PubMed1979

Management of supracondylar fracture with brachial artery thrombosis in a child: case report and literature review.

Brachial artery thrombosis following prompt reduction of a supracondylar fracture of the humerus in a 7-year old is described. Persisting absence of the distal pulses in a viable extremity may herald the insidious development of Volkmann's ischemia. Pulse volume recordings provide a safe, objective means of evaluation. Arteriography by direct open technique avoids the hazards of percutaneous puncture in children.

Brachial Artery↗
PubMed1969

Civil disturbance.

Explore the source record for details and available documents.

Civil Disorders↗
PubMed1984

Vascular injuries and closed extremity fractures in children.

The association of a major vascular injury with a closed extremity fracture in the pediatric patient is uncommon. The present study of seven such patients includes five fractures treated by open reduction and internal fixation (ORIF) prior to vascular reconstruction. Two were treated in skeletal traction without vascular reconstruction. Most vascular injuries were not diagnosed initially, consequently delaying repair. Early follow-up examination revealed the following complications: wound infections, below-knee amputation, deep vein thrombosis (DVT), and motor and sensory deficits. All of the fractures healed. Late follow-up examinations revealed two cases of overgrowth and one of limb undergrowth. Minor motor and sensory deficits were present, but overall function was good. Arteriography should be performed prior to surgical repair. Because of problems with growth disturbance that require long-term follow-up evaluation, all major vascular injuries should be repaired despite adequate collateral circulation to keep the limb viable. Prompt, accurate diagnosis followed by surgical repair will improve the long-term results.

Accidents, Traffic↗
PubMed1982

Salvage replantation of lower limb amputations.

Three cases are reported in which the microsurgical salvage of parts of traumatic lower extremity amputations associated with degloved proximal skin loss provided sturdy, sensate skin and soft-tissue coverage and thereby preserved functional below-knee amputation levels. In two instances, a free innervated filletted flap was constructed from the foot of the amputated limb, and in the third case, the amputated lower leg was shortened, successfully replanted, and followed later by elective amputation of a foot at the Syme level. At a mean follow-up of 2 years, all three patients are ambulating well in below-knee prostheses.

Adult↗