Nursing care study: internal fixation of intertrochanteric fracture with complicating thromboembolism.
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A 3-week-old Standardbred filly had a non-weightbearing forelimb lameness caused by scapular neck fracture. The fracture was repaired with 2 dynamic compression plates placed 90 degrees to each other. A 10-hole 4.5-mm narrow dynamic compression plate was placed on the cranial aspect of the scapular spine, and a 10-hole 3.5-mm dynamic compression plate was placed caudal to the scapular spine. One year after surgery, the filly was not lame when exercising in the pasture, and muscle atrophy was not evident on the affected limb. Eighteen months after surgery, the filly was in race training with no apparent problems caused by fracture repair.
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Fractures of the femoral capital physis were stabilized with small pins or a lag screw in 36 dogs (4 bilateral injuries). Radiography was used to monitor the development of osteoarthritis in affected joints and narrowing of the femoral neck. More radiographic signs of arthritis (P less than 0.05) developed in the coxofemoral joints of dogs that were less than or equal to 4 months old when injured, compared with those in dogs greater than 4 months old. Of 40 capital physeal injuries, 35% had concurrent ipsilateral coxofemoral joint injuries and developed more radiographic signs of arthritis (P less than 0.05) than did those that had no other coxofemoral injury. Narrowing of the femoral neck developed in 70% of the healing capital physeal repairs, but in most dogs, narrowing was not associated with segmental collapse of the femoral neck. Neither time interval from injury to surgical fixation nor surgical approach used had an effect (P greater than 0.05) on the development of narrowing of the femoral neck.
A comminuted scapular fracture in a foal was treated surgically by use of 2 dynamic compression plates. The plates were applied upside down, so that the convex surface of the plate faced the bone. At 5 months after surgery, the plates were removed, and the foal recovered without complications.
A simple modification of the usual technique for inserting a implant into the distal femur is presented. It is intended to avoid malalignment of the distal femur in the sagittal plane in cases of severely comminuted supracondylar fractures.
Experiences in the use of biocompatible polymer rods in different orthopedic-traumatologic operations are reported. Results of their use on 113 patients are described. Also observed was a marked stimulating effect of the biocompatible polymer materials on the reparative processes of bones.
Biomechanical tests of a new method of fixation for intracapsular hip fractures compared with other types of mechanical fixation were investigated under one specific loading condition. Human femora fixed in formalin were classified by the Singh index for degree of osteoporosis. Specimens of Grade III or less were grouped as osteoporotic, and Grade IV or greater, normal. Both normal and osteoporotic bones were tested. A transverse osteotomy in the subcapital region was fixed by one of two techniques: (1) Asnis screws (AS) or (2) variable length telescoping compression screws (VLCS). Each specimen was roentgenographed after fixation to assess the placement of the devices and reduction. Each femur was held in an angle vise that was placed on rollers on a table mounted on the servohydraulic testing machine. Compression was applied at a constant displacement rate of 10 mm per second to failure. Load and displacement were monitored; specimens were photographed and roentgenographed after failure. In osteoporotic bone, the VLCS provided yield and ultimate load values several times greater than those of the AS. Resistance to combined compression varus loading was significantly higher with the experimental system in osteoporotic bone. In normal bone there was no significant difference between the two systems.
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Operative treatment of proximal humeral fractures is performed with a variety of fixation techniques. Selection of the optimum device for fixation is dependent on anatomic considerations, fracture characteristics, surgical exposure, and biomechanical features of fixation devices. Fixation objectives are evaluated in light of Neer's four segment classification. An extended deltopectoral approach with release of anterior deltoid distal insertion as well as the proximal pectoralis major raphe provides a wide exposure. The approach heals rapidly and allows rapid rehabilitation. The shoulder fracture fragments are adaptable to tension band wiring. With loss of bone stock, tension band wiring becomes increasingly important because compression or shearing forces can be expended in the tendinous insertion of the fragments. Fixation principles are applied according to specific fracture patterns. Whatever the choice of fixation method, a protracted and vigorous rehabilitation program is essential to achieve maximal functional recovery.