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Management of Ballistic Face and Neck Trauma in an Austere Setting
Published in Mansoor Khan, David Nott, Fundamentals of Frontline Surgery, 2021
No evidence exists that most facial fractures result in greater morbidity if they are not fixed early. On the contrary, military evidence gained from Iraq and Afghanistan has reiterated lessons from earlier conflicts that inappropriate use of internal fixation reduces vascularity and predisposes towards infection. Internal fixation should only be considered in the first 48 hours in non-comminuted clean fractures representative of those seen in civilian practice and should be performed by a clinician used to managing such injuries. If in doubt, temporary stabilisation with MMF as described in the previous section is recommended.
The rheumatoid foot
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Patricia Allen, Jasdeep Giddie
Various methods of internal fixation have been described including Kirschner wire (k-wire) stabilisation, Steinman pin, staples, cortical screws, standard and contoured locking plates and a combination of plates and screws. The risk of non-union following 1st MTPJ arthrodesis is higher in cases done for degenerative disease with an associated hallux valgus deformity. Thus, whichever fixation is used, it is imperative to achieve a stable construct. A biomechanical study by Politi et al. showed a combination of a dorsal plate and compression screw with power conical reaming of the surfaces provided the most stable construct (14).
Open versus Closed Treatment of Fractures of the Mandibular Condylar Process: A Prospective Randomised Multi-Centre Study
Published in Niall MH McLeod, Peter A Brennan, 50 Landmark Papers every Oral & Maxillofacial Surgeon Should Know, 2020
Henry Leonhardt, Adrian Franke
Selecting between open and closed treatment of mandibular condyle fractures is still controversial, though many studies have attempted to clarify this problem. Open reduction and internal fixation seem to obtain better results, but one has to consider the difficulties of the surgical approach and the risks of the operation. The aim of the study was to compare both strategies in treatment of moderately displaced condylar fractures and/or fractures with shortening of the mandibular ramus in a prospective and randomised multicentre study.
Analytical review on the biocompatibility of surface-treated Ti-alloys for joint replacement applications
Published in Expert Review of Medical Devices, 2022
Joint replacement is a surgical procedure in which an artificial joint surgically replaces arthritic or damaged joints made up of metals or plastic components. Damage to the joint may be caused due to several reasons such as aging, accident, or osteoarthritis. So, such damage causes orthopedic surgery that generally requires internal fixation of joints to provide stability during the bone healing process. Historically, cemented and cementless implant designs were used for total joint replacement (TJR) [1]. Cementless techniques are achieving more attention and popularity for TJR due to the removal of the second surgery requirement in cemented implants [2]. In cemented technique, initially, implants possess excellent mechanical strength, but later osteolysis causes loosening of implants. The biological response of cementless implants provides long-term mechanical stability. These implants’ stability depends on several parameters, such as corrosion behavior, debris created, and ions released from the implant. So, bone adaptation to implant and stress shielding is the central areas of concern [3].
Perinatal pubic symphysis separation combined with pubic fracture: a case report and literature review
Published in Journal of Obstetrics and Gynaecology, 2022
Liang Deng, Liang-Yu Xiong, Ji-Huan Zeng, Qiang Xiao, Yuan-Huan Xiong
In terms of the treatment, for pubic symphysis separation with separation distance ≤ 40 mm, conservative treatment can be performed with a pelvic correction belt. The elasticity of the pelvic correction belt can fix the crotch, tighten the separated pelvis, protect the pubis, and relieve the pain of pubic. Hence, the mechanical distribution of pelvis, back and buttock can be further improved, and the pubic symphysis can be recovered and maintained in the normal anatomical position (Culligan et al. 2002). For the parturient with a separation distance > 40 mm or combined with the persistent pain and pelvic instability, the active surgical intervention may be a sensible choice. With regard to this, the common surgical methods include external fixation and internal fixation, in which the internal fixation is the preferred method (Sujana et al. 2017). The internal fixation mainly includes the screws and steel plates fixation, which can provide sufficient mechanical stability and effective compression resistance and anti-rotation ability. In recent years, the minimally invasive surgeries represented by percutaneous cannulated screws have obtained remarkable results, which can effectively reduce the surgical trauma, shorten the operation time, and further contribute to the rapid postoperative recovery (Saeed et al. 2015). In this case, we have applied the conventional open reduction and internal fixation, and fixed with screws and steel plates. After one year of follow-up, the screws and steel plates were still fixed firmly and the separation distance of pubic symphysis was also effectively controlled.
Comparison of outcome between nonoperative and operative treatment of medial epicondyle fractures
Published in Acta Orthopaedica, 2020
Petra Grahn, Tero Hämäläinen, Yrjänä Nietosvaara, Matti Ahonen
Nonoperative treatment was carried out by immobilizing the injured upper extremity (1 bilateral injury) either with an above-elbow cast (n = 38) or a collar-and-cuff sling (n = 3) for a mean 24 days (19–34). Closed reduction was not attempted in the nonoperative group. Internal fixation was performed at mean 5 days (0–19) from the injury by a cannulated screw in 33, smooth pins in 6, or with a bone anchor in 1 patient. Bone anchors were additionally used in 2 instances, once in combination with a screw and once with pins. Half of the operations were done by an attending pediatric orthopedic surgeon or a pediatric surgeon, half by registrars. Mean length of postoperative immobilization was 30 days (21–44) either in an above-elbow splint (n = 36) or with a collar-and-cuff sling (n = 5). All wounds healed uneventfully without recorded infections. The rate and timing of hardware removal was registered.