Evaluation of Intraoperative Fluoroscopic Techniques to Estimate Femoral Rotation: A Cadaveric Study.

Objectives: To compare three fluoroscopic methods for determining femoral rotation.

Methods: Native femoral version was measured by computed tomography in 20 intact femurs from 10 cadaveric specimens. Two Steinmann pins were placed into each left femur above and below a planned transverse osteotomy which was completed through the diaphysis.

Triceps Tenotomy as an Alternative Exposure for Fixation of OTA/AO 13-C Fractures: A Technical Trick.

Intra-articular fractures of the distal humerus present challenges to treating physician and patient alike. The olecranon osteotomy is accepted as the standard exposure for intra-articular distal humerus fractures; nevertheless, complications such as nonunion and implant prominence are common. In this article, we describe the clinical outcomes and anatomic features of the triceps tenotomy as an alternative method of exposure for internal fixation of intra-articular distal humerus fractures.

Locking plate fixation of proximal humerus fractures in patients older than 60 years continues to be associated with a high complication rate.

Background: Locking plate technology has increased the frequency of open reduction and internal fixation (ORIF) of proximal humerus fractures (PHF). A number of technical pearls have been recommended to lower the complication rate of ORIF. These pearls are particularly relevant for patients aged >60 years, when nonoperative treatment and arthroplasty are alternatives commonly considered.

Short Versus Long Cephalomedullary Nails for Pertrochanteric Hip Fractures: A Randomized Prospective Study.

Objective: To compare functional and clinical outcomes in patients with pertrochanteric hip fractures treated with either a short (SN) or long (LN) cephalomedullary nail.

Design: Prospective, randomized.

Setting: Clinical investigation was performed at the Mayo Clinic's Level 1 Trauma Center in Rochester, MN.

Vascularized Medial Femoral Condyle Graft for Manubrium Nonunion: Case Report and Review of the Literature.

Fractures of the sternum are rare. Persistent nonunions, however, can lead to chronic pain and significant functional limitations. The vascularized medial femoral condyle is a versatile tool in the surgeon's armamentarium.

Fibular shaft allograft support of posterior joint depression in tibial plateau fractures.

Posterior depression of the lateral articular surface of the tibial plateau can be difficult to elevate and support with morselized bone graft and internal fixation. Progressive collapse after open reduction and internal fixation has been described and can lead to failure in treatment. A standard anterolateral approach to the tibia may not allow direct reduction and stabilization of posterolateral joint depression given the anatomic barriers of the fibular collateral ligament and the proximal tibiofibular articulation.

Technical tips for fixation of proximal humeral fractures in elderly patients.

Despite the application of modern locking plate technology, complications remain common after fixation of proximal humeral fractures in elderly patients. Varus deformity and intra-articular hardware are most often responsible; fortunately, both of these complications can be avoided. Recent advances in imaging, reduction techniques, fixation methods, and postoperative care have made surgical outcomes more reliable.

Complications and outcomes of functional free gracilis transfer in brachial plexus palsy.

The purpose of this study was to evaluate the outcomes and complications following free functional gracilis transfer for restoration of elbow flexion and/or finger flexion in patients with acute or chronic brachial plexus injuries. A review of 130 free functioning gracilis muscles transferred for brachial plexus injuries was undertaken to evaluate the failure rate as well as late complications. The overall failure rate (defined as a non-function muscle or one that failed acutely) was 15.

Complex distal humeral fractures: internal fixation with a principle-based parallel-plate technique. Surgical technique.

Background: Severe comminution, bone loss, and osteopenia at the site of a distal humeral fracture increase the risk of an unsatisfactory result, often secondary to inadequate fixation. The purpose of this study was to determine the outcome of treating these fractures with a principle-based technique that maximizes fixation in the articular fragments and stability at the supracondylar level.

Methods: Thirty-four consecutive complex distal humeral fractures were fixed with two parallel plates applied (medially and laterally) in approximately the sagittal plane.

Complex distal humeral fractures: internal fixation with a principle-based parallel-plate technique.

Background: Severe comminution, bone loss, and osteopenia at the site of a distal humeral fracture increase the risk of an unsatisfactory result, often secondary to inadequate fixation. The purpose of this study was to determine the outcome of treating these fractures with a principle-based technique that maximizes fixation in the articular fragments and stability at the supracondylar level.

Methods: Thirty-four consecutive complex distal humeral fractures were fixed with two parallel plates applied (medially and laterally) in approximately the sagittal plane.

Locking plate fixation for proximal humeral fractures: initial results with a new implant.

Treatment of proximal humeral fractures remains controversial, with multiple reported techniques and variable results. Recently, locking plates have become available for fixation of osteopenic and comminuted fractures. This study reports our initial experience with a new locking plate designed specifically for proximal humeral fractures.

Neurovascular compression following isolated popliteus muscle rupture: a case report.

This case report concerns an unusual complication of neurovascular compression following an isolated popliteus muscle rupture. A 59-year-old man, after a fall from a horse, gradually developed symptoms of a swollen leg, dysesthesias in the sole of his foot, and muscle weakness of his toe flexors. At presentation, he was found to have a complete tibial nerve injury at the level of the popliteal fossa and significant neuropathic pain.

Bankart repair in patients aged fifty years or greater: results of arthroscopic and open repairs.

Currently, there is little information on the results of Bankart repairs in older patients. Therefore, the purpose of this study was to determine the results, complications, and rates of revision among patients aged 50 years or greater undergoing Bankart repairs. Between 1992 and 1999, 12 Bankart repairs were performed on patients aged 50 years or greater (mean, 57 years) at our institution.

Radiographic analysis of polyethylene glenoid components using modern cementing techniques.

The purpose of this study was to examine the initial radiographic appearance and changes occurring over time in patients who have undergone total shoulder arthroplasty by modern methods of bone preparation and current cement techniques. Sixty-five patients underwent seventy total shoulder arthroplasties by use of a cemented all-polyethylene, keeled glenoid component. The surface radius was equal to the radius of a one-piece humeral component.

Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years.

Background: There is a paucity of data on the treatment of femoral neck fractures in young patients. The purpose of the present study was to review the results and complications associated with the treatment of femoral neck fractures with internal fixation in a large consecutive series of young patients.

Methods: Between 1975 and 2000, eighty-three femoral neck fractures in eighty-two consecutive patients who were between fifteen and fifty years old were treated with internal fixation at our institution.

Treatment of supracondylar femur nonunions with open reduction and internal fixation.

We reviewed a consecutive series of 22 adults with 22 supracondylar femoral nonunions treated with open reduction and internal fixation (ORIF) to determine the results and complications associated with the procedure. Twenty-one of 22 nonunions (95%) healed. Knee Society pain scores improved from 18 to 88 (P < 0.

Infection after shoulder instability surgery.

Currently, there are no reported series on the outcome of patients treated for infection after shoulder instability surgery. Therefore, the purpose of this study was to review patients who were treated for infection after shoulder instability surgery at our institution between 1980 and 2001 to determine the functional outcome and organisms responsible for infection. During this period, six patients were treated for infection after shoulder instability surgery.

Intramedullary fixation of diaphyseal femoral fractures in elderly patients: analysis of outcomes and complications.

The efficacy of intramedullary fixation for diaphyseal femoral fractures in young patients has been well documented. There is a paucity of data, however, on the efficacy of intramedullary techniques used in the ever growing elderly population. The purpose of this study was to analyze the outcomes and rate of perioperative complications associated with using intramedullary fixation to treat diaphyseal femur fractures in patients older than 65 years.

Management of the smashed distal humerus.

The purpose of this article is to present a principle-based approach to treating the smashed distal humerus. These injuries are challenging to even the most experienced surgeons. The four goals, in order of priority, are soft tissue healing without infection, restoration of diaphyseal bone stock, union between the distal fragments and the shaft, and a stable and mobile articulation.

Managing Posterior Shoulder Instability.

In brief Posterior shoulder instability, a recently recognized source of pain in throwing, overhand, and contact sports, usually results from repetitive microtrauma or a single traumatic episode. Physical signs often are not obvious, so targeted physical tests, provocative maneuvers, and radiographic studies are needed to identify abnormal humeral head translation. Examination under anesthesia or arthroscopy may be required.