Pedicled Peroneus Brevis Muscle Flaps as an Alternative to Fasciocutaneous Rotational Flaps for Lower-Extremity Soft Tissue Defects.

Objectives: To report our experience using a peroneus brevis flap (PBF) for soft tissue defects of the distal third of the tibia, ankle, and hindfoot in resource-challenged environments.

Design: Retrospective review.

Setting: Rural outpatient surgical facility in Honduras.

Focal Dome Osteotomy for the Treatment of Diaphyseal Malunion of the Lower Extremity.

The treatment of malunion of the lower extremity diaphysis is challenging. Diaphyseal osteotomies require extra care to promote bone healing. This may be enhanced through osteotomies, which do not produce bone gaps and allow for compression.

Talar Neck and Sustentaculum Fracture Fixation.

Talar neck fractures are uncommon fractures that result from high-energy trauma causing bony and soft tissue injury. When combined with sustentaculum fractures, care must be taken to plan the approach and fracture fixation strategy. We present a 57-year-old woman who experienced a motor vehicle accident, sustaining a Hawkins II talar neck fracture with associated sustentaculum tali fracture.

Medial Submuscular Plating of the Distal Femur.

Distal femur fractures are often treated with laterally based plate constructs. The use of medial plates is less common because of the concern for the proximity to vascular structures. With a solid understanding of the anatomy, the technique can be used more frequently to optimize fixation in medial distal femur fractures and osteoporotic, comminuted, bone loss, and periprosthetic fractures.

Distally Based Peroneus Brevis Rotation Flap.

Soft tissue defects of the distal leg, ankle, and hindfoot pose challenges for orthopaedic surgeons. The distally based peroneus brevis muscle flap is a viable local muscle rotation flap to cover defects in these challenging circumstances, and can be learned and performed by most orthopaedic surgeons without the need for microvascular techniques. This video demonstrates the technique for a peroneus brevis rotation flap in a patient with a lateral ankle defect and exposed bone.

Antegrade Nailing for Midshaft Femur Fractures.

The standard of care for treatment of midshaft femur fractures is locked intramedullary nailing. Entry point and patient position remain variables without a single universal method agreed as optimum. Morbid obesity poses additional challenges for intramedullary nailing, where special considerations must be taken.

Bridge Plating for Comminuted Ulna Fractures.

Highly comminuted fractures of the forearm are challenging for orthopaedic surgeons to manage because of the functional importance of anatomic restoration of alignment while obtaining sufficient fixation. The use of spanning plate fixation to stabilize comminuted ulna shaft fractures allows the patient early range of motion, whereas maintaining appropriate alignment and maximizing the patient's chances for a good outcome. This video demonstrates a technique for treating a highly comminuted open forearm fracture using spanning or bridge plating techniques.

Reverse Sural Artery Pedicle Flap.

Objective: To demonstrate the technical aspects of a reverse sural artery (RSA) flap.

Design: Video case presentation.

Setting: Community Level 2 Trauma Center.

Biomechanical strain analysis of the proximal femur following retrograde intramedullary nailing.

BACKGROUND: The purpose of this study was to examine the influence of proximal retrograde intramedullary nail position on proximal femoral strain, since stress risers occurring at the end of an implant can increase fracture risk. METHODS: Proximal femoral strains during axial and torsional loading were measured in composite Sawbone femurs after placement of retrograde intramedullary nails that ended at three different locations (2 cm proximal, 4 cm distal, and at the level of the lesser trochanter). RESULTS: No statistically significant difference was found between the axial or torsional strain observed in the intact femur and that seen after placement of a retrograde femoral nail ending at any of the three positions.

RIA: one community's experience.

The Reamer Irrigator Aspirator (RIA) has three main indications in our community trauma practice. The most common indication for RIA is harvesting of autololgous bone graft from the femur for nonstructural bone graft. The second most common indication is for irrigation and debridement of intramedullary osteomyelitis.

Femur fractures and lung complications: a prospective randomized study of reaming.

Reaming the intramedullary canal during fixation of femoral shaft fractures may contribute to pulmonary morbidity in patients with trauma. The purpose of our study was to compare acute and late pulmonary complications after reamed or nonreamed nailing of femur fractures. Patients who had femoral shaft fractures were randomized prospectively to a reamed (n = 41) or nonreamed (n = 41) femoral nailing group.

Incision placement for intramedullary tibial nailing: an anatomic study.

Objectives: For intramedullary nailing of tibial shaft fractures, a recent study has determined that the entry site should be just medial to the lateral tibial spine at the anterior margin of the articular surface. Gaining access to this site is often through a medial parapatellar or transpatellar approach. Several studies have indicated that a transpatellar approach may contribute to anterior knee pain.