[Show abstract][Hide abstract] ABSTRACT: Segmental bony defects in open fractures of the tibia are bridged with bone grafting, free vascularized fibular grafts, or an external ring fixator. A 33-year-old man sustained a gunshot injury to his left leg, resulting in Gustillo type IIIB open fractures of the tibia and fibula. The tibia had a segmental massive defect of 19 cm in the midshaft. Debridement and immediate application of an Ilizarov external fixator were performed. The midportion of the ipsilateral fractured fibula served as a bridging vascularized graft for the tibial defect. Good bony union and fibular hypertrophy were obtained. Use of a fractured fibula from a zone previously injured by a gunshot has not been reported. This case demonstrates the successful transfer of a fractured fibula for the bridging of an ipsilateral tibial defect caused by a gunshot injury.
Military medicine 06/2005; 170(5):418-21. DOI:10.7205/MILMED.170.5.418 · 0.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Reports on complete spontaneous Achilles tendon ruptures and associated treatment have become more frequent in the literature in the past two decades, as has the request for treatments that enable the finest possible functional recovery. The best available treatment is a matter of considerable controversy in the literature. The purpose of this study was to compare the isokinetic strength and endurance of the plantarflexor muscle-tendon unit in subjects who sustained rupture of the Achilles tendon and underwent either open surgery or closed percutaneous repair of the Achilles tendon.
Twenty patients (18 males, 2 females) with spontaneous ruptures of the Achilles tendon were included in this study. Ten patients were treated by open surgery, and 10 patients were treated percutaneously. All patients had ruptured their Achilles tendon more than 6 months before the study, and all of the ruptures occurred 3.5 years or less before the day of the testing. All patients underwent an oriented physical examination. An isokinetic Biodex dynamometer (Biodex Medical System, Shirley, NY) was used to measure ankle joint angle, and in plantarflexion to calculate the torque at the ankle joint (Newton/meter), and the average work (jouls) for both maximal power and endurance. Each measurement was compared to the normal ankle.
Biodex dynamometer evaluations at 90 deg/sec demonstrated a significant difference of maximal voluntary plantarflexor torque, endurance performance and range of motion at the ankle joint between the involved and uninvolved sides in patients treated by either mode of treatment. Yet, no statistically significant differences were revealed for the parameters mentioned above between the subjects that were treated either percutaneously or by an open surgery.
In functional terms, the biomechanical outcomes of open surgery and percutaneous repair for acute ruptures of the Achilles tendon are both effective.
Foot & Ankle International 05/2005; 26(4):286-90. · 1.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The use of retrograde intramedullary nailing in fractures of the femur has become widely accepted in the treatment of trauma patients. The indications for retrograde nailing are continuously expanding and include supracondylar femoral fractures, ipsilateral femoral neck and shaft fractures, bilateral femoral fractures, ipsilateral femoral shaft and tibial shaft fractures, femoral shaft fractures below a total hip arthroplasty or above a total knee arthroplasty, ipsilateral femoral shaft and acetabular fractures, and patient obesity.(1-8) There is a paucity of literature regarding removal of retrograde intramedullary femoral nails. The indications for removal include nonunion, malunion, knee pain, local pain at the screws sites, infection, and hardware failure.(9) Arthroscopy-assisted removal of retrograde intramedullary femoral nails was described by Born et al.(10) and Gebhard et al.,(11) but this technique may be involved with further damage to the knee joint and, in the case of an infected implant, may induce contamination of the knee. The use of a transtrochanteric technique allows prudent removal of the nail and is particularly useful in cases of implant infection. We have used this technique in a patient with osteomyelitis of the femur after retrograde nailing after a supracondylar fracture.
The Journal of trauma 02/2005; 58(1):189-92. DOI:10.1097/01.TA.0000072348.20218.14 · 2.96 Impact Factor