Long-term results of displaced talar neck fractures.

Of 36 fractures of the talar neck without comminution of the body, eight were undisplaced, treated closed, and 28 were displaced and treated by open reduction. Twenty of the operations were less than 12 hours after injury. Nineteen of 20 were performed through a medial approach, six with a medial malleolar osteotomy. The long-term results were evaluated by a standard rating system based on classification by the fracture. A protective brace was developed for non-weight-bearing in two patients with complete avascular necrosis, and ankle protection with weight-bearing in ten with partial necrosis. Prompt open reduction and internal fixation, malleolar osteotomy, and protected weight-bearing are recommended in selected cases.

Unilateral external fixation for severe open tibial fractures. Preliminary report of a prospective study.

In a prospective survey of severe open tibial fractures, the incidence of serious complications with relatively rigid one- or two-plane unilateral fixator frames was considerably lower than with internal fixation by plates and screws. Unilateral configurations that contain rigid components provide better wound access than bilateral frames and interfere less with knee and ankle motion; they allow unencumbered partial and even full weight-bearing. This increases comfort and mobility and may have a positive effect on fracture healing. No standard formula exists, however, for the application of an optimal unilateral frame. The clinical and mechanical demands of each patient and injury must be considered individually.

Barbotage of the shoulder with image-intensified fluoroscopic control of needle placement for calcific tendinitis.

In 9 patients with symptomatic calcific deposits in the rotator cuff, followed for an average of 9 years, good to excellent results were obtained by barbotage (needle irrigation and aspiration). The deposit was localized with a needle using an image intensifier. Postbarbotage X-rays show residual deposits, but films taken on follow-up show complete disappearance of the lesion except in one instance where a small density was seen. One patient had early recurrence of symptoms out of the 3 who had postbarbotage cortisone injection. Barbotage is simple, effective, with virtually no complications. Failures of the method were apparently due to difficulty in locating the deposit with the needle. Barbotage is most indicated in the acute phase of the disease but may be used in cases with chronic symptoms to remove dry granular deposits. It is not essential, however, to completely remove the deposits because the resorption process continues. Local cortisone injection either as a primary procedure of after barbotage is not recommended because it aborts the natural course of the disease and promotes recurrences.

Analysis of treatment problems in subtraochanteric fractures of the femur.

In a retrospective study of 82 subtrochanteric fractures of the femur in the St. Paul-Ramsey Hospital, there were 32 treated by traction, 50 by open reduction and internal fixation. In adults 50% of those treated by traction had undesirable results using strict criteria for varus, shortening, and rotational deformity: 21% of those treated by operation had undesirable results due to varus, rotational deformity, medial migration of the distal fragment, and nonunion. Good resutls are related to stable reduction and individualization of a particular implant based on the fracture pattern, including reconstruction of the medial cortical wall, and close contact of the fracture fragments during healing. If reduction is not achievable, bone grafting and extra protection are required. If reduction can be predicted as not achievable, good results can be obtained with traction although the healing period is longer. In the presence of a residual gap in the medial surface of the femur in the region of the lesser trochanter, poor results are frequent.