Intra-articular calcaneal fractures: effect of open reduction and internal fixation on the contact characteristics of the subtalar joint.

Intra-articular calcaneal fractures are associated with significant long-term morbidity, and considerable controversy exists regarding the optimum method of treating them. The contact characteristics in the intact subtalar joint were determined at known loads and for different positions of the ankle and subtalar joint, using pressure-sensitive film (Super Low; Fuji, Itochu Canada Ltd, Montreal, Quebec). We measured the contact area to joint area ratio (pressure > 5 kg force/cm2 [kgf/cm2]) which normalizes for differences in joint size and the ratio of high pressure zone (>20 kgf/cm2) as a reflection of overall increase in joint pressure. Three simulated fracture patterns were then created and stabilized with either 1 or 2 mm of articular incongruity. Eight specimens were prepared with a primary fracture line through the posterior facet, eight with a joint depression-type fracture, and six with a central joint depression fracture. A measure of 1 to 2 mm of incongruity in the posterior facet for all three fracture patterns produced significant unloading of the depressed fragment, with a redistribution of the overall pattern of pressure distribution to parts of the facet that were previously unloaded.

Care of the obstetric patient in the traditional intensive care unit.

Obstetric patients have long been a source of fear for nurses in the intensive care unit (ICU) setting. Several hospitals have moved toward having obstetric ICUs, but most do not have the volume to justify such units, leaving the care of these patients to nurses in traditional ICU settings. Collaboration of care may occur, but it is still imperative that ICU nurses have a basic understanding of the physiologic changes and care necessary to provide optimal outcomes for obstetric patients. Physiologic changes of pregnancy and basic care for pregnant and immediate postpartum patients are reviewed.