ABSTRACT
A retrospective study during a 3-year interval revealed that four of 112 patients had intertrochanteric fractures that were irreducible by the usual closed manipulation and traction techniques at the time of surgery. Each of these patients' preoperative radiographs showed a fracture line that bisected the lesser trochanter and was relatively uncomminuted. Although longitudinal traction and appropriate closed manipulation provide acceptable reduction for most intertrochanteric fractures, the few with the described fracture pattern may require open reduction with removal of interposed soft tissue to achieve satisfactory alignment.
Subject(s)
Fracture Fixation, Internal/methods , Hip Fractures/therapy , Manipulation, Orthopedic/methods , Traction/methods , Adolescent , Adult , Bone Plates , Bone Screws , Female , Hip Fractures/classification , Hip Fractures/diagnostic imaging , Humans , Male , Middle Aged , Radiography , Retrospective Studies , Treatment FailureABSTRACT
Twenty-six legs in 25 patients were monitored prospectively for compartment pressures during intramedullary nailing of open and closed tibial shaft fractures. Twenty-three patients were treated within 24 hours of admission. Twenty-three unreamed and three reamed intramedullary rods were utilized. Compartment pressures were measured initially, following fracture reduction, and during reaming. Pressures were also measured at the completion of nailing with the ankle dorsiflexed and at rest (plantar flexed) to determine positional effects on compartment pressures. Nine fractures (35%) were found to have persistently elevated pressures (> 40 mm Hg) and underwent immediate four-compartment fasciotomy. The remaining group of 17 fractures (65%) was monitored throughout the intraoperative period. No patient monitored intraoperatively developed postoperative compartment syndrome.
Subject(s)
Compartment Syndromes/etiology , Fracture Fixation, Intramedullary/adverse effects , Tibial Fractures/surgery , Adolescent , Adult , Compartment Syndromes/diagnosis , Female , Fracture Fixation, Intramedullary/methods , Fracture Healing , Fractures, Closed/surgery , Fractures, Open/surgery , Humans , Male , Middle Aged , Monitoring, Intraoperative/methods , Pressure , Prospective Studies , Tibial Fractures/physiopathologyABSTRACT
The effect of amiodarone on the ischemic-reperfusion injury was tested in an isolated working preparation, using hypertrophied rat heart at 37 degrees C. Constant filling and afterload pressures and similar heart rates were used. Hearts from spontaneously hypertensive rats (N = 78) had thirty minutes of ischemia. Each received a 12-ml injection, by aortic root infusion, of amiodarone in normal saline or of normal saline alone at 37 degrees C at the onset of ischemia. Heart rate, aortic output, coronary sinus output, atrial pressure, and aortic pressure were recorded before and after global ischemia under steady-state conditions. Dose-response studies were performed at concentrations of 0.01 to 1.0 mg/ml. At every dose administered, amiodarone was found to significantly ameliorate the deleterious effects of global ischemia. The maximal benefit of amiodarone (70 +/- 4.6% recovery of function [mean +/- standard error of the mean], p less than 0.01) was found to be 0.25 mg (0.021 mg/ml), or 0.11 mg/g wet heart weight. Improvement in survival (return of aortic output and heart rate following ischemia) with all doses of amiodarone was statistically significant (p less than 0.002). Decreased recovery of function following global ischemia when doses were greater than 0.25 mg may have been secondary to the known negative inotropic effects of the drug. The mechanisms for the protective effects of amiodarone may be coronary vasodilatation, antiarrhythmic stabilization, or inhibition of calcium flux at the slow channel.
