Hybrid external fixation in the treatment of tibial plafond fractures.

From 1992 to 1994, 37 fractures (36 patients) were treated with hybrid external fixation for tibial plafond or distal tibial fractures. The fractures were classified according to the AO classification: A1 (3), A2 (3), A3 (4), C1 (6), C2 (12), C3 (9). There were 11 open injuries, and in 27 patients (75%) the mechanism of injury was high energy trauma. Results were evaluated based on a subjective and objective rating system. Thirty-four patients were available for followup at an average of 15.2 months. All fractures in this series united with an average time to healing of 4.6 months. Anatomic or good alignment was obtained in all but 1 fracture. There were 12 excellent, 9 good, 7 fair, and 6 poor results. In the 18 C2 and C3 fractures there were 8 good to excellent, 4 fair, and 6 poor results. Degenerative changes were seen on followup radiographs in 4 of these patients. Complications occurred in 12 patients (35%) and included 1 skin slough, 5 pin tract infections, 3 deep infections, 3 nonunions, and 3 loss of reductions necessitating frame revision. This method yielded results comparable with previous studies while decreasing the number of complications resulting from treatment.

Femoral nailing without a fracture table.

This retrospective trail was designed to evaluate the effectiveness and safety of femoral nailing on a radiolucent table with manual traction only. Eighty-three femoral shaft fractures treated by antegrade nailing were included in this study. Group 1 consisted of 24 femur fractures that were reduced and nailed with manual traction. Group 2 consisted of 59 femur fractures treated with the aid of a fracture table. There were 10 patients in Group 1 and 19 patients in Group 2 needing multiple procedures. In Group 1, significantly fewer redrapings and table transfers were necessary. There was no increase in operative time. There were no operative complications in Group 1 and there was 1 operative complication in Group 2--a radial nerve palsy. Postoperative malalignment was minimal in both groups. Intramedullary nailing of femoral shaft fractures on a radiolucent table using manual traction is associated with no increase in morbidity. It also facilitated quicker and more effective treatment of the patient with polytrauma. No undue risks or contraindications were identified; however, the help of an assistant was invaluable.

Bicondylar tibial plateau fractures treated with a hybrid ring external fixator: a preliminary study.

Twenty-three knees in 22 patients with Schatzker type VI tibial plateau fractures were treated with a hybrid ring external fixator using tensioned wires proximally and half-pins distally. All but two injuries were secondary to high-energy trauma. Six were open injuries, and eight patients had other major musculoskeletal trauma. Eight patients were treated with limited open reduction and internal fixation before application of the frame. The remainder received percutaneous cannulated screw fixation to stabilize the articular surface without opening the fracture site. Twenty-three fractures were followed to complete healing. Average time to healing was 4.4 months. Arc of motion averaged 107 degrees, and there were four flexion contractures of 5-15 degrees. Complications consisted of three deep wound infections, one deep venous thrombosis (DVT), one malunion, and one pin tract infection. The average knee score and patient function score were 84.7 and 80.5, respectively (Knee Society Clinical Rating System). There were 13 excellent, three good, one fair, and six poor results. The poor results were in patients who either developed deep wound infections or in those who sustained multiple musculoskeletal trauma compromising the patients' function score and ultimately the average score. This method provides good stabilization and allows early range of motion for complex tibial plateau fractures where extensive dissection and internal fixation are contraindicated due to traumatized soft tissue, osteopenia, and fracture comminution.

Anomalous results of studies on drug interaction in man. I. Nortriptyline and antipyrine.

Conflicting results were obtained in three drug interaction experiments designed to determine in man effects of chronic nortriptyline administration on plasma antipyrine half-lives. In an apparently similar design, each experiment utilized normal volunteers whose plasma antipyrine half-lives were measured before and after chronic nortriptyline administration. The same dose of liquid nortriptyline (0.2 mg/kg p.o. t.i.d. for 8 days) was used in each experiment. All subjects in the first study prolonged their plasma antipyrine half-lives, whereas seven of nine subjects in the second study significantly shortened their plasma antipyrine half-lives. In the third experiment seven of nine subjects showed no significant change in plasma antipyrine half-life. An explanation for these conflicting results obtained in the same laboratory under apparently similar experimental conditions was sought in the nature of the volunteers and in subtle changes in such variables as differences in the batches and length of storage of liquid nortriptyline.