Immediate spica casting for pelvic fractures.

Records of 52 polytraumatized patients with closed pelvic fractures were reviewed retrospectively to determine if spica cast application decreased mortality due to exsanguination. Twelve patients had supplemental stabilization with external fixators or internal fixation of the pelvis. Their results indicated that the spica cast is effective in decreasing or controlling bleeding since no patient died of exsanguination. Several patients did die, however, but the cause of death in these patients was usually adult respiratory distress syndrome with or without other sepsis. Injury severity score, age, hypotension, and platelet count were found to be prognostic indicators for both transfusion requirements and mortality. A spica cast may be a useful adjunctive method for decreasing blood loss in the immediate postinjury period, but prolonged or improper use may lead to additional complications and death.

Radiographic evaluation of modern orthopedic fixation devices.

Orthopedic surgeons employ a wide variety of modern fixation devices in the treatment of fractures. In order to assess these instruments correctly, the radiologist should be aware of both their purpose and their normal appearance. A review of the common internal and external fixation devices used at a major trauma center and the complications of their use has been presented.

Tibial plateau fractures: CT evaluation and classification.

Fractures of the tibial plateau consist of two important components. One is depression of the plateau surface and the other a detached and peripherally displaced component referred to as the split fragment. The classification of these fractures is based on the morphologic appearance as well as the location of the above components. The surgical treatment of these fractures is dependent upon several factors, including the type of fracture, the degree of the fracture depression, and fracture fragment separation as well as the patient's age and physical condition. The degree of the plateau depression is a particularly important criteria for surgical-treatment planning. However, the anatomic configuration of the proximal tibia is such that the fractures of these regions are not adequately visualized on conventional radiographs. In the past, conventional tomography was routinely employed for evaluation of tibial plateau fractures. Recently, computed tomography (CT) has shown to be a more accurate and easier method for evaluation of these fractures. CT can be performed without removal of the knee brace or cast and usually requires less than 12 axial images. Furthermore, the degree of fracture separation and depression can be measured by computerized technique. CT scanning is a reliable method for evaluation and an accurate classification of tibial plateau fractures.

Functional anatomy of the lower limb.

To understand the functional anatomy of the lower limb, one must apply one's knowledge of the gross anatomy to the gait cycle. Gait analysis then leads to a better understanding of the function and dysfunction seen in the lower limb. Data from biochemical studies help one appreciate the forces the major joints are subjected to. These loads are three to five times body weight. The reason normal gait is so smooth is that there is minimal motion of the center of gravity located in the pelvis. Supple joints and good muscle strength are needed or gait disturbances result.

Alternative method for removing an impacted AO intramedullary nail.

An intramedullary femoral nail became impacted after approximately one third of it had been removed by standard AO technique in a 28-year-old man. Vise-grip pliers were used to twist the nail into a cigar-wrapper shape. While the standard nail removal should always be tried first, this method, although arduous and time-consuming, should be considered when faced with the possibility of having to split the femur or saw through the impacted nail.