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AA total of 5 points or more is regarded as unstable aA total of 5 points or more is regarded as unstable Fig. 11.3. Lateral cervical spine X-ray with translation of C6 on C7 Fig. 11.3. Lateral cervical spine X-ray with translation of C6 on C7 patient has significant pain or tenderness to palpation of the cervical spine, flexion extension views should be performed. These must be done under the supervision of a physician, and the patient must be entirely cooperative. Until the patient is...

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Four-part fracture patterns. There are two types of four-part fracture patterns, each differing markedly in treatment and outcome. In the first type, the crescentic head fragment is impacted and stable (a), whereas in the other the head is unstable (b) destroy any remaining blood supply (Fig. 4.11). The avulsed abductor mechanism, often in one large fragment consisting of the greater and lesser tuberosities with the intervening long head of biceps tendon, may be replaced without...

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What Shear Hemipelvis

DC Plates Lag screws Transiliac bars 1 inf. plate 2 plates DC Plates Lag screws Transiliac bars 1 inf. plate 2 plates Loss of tamponade and the possibility of massive hemorrhage because of clotting problems must be recognized. The superior gluteal artery is commonly injured during pelvic trauma, but the injury may be unrecognized because the artery may clot. With the massive blood transfusions required in these patients, the clotting mechanism may be defective on the fifth-tenth postoperative...

Distal Radius Fractures

It remains a mystery as to why the management of the complex group of fractures of the distal radius is still so often directed by a statement made by Abraham Colles over 190 years ago (1814) One consolation only remains, that the limb will, at some remote period, enjoy perfect freedom in all its motions, and be completely exempt from pain. The deformity, however will remain undiminished through life. Advances in the understanding of fracture patterns, options in management, and the results...

Ulna Plate Lateral Placement

Lag Screw Ulna Radius

Technique of Fracture Fixation Principles of Stable Fixation As previously indicated, to obtain maximum function the surgeon must achieve anatomical reduction and stable internal fixation. In general, stable internal fixation may be achieved by internal splinting with intramedullary devices or by compression, using plates. In the forearm, intramedullary devices do not control rotational stability and should therefore rarely if ever, be used (Fig. 9.10). Therefore, compression, with...

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Sacral Fracture Anterior

Sacrotuberous ligament with chewed remains ofglut. max. orign Fig. 12.45a-c. Posterior pelvic fixation. Note that the surgical incision should be made either 1 cm medial or lateral to the posterior iliac spine and not directly over the subcutaneous border (a). Depending on the amount of exposure required posteriorly, the insertion of the gluteus maximus may be dissected from the lateral aspect of the ilium into the greater sciatic notch with an elevator, as noted in the diagram. b...

The Distal Radioulnar Joint

Radial Styloid Fracture Splint

The distal radioulnar joint (DRUJ) is an area of growing interest. Work by Palmer (1987), Bower (1988), and others has provided us with a better understanding of the biomechanics of this complex region. Many distal radius fractures involve the DRUJ. Displacement of the distal radial metaphysis without an associated ulnar shaft fracture must result in a partial or complete disruption of the distal radial ulnar articulation. Fortunately, with reduction of the radius, the sig-moid notch usually...

Fractures and Specific Management 1181

Posterior Occipital Cervical Fusion

Occipitocervical injuries are rarely survivable, and these patients are not seen in the emergency department. Seventy-two percent of patients with fatal craniospinal injuries have neck lesions, with a significant number of ligament injuries occurring in the upper cervical region (Bohlman 1979). Radiological identification of these patients is often delayed if they survive the initial scene of the accident. In the normal individual, the tip of the odontoid will point to the clivus at the base of...

References

Axelrod TS, Cheng SL-T (1995) Complex dislocations of the distal radioulnar joint. J Hand Surg Am Axelrod TS, McMurtry (1990) Open reduction and internal fix ation of comminuted intraarticular fractures of the distal radius. J Hand Surg Am 15 1-11 Axelrod TS, Paley D, Green J, McMurtry RY (1988) Limited open reduction of the lunate facet in comminuted intraar-ticular fractures of the distal radius. J Hand Surg Am 13 372-377 Bower WH (1988) The distal radioulnar joint. In Green DP (ed) Operative...

Sacrospinous Ligament Avulsion

Type B - Partially Stable Fractures Table 12.2 12.3.3.1 Open Book Anteroposterior Compression Fractures B1, B3.1 External rotatory forces applied to the pelvis usually cause a disruption of the symphysis pubis however, they may also cause an avulsion fracture of the pubis adjacent to the symphysis or a fracture through the pubic rami, the symphysis avulsion or disruption being more common. Since the force is a continuum and may stop at any point, several possibilities exist. First, an opening...