Complex Fractures of the Limbs: Diagnosis and Management by E. Carlos Rodríguez-Merchán, Juan Carlos Rubio-Suárez

By E. Carlos Rodríguez-Merchán, Juan Carlos Rubio-Suárez

This publication offers updated tips at the prognosis and remedy of crucial complicated fractures of the limbs, together with fractures of the proximal and distal humerus, fractures and dislocations of the elbow, fractures of the distal radius, pelvis, acetabulum, distal femur, proximal tibia, tibial pilon, calcaneus and osteoporotic knee fractures. the main advanced articular fractures are analyzed, delicate tissue assurance is reviewed, and the administration of open fractures and nonunions is defined and illustrated. different chapters examine harm regulate administration and speedy bone fixation within the polytrauma sufferer, skeletal reconstruction and rehabilitation of complicated fractures of the limbs. The booklet bargains information to orthopaedic surgeons on which therapies come up with the money for the easiest upkeep of absolutely practical joints round the fractured bone. With this target in brain, the authors have constructed ideas that could restoration complete articular functionality of the limbs in either the fast and the longer term. Complex Fractures of the Limbs can be a useful relief to orthopaedic surgeons in treating sufferers with this quite common and critical scientific problem.

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The median nerve is most frequently involved, 4 Complex Fractures of the Distal Radius a 33 c b Fig. M. Martínez-Díez 34 Fig. 1 (continued) d followed by the radial and ulnar nerves. Acute carpal tunnel syndrome is more common in patients who have more severe and comminuted fractures and also in those undergoing multiple closed reduction attempts [27]. Carpal tunnel symptoms are common and usually related to swelling and contusion. A carpal tunnel release should be considered if the symptoms are more severe or progressive.

At an average of 26 months of follow-up after the injury, six patients had malalignment of the anteromedial facet with varus subluxation of the elbow. In four of them, the fragment had not been specifically treated, and in two of them there was a loss of fracture fixation. All six patients developed signs of osteoarthritis and had poor results. In contrast, the remaining 12 patients (nine with fixation of the coronoid fracture) had good or excellent elbow function [21]. The authors recommended to securely fix the coronoid fracture to restore good elbow alignment to increase elbow stability and to decrease the risk of early posttraumatic osteoarthritis.

Compartment syndrome is a rare complication, but can have dramatic consequences. Young male patients are most at risk because they are more likely to have sustained a high-energy injury. Many factors have been associated with an increased risk for displacement, including increasing age, dorsal comminution, and degree of dorsal angulation at presentation [28]. Compound fractures and fractures treated operatively are at risk for infection. Infection rate with K-wire fixation has been reported to be as high as 33 % [29].

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