תוצאת חיפוש

Surgical Repair of Fractures of the Clavicle

O. Safran, R. Mosheiff, Y. Mattan, M. Liebergall

Orthopedic Dept., Hadassah-University Hospital, Jerusalem

Clavicular fractures make up 45% of shoulder girdle fractures. The clavicle's susceptibility to injury is due to its subcutaneous position and its role as the bony connection between the thorax and the shoulder. In 95% of cases the mechanism of injury is a direct blow to the shoulder. These fractures are usually treated conservatively without surgery. But there are a few such fractures that require surgical repair in order to unite well. 9 patients were operated on for clavicular fractures during 1991-1995. The indications for surgical repair were lateral-third fracture, floating shoulder, neurovascular deficit or nonunion. The methods used were open reduction and fixation with either plate and screws, Kirchner wires, cerclage or a combination. All fractures united well, with no infections or new neurovascular deficits. Good range of shoulder motion and acceptable cosmetic results were achieved in all. 1 patient had functional limitation due to brachial neuritis caused by brachial damage at the time of injury. Indications for surgical repair and the methods used in these cases are similar to those described in the literature. The high rate of union and absence of complications support surgical repair for the few clavicular fractures that are not likely to unite properly.

Immediate Orthopedic Surgery in Multiple Trauma

R. Mosheiff, D. Segal, M. Liebergall

Orthopedic Dept., Hadassah Medical Center, Jerusalem

The increase in mortality and morbidity from multiple trauma due to road accidents, industrial trauma and combat injuries obligates treatment based on emergency systems and trauma centers. Follow-up of the frequency of different types of injury calls attention to increasing involvement of the orthopedic surgeon in primary treatment. This situation calls for appropriate deployment of immediate surgical treatment which will rapidly enable mobility. We present several methods for immediate orthopedic treatment of multiple-trauma patients.

Smoking Habits of Young Israeli Soldiers

I. Askenazi, J. Shemer

Medical Corps, Israel Defense Forces, and Sackler Faculty of Medicine, Tel Aviv University

A random sample of 32,166 soldiers were interviewed (on their day of discharge from the Israeli Defence Forces, between 1980-1995) with regard to smoking habits. Among men, prevalence of current smoking was 46.8%, and among women 32.9%. Over the study period, prevalence in men decreased 27%. Among women, prevalence decreased from 1981 to 1991, but since then it has steadily increased. Among men, mean number of cigarettes smoked decreased from 21.6 in 1989 to 16.6 in 1995. Among women cigarettes smoked decreased from a mean of 14.3 in 1989 to 13.1 in 1995. 65.9% of the men and 49.3% of the women had started smoking by the age of 18. Among men the age distribution of smoking changed hardly at all over the years of the study. However, the proportion of women who began to smoke in the youngest age bracket (15 years of younger) doubled over the course of the study.

Treatment of Open Fractures due to Dog Bite

A. Dimant, M. Liebergall, S. Porat R., Mosheiff

Orthopedic Dept., Hadassah-University Hospital, Ein Kerem, Jerusalem

2 patients aged 12 and 19, respectively, sustained open fractures of the wrists due to dog bites. Both were bitten on a wrist by Rotweiller dogs, but with different magnitudes of injury to bone and soft tissue. Treatment, clinical course and recovery are described, together with recommendations for dealing with open fractures due to animal bites. In the presence of considerable injury to soft tissue and bone, and of exposure to canine oral flora, open fractures due to dog bites should be dealt with as high grade open fractures.

Leg-Lengthening For Length Inequality

Zvia Burgansky, Abraham Ganel, Uri Givon

Pediatric Orthopedics Unit, Chaim Sheba Medical Center, Tel Hashomer (Affiliated with the Sackler Faculty of Medicine, Tel Aviv University)

32 patients (age range 1.5-22 years) were treated for leg-length discrepancy. 39 lengthening procedures were performed of which 36 involved gradual distraction, in 2 cases chondrodiasthesis was used, and 1 had 1-step elongation. Gradual distraction was done according to Ilizarov, including corticotomy and a 1-week delay before the initiation of distraction. In 33 cases Wagner's external fixator was used, in 2 an Ilizarov frame and in 1 an orthofix fixator. There was complete clinical and radiological union in all but 1 case. Significant correction of leg-length discrepancy and equalization of leg-length was achieved in most patients. In some growing patients over-correction was successfully achieved. The most prevalent complications were pin-site problems, axis deviation, joint subluxation and joint contractures. At latest follow-up most of these complications had disappeared. 91% of the patients either functioned normal or were only mildly limited.