ROCKWOOD ORTHOPAEDICS PDF
Pages, " x 11", Black & White, English, Originally published by Lippincott Williams & Wilkins, See Available Translations. Need a PDF reader. Orthopaedics and Trauma Home · Mobile Rockwood and Green's fractures in adults vol 1 and vol 2 and fractures in children. 3rd Edition ISBN PDF ( KB). Rockwood & Green - Download as PDF File .pdf), Text File .txt) or read online. Wirth MD Professor of Orthopaedics The Charles A. Associate Faculty. Boston .
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Rockwood and Green's Fractures in Adults - 2 Volume Set - edition pdf . Practice of Pediatric Orthopaedics: 2nd (second) Edition Ebook Pdf, Pediatrics, Free. Series: Rockwood, Green, and Wilkins' fractures in adults and children package. the next generation of orthopaedic trauma surgeons who will be determining. PG Moreau, Rockwood and Green's Fractures in Adults. ; 14(1): by Charles A. Rockwood, Jr., David P. Green, Department of Orthopedics (MBC- 77).
Despite this, our series is the largest of its kind and gives a robust picture of patient centred and clinical outcomes when using Rockwood clavicle pins. There does appear to be a higher rate of irritation symptoms in patients with a slim build. Rockwood pins appear to be as effective as plates in achieving union and maintaining length in both the acute and delayed setting with the advantages of smaller skin incisions and less periosteal disruption than a plate.
Although they seemingly avoid the potentially catastrophic risks of migration seen in other intramedullary devices, the rate of pin prominence and need for a further procedure present a significant disadvantage.
In choosing between plate and Rockwood pin fixation, one should weigh this less invasive technique against its potential for inconvenience and complications. The authors have no conflict of interest to declare.
Epidemiology of clavicle fractures J Shoulder Elbow Surg ; 11 5 : The incidence of fractures of the clavicle Clin Orthop Relat Res ; Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture J Bone Joint Surg Am ; A 7 : Closed treatment of displaced middle-third fractures of the clavicle gives poor results J Bone Joint Surg Br ; 79 4 : Treatment of acute midshaft clavicle fractures: systematic review of fractures: on behalf of the Evidence-Based Orthopaedic Trauma Working Group J Orthop Trauma ; 19 7 : Deficits following nonoperative treatment of displaced midshaft clavicular fractures J Bone Joint Surg Am ; 88 1 : Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures.
Open reduction and internal fixation of clavicular fractures J Bone Joint Surg Am ; 63 1 : A simple technique for internal fixation of the clavicle. A long term evaluation Clin Orthop Relat Res ; Fixation of fractures of the midshaft of the clavicle with Kirschner wires Results in patients J Bone Joint Surg Br ; 80 1 : Complications of intramedullary Hagie pin fixation for acute midshaft clavicle fractures J Shoulder Elbow Surg ; 16 3 : Minimally invasive intramedullary nailing of midshaft clavicular fractures using titanium elastic nails J Trauma ; 64 6 : Flexible intramedullary nailing for stabilization of displaced midshaft clavicle fractures technique and results in 87 patients Acta Orthop ; 78 3 : Finally, the corresponding authors of all eligible studies were contacted and asked to review the search results to identify any studies which may have been initially missed.
The full texts of all potentially eligible studies were obtained. These were then reviewed against the eligibility criteria before inclusion in the review. Data extraction One reviewer extracted all the data onto a pre-defined database CH.
This was then independently verified by a second reviewer for accuracy RC.
Rockwood and Green Fractures in Adults and Children- 9th Edition
Methodological appraisal Study methodological assessment was evaluated using the PEDro score. This is an eleven-item critical appraisal tool which assesses documentation of eligibility, subject allocation and randomisation, subject assessment and blinding, subject follow-up, data assessment and analysis.
This has previously been demonstrated to be a reliable and valid scoring system [ 11 , 12 ].
The critical appraisal was conducted by one reviewer CH , and independently verified by a second reviewer RC. Outcomes of interest The primary outcome was the Constant score [ 13 ].
Secondary outcomes included: duration of sick leave, strength, pain, cosmetic outcome, implant failure, infection rate, throwing ability, loss of reduction of anatomical position, ossification of the coracoclavicular ligament, range of motion, and the incidence of acromioclavicular joint osteoarthritis OA.
Data analysis An assessment of study heterogeneity was made by observing for population or interventional differences between the studies from the data extraction tables.
When these assumptions were not met, a random-effects model was adopted. A meta-analysis was conducted where appropriate to pool outcomes.
For dichotomous outcomes, the effects measure was the risk difference RD. For continuous outcome measures, the effect measure was mean difference MD or standardised mean difference Std MD. The principal analysis was to compare outcomes between operative and non-operative management of acromioclavicular joint grade III dislocations. This zone often is broken into three subzones: the zone of maturation, the zone of degeneration, and the zone of provisional calcification.
The zone of provisional calcification constitutes a transitional area between calcified and noncalcified extracellular matrix proteins, effectively making this zone the weakest [ 24 ].
Through histologic analysis, Salter and Harris showed that fracture propagation and physeal separation typically occur at this level. The physis is encircled at is periphery by fibrocartilaginous tissue that includes the groove of Ranvier and the ring of LaCroix Fig. The groove of Ranvier is a microscopic stricture at the diaphyseal end of the physis. It contains chondroblasts, osteoblasts, and fibroblasts that support the peripheral growth of the physis. The ring of LaCroix is a strong fibrous structure that overlies the groove of Ranvier and connects the epiphyseal periosteum to the metaphyseal periosteum, adding stability to the physis [ 22 ].
Salter and Harris [ 26 ] reported that, in the majority of physes, the blood supply to the proliferating cells arises from the epiphysis via its periosteum. Since the zone of provisional calcification is metaphyseal relative to the proliferating cells of the physis, epiphyseal blood supply theoretically remains intact with Types I and II fractures.
Conversely, Types III and IV fractures exit epiphyseal, violating and potentially devascularizing the proliferating cell layer. Salter and Harris recognized that certain physes were especially prone to devascularization, namely the femoral and radial head.
The epiphyses in these locations are completely covered by articular cartilage and have no periosteal blood supply. Alternately, the blood supply is metaphyseal and laterally traverses the rim of the physis, easily disrupted by the shear forces seen in a Type 1 fracture [ 6 ].
This model provides a framework to think about the types of physeal fractures, however, clinical reality is somewhat more complex.
Subsequent histologic studies have shown that, depending on the forces involved, physeal injuries commonly involve multiple layers of the physis and rarely are isolated to the zone of provisional calcification [ 9 , 14 ].
This is clinically evident with Type II fractures. These fractures can result in growth arrest despite theoretically leaving the proliferating cells and their blood supply intact. Jaramillo et al. Validation Although the Salter-Harris classification is in common use, there are relatively few formal validation studies. Thawrani et al.
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Several studies have compared the ability to classify fractures involving the growth plate on plain radiographs versus three-dimensional 3-D imaging [ 11 , 19 , 27 ].
These studies do not specifically use interobserver reliability as an endpoint, instead showing that fracture displacement is consistently underappreciated on plain radiographs [ 11 , 19 ], and that 3-D imaging can better elucidate fracture patterns and change the classification of the fracture [ 27 ].
A high rate of interobserver reliability of the classification is important to its clinical utility. Despite a lack of formal validation, the Salter-Harris classification has stood the test of time and is in widespread use. One may speculate that this prevalence is attributable to its inherent simplicity and being nearly universally known in the orthopaedic community.
There are limitations to using a poorly validated classification system and there may be some benefit to perform additional validation studies of the Salter-Harris classification.
Limitations The most significant limitation, as discussed above, is a paucity of studies formally validating the Salter-Harris classification, including interobserver reliability, intraobserver reliability, and accuracy in predicting fracture behavior. This validation is necessary to establish confidence in the classification and its implications.
Lack of validation does not mean the classification is invalid, however, users should be aware of this limitation and use the classification accordingly.
Future efforts to improve validation of the Salter-Harris classification could potentially resolve these concerns. It is tempting to equate physeal arrest with prognosis when discussing fractures involving the physis, however, physeal arrest is only one component and is of variable clinical significance depending on remaining growth and the location of the deformity. Salter and Harris [ 26 ] recognized the complexity of this issue and commented that prognosis was not related to fracture classification alone, but also to the age of the patient, preservation of blood supply, presence of an open fracture, method of reduction, intraarticular displacement, quality of reduction, method and length of immobilization, and, of particular importance, the specific physis involved.
Even if the outcome is limited to the presence of growth arrest alone, many authors agree that the Salter-Harris classification is not a good predictor of prognosis [ 2 , 3 , 7 , 12 , 23 , 29 ]. Initial fracture displacement and accuracy of reduction have been found to be the most important prognostic indicators [ 2 , 12 ].
Multiple studies examining physeal fractures at the distal tibia also have found that fracture displacement and mechanism of injury are the most significant prognostic indicators [ 10 , 25 , 28 ]. In a study of distal radius fractures, Cannata et al.
The most commonly reported predictors of physeal arrest appear to be initial fracture displacement, mechanism of injury, and accuracy of reduction. Discussion of the prognostic utility of the Salter-Harris classification highlights another significant limitation, which is lack of anatomic specificity. In their original article, Salter and Harris [ 26 ] recognized important variations in gross anatomy between different physes, however their proposed classification and discussion focused on the microanatomy of the generic physis.
This prevents the classification from becoming overly complex; however, it limits the ability of the classification system to guide treatment or indicate prognosis with any specific fracture.
This lack of specificity and comprehensiveness has been the impetus behind several subsequently proposed classification systems. In , Ogden [ 15 ] proposed a classification scheme that expanded the Salter-Harris classification by adding four additional fracture types and multiple subtypes of each of the five original fracture types.
The classification was meant to be applicable throughout the body, but rarely is used today, likely because of its complexity. In , Peterson [ 17 ] proposed an expanded system based on an impressive epidemiologic study of physeal injuries. A Peterson I injury is a metaphyseal fracture with extension into the physis Fig. A Peterson Type VI injury represents the loss of part of the physis.
Peterson and Burkhart [ 18 ] also removed the Salter-Harris Type V fracture variant, questioning its existence; however, the omission of the Salter-Harris Type V fracture generally is not accepted. The fracture line is marked by arrows and can be seen crossing the metaphysis, and also extending into the physis.
Conclusions and Uses The Salter-Harris classification continues to be relevant and serve an important purpose in orthopaedics despite substantial limitations. It is not a comprehensive system for classifying physeal injuries, guiding treatment, or determining prognosis.
These limitation may be inherent to a classification that is intended to be generically applied to physeal fractures and does not attempt to account for anatomic variation between physes or unique clinical considerations of fractures in different locations. The Salter-Harris classification does provide a foundation to help clinicians understand how pediatric fractures relate to the anatomy and architecture of an open physis.
Additionally, the generic nature of the classification allows it to be extremely simple and widely applied.Germany Robert M. Discussion of the prognostic utility of the Salter-Harris classification highlights another significant limitation, which is lack of anatomic specificity. The mean clavicle lengthening was smaller and non-significant in group B and this reflects the fact that several of the cases had previously been reduced with an attempt at fixation.
You already recently rated this item. California Kenneth A. Take Survey. Court-Brown " ;. Mechanism of Injury and Relevant Anatomy The supracondylar region is located directly above the articular condyles of the distal humerus and consists of an area of cancellous bone encased within a thin cortex. Chief Orthopaedic Trauma Service.