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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2007 October;58(5):459-65
Surgical treatment of the injured: respecting the tissues
Lettich T., Parmar BS R., Parvizi J.
Department of Orthopedic Surgery Rothman Institute and Thomas Jefferson University Philadelphia, PA, USA
Traditional techniques of open reduction and internal fixation for the repair of factures remain useful techniques for the fixation of fractures. Often, these procedures are the only choice for the orthopedic surgeon to use. External fixation is associated with increased chances of postoperative complications such as pin site wound infection, however it remains a very efficient technique for initial reduction of the fracture site. The LISS system provides many added benefits over open procedures, however there are still limitations. Failure in the LISS is usually due to malpositioning on the device. Conscious effort to ensure proper placement will drastically reduce the chances of loosening or migration of the plate. Although in very early stages, the percutaneous transiliac screw seems to hold the potential for excellent results. Careful patient selection was noted to be the key for optimal results. The PCCP is able to provide stability through two 9 mm screws as opposed to the DHS which requires >16 mm screws to obtain stability. This greatly reduces the likelihood of damaging the lateral wall of the greater trochanter. Whether the fracture is of the femur, tibia, periprosthetically, in the elderly, of the iliac, or sacrum there are increasing numbers of techniques which allow a surgeon to get maximum reduction and fixation, and thus maximum results, with a minimal surgical approach that spares the soft tissues and underlying vasculature.