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Transformation of Plane Stress01:18

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Studying stress transformation is essential in understanding how stress components within a material, like a cube under plane stress, change with rotation. This change is analyzed by considering a prismatic element within the cube. As the element rotates, the stress components acting on it—both normal and shearing stresses—change in magnitude and orientation. This change is quantified using trigonometric functions of the rotation angle, relating the forces acting on the rotated element's...
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Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
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Internal Rotation Stress Testing Improves Radiographic Outcomes of Type 3 Supracondylar Humerus Fractures.

Jennifer M Bauer1, Christopher M Stutz2, Jonathan G Schoenecker1

  • 1Monroe Carell Jr Children's Hospital at Vanderbilt Medical Center, Pediatric Orthopaedic Surgery, Nashville, TN.

Journal of Pediatric Orthopedics
|December 16, 2016
PubMed
Summary

Routine use of the intraoperative internal rotation stress test (IRST) for type 3 supracondylar humerus fractures safely improved rotational alignment. This technique reduced rotational loss of reduction and the need for reoperation.

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Area of Science:

  • Orthopedic surgery
  • Pediatric orthopedics
  • Trauma surgery

Background:

  • Type 3 supracondylar humerus fractures are prone to rotational instability.
  • Maintaining reduction is crucial for optimal outcomes.
  • Current methods may not consistently prevent rotational malalignment.

Purpose of the Study:

  • To evaluate the efficacy of routine intraoperative internal rotation stress test (IRST) in maintaining reduction.
  • To determine if IRST safely improves rotational alignment in type 3 supracondylar humerus fractures.
  • To assess the impact of IRST on the need for additional fixation and reoperation.

Main Methods:

  • A prospective cohort using IRST was compared to a retrospective cohort (pre-IRST).
  • The IRST protocol involved fracture reduction, 2 lateral pins, and IRST to guide medial pin placement if needed.
  • Primary outcomes included rotational alignment (Baumann's angle, lateral humerocapitellar angle, rotation index).

Main Results:

  • The IRST cohort showed significantly less overall and major rotational loss of reduction compared to the pre-IRST cohort.
  • No major loss of reduction was observed for Baumann's angle in either group.
  • No postoperative nerve injuries occurred, and reoperations for fixation loss were less frequent in the IRST group.

Conclusions:

  • Intraoperative IRST is a safe and effective adjunct for type 3 supracondylar humerus fractures.
  • The IRST protocol improves rotational alignment and reduces the need for revision surgery.
  • A mini-open approach for medial pin placement is safe and facilitates improved fixation.