The Treatment of Fractures

Classifications in Brief: The Neer Classification for Proximal Humerus Fractures

“…In 1970, Charles Neer described his four-segment classification system [18]. He believed the existing classifications were inadequate for research purposes, as they did not differentiate between injuries of varied severity nor did they group like fractures [5,12,18]. The classification systems at that time were based on the mechanism of injury or level of the fracture line, but did not consider many surgically important aspects or pathologic features of injury such as tuberosity displacement [18].…”

Practical Use of Emergency Tourniquets to Stop Bleeding in Major Limb Trauma

“…This explains why tourniquet problems were reported by experienced surgeons from the US Civil War, World War I, the Spanish Civil War, and early World War II. [21][22][23][24] Articles and textbooks written by senior consultants at the end of tertiary referral patterns are common, influential, and long referenced, 13,18,20,21 but they do not have the perspective of prehospital providers and prehospital data as noted in recent literature. 7,30,31,39,40 A fresh look at emergency tourniquets is appropriate in a reassessment of the risks and benefits for selected patients and populations.…”

Fractures of the Capitellum and Trochlea

“…Extension of these fractures into the lateral aspect of the trochlea has been recognized for years [1][2][3][4][5][6][7][8][9][10] and can be diagnosed on the basis of a characteristic radiographic finding, termed ''the doublearc sign'' by McKee et al 8 . Three recent papers confirm that these fractures often involve a greater portion of the anterior aspect of the trochlea, the lateral epicondyle, the posterior aspect of the lateral column, and sometimes the posterior aspect of the trochlea and the medial epicondyle, as compared with the small amount covered in the concept of the ''coronal shearing fracture.''…”

“…[10][11][12] Most orthopaedic surgeons have limited experience treating fractures of the capitellum and trochlea. While nonoperative treatment and fragment excision have been considered reasonable options in the past [1][2][3][4][5]7,9 , recognition of the relative complexity of many of these fractures has made operative treatment the preferred Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.…”