Reevaluation of routine exchange nailing as the recommended treatment for aseptic femoral delayed union or nonunion may be required. A significant number of patients who undergo reamed exchange nailing will require additional procedures to achieve fracture healing.

We cannot recommend the sole use of either computed tomography venography or magnetic resonance venography to screen and direct the treatment of asymptomatic thrombi in patients with fracture of the pelvic ring because of the high false positive rates. If these studies are used as screening tools, confirmation of the presence of thrombosis with selective venography should be performed prior to initiating invasive treatment with a vena cava filter. Clinical decisions based solely on one of these imaging techniques may result in inappropriate aggressive treatment due to the high false-positive rate.

Four groups were studied to determine the cooling effect at skin level of ice application over common ankle bandages and casts. The plaster cast, synthetic cast, and Ace wrap dressing groups had 18 participants and the Robert-Jones dressing group had four participants. In a standardized fashion, ice bags were applied over each bandage or cast and skin temperatures were measured with a thermocouple over a 90-min period. The average final skin temperature was 16.5 degrees in the plaster cast, 18.8 degrees in the synthetic cast, 21.2 degrees in the Ace wrap dressing, and 28.7 degrees in the Robert-Jones dressing. The temperature curves showed that ice application effectively decreased skin temperatures through the plaster cast, synthetic cast, and Ace wrap dressing. The cooler temperature did not adequately penetrate the Robert-Jones dressing.