The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Feb 2008
Fracture displacement and screw cutout after open reduction and locked plate fixation of proximal humeral fractures [corrected].
Fixation of proximal humeral fractures is challenging. Locking plate technology offers mechanical advantages for treating unstable fractures in weak bone. In this study, we assessed the radiographic and clinical results of a single surgeon's experience treating proximal humeral fractures with a locked proximal humeral plate. ⋯ The use of locking plates in the surgical treatment of proximal humeral fractures is associated with an unexpectedly high rate of screw cutout and revision surgery, especially in patients older than sixty years who have a three or four-part fracture. The indications for open reduction and internal fixation in these patients require continued analysis.
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Delivery of intravenous antibiotic prophylaxis within one hour prior to surgical incision is considered important in helping to decrease the incidence of surgical site infections, but methods to ensure compliance have not been established. ⋯ Piggybacking of verification of prophylactic antibiotic administration onto the wrong-site-surgery time-out protocol is an effective, cost-free, and easy-to-adopt method to ensure compliance with appropriate timing of prophylactic antibiotics.
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When performing total hip arthroplasty without computer navigation, surgeons align the acetabular component with landmarks such as the plane of the operating table and the presumed position of the pelvis. In contrast, first-generation computer navigation systems rely on the pelvic anterior plane, defined by the anterior superior iliac spines and the pubic tubercle. We sought to study the effect of patient positioning on the tilt of the pelvis as measured in the pelvic anterior plane and its effect on cup alignment angle values. ⋯ For navigation systems that rely on the pelvic anterior plane, cup alignment values can be converted to familiar target values with our nomogram with good accuracy and reproducibility. The next generation of navigation systems should be able to measure the pelvic tilt for each individual patient and automatically adjust alignment values.
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J Bone Joint Surg Am · Feb 2008
Chronic posttraumatic elbow disorders treated with metallic radial head arthroplasty.
Metallic radial head arthroplasty is a proven technique for the treatment of complex radial head fractures. The purpose of this study was to evaluate the functional outcomes of a metallic radial head arthroplasty in patients with chronic posttraumatic elbow disorders. ⋯ Metallic radial head arthroplasty for the treatment of posttraumatic elbow disorders appears to be a safe and durable procedure that can provide a functional range of motion and pain relief for at least five to ten years. However, longer follow-up is needed to evaluate progression of lucencies adjacent to stems and osteoarthritis.
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Biologic therapies to promote fracture-healing such as use of bone morphogenetic proteins (BMPs) are being increasingly employed in multiple clinical scenarios. However, it has been challenging to design therapies that deliver sufficient quantities of protein over a sustained time period. ⋯ This approach has demonstrated tremendous potential in preclinical animal models of fracture-healing. This article will review the current state of gene therapy approaches to fracture-healing with an emphasis on potential clinical applications.