The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Aug 2009
Better prophylaxis against surgical site infection with local as well as systemic antibiotics. An in vivo study.
Prophylactic systemic antibiotics significantly lower the risk of postoperative infection, and injection of antibiotics directly into the wound cavity has been found to be even more effective. In this study, we investigated the efficacy of direct injection of antibiotics into a wound cavity after wound closure, both alone and in combination with systemic administration of antibiotics. We hypothesized that a combination of preoperative systemic administration and postoperative local injection would be the most effective treatment. ⋯ As we hypothesized, the combination of systemic cefazolin and local gentamicin proved to be the most effective regimen. Local injection of gentamicin proved more effective than systemic administration of cefazolin but was not as effective as the combination of both antibiotics. The initially high concentrations of locally applied antibiotic and the utilization of two different classes of antibiotics may have contributed to the observed efficacy.
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J Bone Joint Surg Am · Aug 2009
Far cortical locking can reduce stiffness of locked plating constructs while retaining construct strength.
Several strategies to reduce construct stiffness have been proposed to promote secondary bone healing following fracture fixation with locked bridge plating constructs. However, stiffness reduction is typically gained at the cost of construct strength. In the present study, we tested whether a novel strategy for stiffness reduction, termed far cortical locking, can significantly reduce the stiffness of a locked plating construct while retaining its strength. ⋯ Far cortical locking significantly reduces the axial stiffness of a locked plating construct. This gain in flexibility causes only a modest reduction in axial strength and increased torsional and bending strength.
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J Bone Joint Surg Am · Aug 2009
Long-term functional outcomes after operative treatment for intra-articular fractures of the calcaneus.
Calcaneal fractures can have long-term consequences in terms of pain and disability. Comparative studies have suggested that operative treatment of these fractures may result in better outcomes than nonoperative treatment; however, to our knowledge, the long-term outcomes of operative treatment of calcaneal fractures have not been reported for a large cohort of patients. ⋯ The long-term outcomes of operative treatment described in the present report are comparable with the long-term outcomes previously reported among smaller patient cohorts. Additional investigation is required to determine why patients with fractures that resulted from a motor-vehicle accident reported worse outcomes than patients with fractures that resulted from a fall.
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J Bone Joint Surg Am · Aug 2009
Clamp-assisted reduction of high subtrochanteric fractures of the femur.
Subtrochanteric fractures can be a treatment challenge. The substantial forces that this region experiences and the fact that the proximal fragment is frequently displaced make accurate reduction and internal fixation difficult. The purpose of this study was to evaluate a series of patients who had undergone clamp-assisted reduction and intramedullary nail fixation to determine the impact of this technique on fracture union rates and reduction quality. ⋯ Surgical treatment of subtrochanteric femoral fractures with clamp-assisted reduction and intramedullary nail fixation techniques with judicious use of a cerclage cable can result in excellent reductions and a high union rate. Careful attention to detail is important to perform these maneuvers with minimal additional soft-tissue disruption.
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J Bone Joint Surg Am · Aug 2009
Randomized Controlled Trial Multicenter Study Comparative StudyFunctional outcomes for unstable distal radial fractures treated with open reduction and internal fixation or closed reduction and percutaneous fixation. A prospective randomized trial.
Despite the recent trend toward internal fixation of distal radial fractures, few randomized trials have examined whether volar plate fixation is superior to other stabilization techniques. The purpose of the present study was to compare (1) open reduction and internal fixation with use of a volar plate and early mobilization with (2) percutaneous fixation and casting or external fixation for the treatment of dorsally displaced unstable extra-articular and simple intra-articular fractures of the distal part of the radius, with a specific emphasis on early functional recovery. ⋯ Both closed reduction with percutaneous pin fixation and open reduction with internal fixation with use of a volar plate are effective methods for the treatment of dorsally displaced, unstable, extra-articular or simple intra-articular fractures of the distal part of the radius. Better functional results can be expected in the early postoperative period in association with open reduction and internal fixation, and this form of treatment should be considered for patients requiring a faster return to function after the injury.