Acta orthopaedica
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There is no consensus on the best surgical treatment of periprosthetic femoral fractures. We report our experience with a dynamic compression plate. ⋯ Open reduction and internal fixation using DCPs seems to be a valid method for the treatment of postoperative periprosthetic femoral fractures with stable stem in place. If the stem is unstable, we suggest that DCPs may be used in association with femoral revision using a long stem. In cases with stable stem (B1), we are inclined to agree with other authors that additional fixation using an extramedullary cortical strut graft may be necessary to improve stability and promote final healing.
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Malunions or nonunions after displaced talar fractures cause significant disability. Salvage procedures such as corrective arthrodesis do not restore normal foot function. ⋯ Secondary anatomical reconstruction with joint preservation leads to considerable functional improvement in painful talar malunions. Partial AVN does not preclude good to excellent functional results. The quality of the bone stock and joint cartilage (rather than the time from injury) appears to be important for the choice of treatment.
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Nonoperative treatment is preferred for clavicular fractures irrespective of fracture and patient characteristics. However, recent studies indicate that long term results are not as favourable as previously considered. ⋯ The risk for persistent symptoms following nonoperative treatment of clavicular fractures was far higher than expected. Based on these findings it seems reasonable to explore the possibly use of alternative treatment options including surgery for certain clavicular fracture types.
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Whilst it is well known that fractures of the pelvic rami in the elderly are frequently associated with posterior ring injuries, the extent of this second injury is less well known. We evaluated this question by MRI scanning a group of elderly patients presenting at our unit with pelvic rami fractures. ⋯ Pelvic rami fractures in the elderly are nearly always associated with posterior ring injuries. This probably explains why these patients take longer to rehabilitate than might be expected if only the anterior injury is considered, and it also explains why they experience long-term back pain.