Acta orthopaedica
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Randomized Controlled Trial Comparative Study
A compression bandage improves local infiltration analgesia in total knee arthroplasty.
High-volume local infiltration analgesia has been shown to be an effective pain treatment after knee replacement, but the role of bandaging to prolong analgesia has not been evaluated. ⋯ A compression bandage is recommended to improve analgesia after high-volume local infiltration analgesia in total knee arthroplasty.
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Comparative Study
The Norwegian Hip Fracture Register: experiences after the first 2 years and 15,576 reported operations.
The Norwegian Hip Fracture Register was established in January 2005 to collect nationwide information as a basis for improved management of patients with hip fractures. We now report our experience after the first 2 years. ⋯ After only 2 years, our nationwide system for surveillance of demographics, treatment, and outcome of hip fractures is functioning well. As expected, the response rate for the 4-month questionnaires was relatively low due to the old population with high comorbidity and cognitive impairment. The different treatment methods used for patients in the same groups of fracture types show that there is still no consensus in Norway regarding the treatment of hip fractures.
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Primary arthroplasty and internal fixation are the two main options for treatment of displaced femoral neck fractures. Despite the fact that there have been several randomized studies, the optimal treatment in the elderly is still controversial. In the present study, based on data from the Norwegian Hip Fracture Register, we compared satisfaction, pain, and quality of life 4 months after surgery in patients over 70 years of age with a displaced femoral neck fracture operated with internal fixation or with a bipolar hemiarthroplasty. ⋯ Our findings suggest that elderly patients with displaced femoral neck fracture should be treated with arthroplasty.
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Strategies to manage tibial fractures include nonoperative and operative approaches. Strategies to enhance healing include a variety of bone stimulators. It is not known what forms of management for tibial fractures predominate among Canadian orthopedic surgeons. We therefore asked a representative sample of orthopedic trauma surgeons about their management of tibial fracture patients. ⋯ Current practice regarding orthopedic management of tibial shaft fractures in Canada strongly favors operative treatment with intramedullary nailing, although respondents were divided in their preference for reamed and unreamed nailing. Use of bone stimulators is common as an adjunctive modality in this injury population. Large randomized trials are needed to provide better evidence to guide clinical decision making regarding the choice of reamed or unreamed nailing for tibial shaft fractures, and to inform surgeons about the actual effect of bone stimulators.