Acta orthopaedica
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In acetabular fracture treatment, 3 disease-specific outcome scores are mainly used: the original and modified Merle d'Aubigné-Postel Score, and the Harris Hip Score. ⋯ Despite the excellent overall correlation between the outcome scores, the Kappa agreements were only moderate. The scores were all skewed in distribution with considerable ceiling effects that could limit their clinical use. The scores did not capture any differences in 25% of the observations at the upper end of the scales.
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Internal fixation has become the preferred treatment for type-C pelvic ring injuries, but controversies persist regarding surgical approach and surgical technique. ⋯ Our results suggest that special attention should be paid to preoperative planning, reduction of the fracture, decompression of the nerve roots, and fixation of the most severe sacral fractures. Our results seem to favor internal fixation of displaced (> 10 mm) and unstable rami fractures and symphyseal disruptions in conjunction with posterior fixation, to achieve better stability of the whole pelvic ring.
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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.