Injury
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Stabilisation of fractures with an intramedullary nail is a widespread technique in the treatment of femoral shaft fractures in adults. To ream or not to ream is still debated. The primary objective of this study was to determine the incidence of non-union following unreamed intramedullary stabilisation of femoral fractures. Secondary objectives were intra- and postoperative complications and implant failure. ⋯ In this study, the incidence of non-union following unreamed intramedullary nailing is low (1.9%) and comparable with the best results of reamed nailing in the literature.
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Short-term follow-up of angular stable fixation for proximal humeral fractures has been well documented in the literature. Longer follow-up series are difficult to find. However, especially regarding the risk of avascular humeral head necrosis longer follow-up series are high of clinical relevance. ⋯ Results of open reduction and internal fixation with angular stable implants for proximal humeral fractures are reliable, however long-term complications such as avascular necrosis of the humeral head need to be evaluated further on since its incidence increases over the time.
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Neglected femoral diaphyseal fractures are not uncommon in developing nations however there is a paucity of literature in this regard. Due to lack of effective traction, reduction or immobilisation these fractures are invariably associated with shortening and adjacent joint stiffness, presenting a challenging problem to the treating surgeon. The socioeconomic constraints in our society which result in patients seeking non-medical forms of treatment in the first place also warrant the need for an economically viable, simple effective form of treatment which can be carried out in a less advanced setup, gives reliable outcomes and allows early return to work. ⋯ We conclude that the treatment of neglected femoral diaphyseal fractures with open intramedullary nailing and bone grafting followed by manipulation of the knee with preoperative traction in selected cases is a satisfactory method of treatment showing reliable bony union however knee mobilisation should be undertaken with caution.
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Review
The clinical use of platelet-rich plasma in the promotion of bone healing: a systematic review.
Platelet-rich plasma has been shown in several in vitro and animal studies to play a role in promoting new bone formation. A systematic literature review was conducted to identify the current relevant evidence base, searching across multiple sources including Medline, Embase and the Cochrane Library, and finding five clinically relevant articles. ⋯ Two other reports were case series. Early clinical results suggest that the use of platelet-rich plasma is safe and feasible, but that at present there is no clinical evidence of benefit in either acute or delayed fracture healing.
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Fractures of the talar neck and body are rare and serious injuries. The vast majority are either intra-articular or lead indirectly to an intra-articular incongruity through a dislocation at the talar neck. Because of the high energy needed to produce talar fractures, they are frequently seen in multiply injured and polytraumatised patients. ⋯ Only total AVN with collapse of the talar body leads to inferior results with the need for further surgery whilst prolonged immobilisation or offloading of the affected foot is not indicated for partial AVN. Talar malunions and non-unions after inadequate treatment of displaced fractures are debiliating conditions that should be treated by surgical correction. Treatment options include corrective osteotomy by recreating the former fracture with secondary fixation, free or vascularised bone grafting and salvage by realignment and fusion of the affected joint(s).