Injury
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The utilisation and consequences of standardised operative procedures may importantly differ between different healthcare systems. This is the first investigation comparing the treatment and outcome of femoral shaft fractures stabilised with an identical implant between trauma centres in 2 continents (Europe, EU and South Africa, SA). ⋯ Our investigation demonstrates the importance of several major differences between 2 different regions of the world in the treatment of femoral shaft fractures, despite involving only high level trauma centres and using an identical implant. The intercontinental comparison of results from clinical studies should be interpreted very carefully considering the heterogeneity of populations and clinical settings.
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Vertebral compression fractures are a common clinical manifestation of osteoporosis. The introduction of kyphoplasty has allowed minimally invasive treatment of these fractures. However, in patients with loss of vertebral wall integrity, balloon kyphoplasty is contraindicated due to the possibility of extruding wall fragments into the canal and cement extravasation. We evaluated the efficacy and safety of kyphoplasty in the treatment of vertebral compression fractures in patients with compromised vertebral walls using individualised surgical techniques to avoid cement extravasation. ⋯ Kyphoplasty is a safe, clinically effective treatment for osteoporotic vertebral fracture with peripheral wall damage when using individualised surgical techniques to prevent bone cement leakage.
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Comparative Study
The comparison of two classifications for trochanteric femur fractures: the AO/ASIF classification and the Jensen classification.
This study compares the reproducibility of two classifications for trochanteric femur fractures: the Jensen classification and the AO/ASIF classification. Furthermore we evaluated the agreement on fracture stability, choice of osteosynthesis, fracture reduction and the accuracy of implant positioning. In order to calculate the inter-, and intra-observer variability 10 observers classified 50 trochanteric fractures. ⋯ The postoperative agreement on choice of implant, fracture reduction and position of the implant was kappa0.17, kappa0.29 and kappa0.22, respectively. Both classifications showed poor reproducibility. This study suggests that the definition of stability of trochanteric fractures remains controversial, which possibly complicates the choice of osteosynthesis.
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Knowledge of the bony thickness of the acetabular columns is one requisite for safe execution of percutaneous fixation of acetabular fractures. We performed a cadaveric study to determine anatomical dimensions of the columns of acetabulum with reference to percutaneous screw fixation. Twenty-two hemipelves (11 pairs) from 6 male and 5 female cadavers were measured and statistically analysed. ⋯ The mean thickness of the posterior column wall of the acetabulum along the screw path displayed 21.3mm (range, 16.5-30.3mm). This study provides a clinical map for safe passage of both antegrade and retrograde percutaneous screws. Anatomic data suggests that 7.3mm cannulated screws can be safely accommodated by the anterior and posterior columns of the acetabulum.