Injury
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Comparative Study
Judet osteoperiosteal decortication for treatment of non-union: the Cornwall experience.
The treatment of non union can be challenging with a variety of surgical options available to achieve bone consolidation. Robert Judet first described a method of osteo-periosteal decortication in 1963. He stated that by elevating cortical chips that remain attached to the periosteum and overlying soft tissues surrounding the site of non-union, combined with mechanical support, the bone consolidated. Despite excellent results presented in 2008 of 99% union rates with a mean delay of 8 months, the technique has not yet become popularised. We aim to show that Judet's method of decortication can achieve good results in the management of failure of union in a hospital other than Judet's. ⋯ Relevant to general trauma orthopaedic surgeon and specialist orthopaedic surgeons with an interest in fracture non-union.
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The management of femoral shaft fractures using intramedullary nailing is a popular method. The purpose of this study was to evaluate the long-term functional outcome after antegrade or retrograde intramedullary nailing of traumatic femoral shaft fractures. We further determined predictors of these functional outcome scores. ⋯ Our findings suggest that the ROM of hip and knee returns to normal over time, regardless of the nailing method used. However, pain in the lower limb is an important predictor and source of disability after femoral shaft fractures, even though most patients achieved good functional outcome scores.
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Comparative Study
Biomechanical analysis of second-generation headless compression screws.
Headless Compression Screws (HCS) are commonly utilized for the fixation of small bone and articular fractures. Recently several new second generation HCS (SG-HCS) have been introduced with the purported benefits of improved biomechanical characteristics. We sought to determine and compare the biomechanical efficiencies of these screws. ⋯ All SG-HCS demonstrated greater biomechanical characteristics than the first generation Herbert-Whipple screw. The Mini-Acutrak 2 with a variable pitch design generated the maximum compression force and showed the most reliability and sustainability. Screws with independently rotating trailing heads (Twinfix and Kompressor Mini) demonstrated loss of compression with extra turns. The increase of fastening torque due to over-fastening and loss of compression at the same time in some screw designs, demonstrated how the fastening torque (applied by the surgeon) can be a misleading measure of the compression force. Application of SG-HCS in osteoporotic bone without pre-drilling can slightly increase the compression force.
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The aim of the present study was to investigate the safety and efficacy of local implantation of BMP-7 for the treatment of resistant non-unions in the upper and lower limb. Fifty-two patients (30 males, mean age 52.8 years; range 20-81) were treated with local BMP-7 implantation in a bovine bone-derived collagen paste with or without revision of fixation. Thirty-six patients had closed injuries, ten had open injuries and six had infected non-unions. ⋯ Two patients with subtrochanteric femoral fractures failed to achieve union secondary to inadequate fracture stabilisation, persistent unfavourable biological environment and systemic co-morbidities. One patient developed synostosis attributed to the BMP-7 application. This study demonstrates BMP-7 implanted in a bovine-derived collagen paste is an effective adjunctive treatment for resistant non-unions in the upper and lower limb.
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Trans-gastrointestinal tract GSW's to the spine are devastating injuries with significant potential for infectious complications. We sought to address antimicrobial management of these injuries. ⋯ Despite the potential for significant deep infections of the spine, standard antimicrobial prophylaxis is sufficient for the initial management of these patients.