Injury
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Following an increase in the incidence of scapular fractures and interest in the outcome of their treatment, a basic classification system was developed for ease of use in the emergency setting. It has been expanded to a comprehensive system to allow for more in-depth classification of scapular fractures for clinical research and surgical decision making. It focusses on three specific regions of the scapula: the scapular body, the glenoid fossa and the lateral scapular suspension system (LSSS). This article presents a classification of the LSSS involvement to better characterise the injuries of this region and to emphasise its relevance to evaluation of the position of the scapula, hence the glenoid fossa, and so the centre of rotation of the shoulder joint. ⋯ While LSSS involvement can be reliably identified, its characterisation regarding complexity is problematic even with 3D CT images. The proposed LSSS system is considered clinically relevant and sufficient to further assess its role in treatment-decision processes and outcome prognosis.
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Review Meta Analysis Comparative Study
Meta-analysis of joint preservation versus arthroplasty for the treatment of displaced 3- and 4-part fractures of the proximal humerus.
This meta-analysis compares the clinical outcomes of joint preservation versus arthroplasty in the treatment of displaced proximal humerus fractures. ⋯ In the existing literature, displaced proximal humerus fractures demonstrate improved Constant scores when treated with joint-preserving options. Age, fracture pattern, and complication rate are significant predictors of the Constant score independent of the selected treatment. Given the observed heterogeneity and variance in treatment techniques in the included studies, more comparative studies are needed to definitively recommend joint-preserving techniques versus arthroplasty for specific fracture patterns.
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Gunshot wounds (GSW) to the spine represent a major health concern within today's society. Our study assessed the epidemiologic characteristics of patients with GSW to the spine treated in New Orleans. ⋯ This study evaluates the largest number of patients with GSW to the spine per year treated in a single centre, illustrating the violent nature of New Orleans. In this urban population, there was a clear correlation between drug use and suffering a GSW to the spine. Surgical intervention was seldom indicated in these patients and was predominately used for fixation of unstable fractures and decompression of compressive injuries, particularly below T11. Minimally invasive techniques were used successfully at our institution to minimize the risk of post-operative CSF leak.
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Computer-assisted guidance systems are not used frequently for musculoskeletal injuries unless there are potential advantages. We investigated a novel fluoroscopy-based image guidance system in orthopaedic trauma surgery. ⋯ The novel image-guidance system could be integrated into the surgical workflow and was used successfully in orthopaedic trauma surgery. Expected advantages should be explored in randomised studies.
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Many types of steel plates are used for internal fixation of calcaneal fractures through extensive lateral approach. The fixation screw at the anterior calcaneal process must be placed into the dense compression trabeculae located directly under the calcaneocuboid articular surface to achieve a stable fixation. ⋯ Screws should be implanted under the calcaneocuboid articular surface and the length and direction of the screw should be selected according to the transverse diameter of the calcaneal articular surface and the inner tilt angle, respectively.