Injury
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Review Meta Analysis
Is early hip fracture surgery safe for patients on clopidogrel? Systematic review, meta-analysis and meta-regression.
Hip fracture is a common presentation in the elderly population, many of whom will be taking the antiplatelet clopidogrel, which has the potential to increase perioperative bleeding. The aim of this systematic review and meta-analysis was to answer the questions: (1) is early hip fracture surgery for patients on clopidogrel associated with worse postoperative outcomes compared to patients not on clopidogrel? (2) is early versus delayed surgery for these patients associated with worse postoperative outcomes? ⋯ Early surgery appears safe for patients with hip fracture though there may be a small increase in the rate of blood transfusion. However, larger prospective trials are required to confirm these findings.
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Intravascular bullets may cause diagnostic and management difficulties. We describe a bullet overlying the cardiac silhouette on X-ray which was identified to be at the cavoatrial junction on cavography. The bullet was removed via endovascular techniques utilizing occlusion balloon and reverse trendelenberg position.
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Randomized Controlled Trial Comparative Study
A prospective randomised study comparing TightRope and syndesmotic screw fixation for accuracy and maintenance of syndesmotic reduction assessed with bilateral computed tomography.
The accuracy and maintenance of syndesmosis reduction are essential when treating ankle fractures with accompanying syndesmosis injuries. The primary aim of this study was to compare syndesmosis screw and TightRope fixation in terms of accuracy and maintenance of syndesmosis reduction using bilateral computed tomography (CT). ⋯ Syndesmotic screw and TightRope had similar postoperative malreduction rates. However, intraoperative CT scanning of ankles with TightRope fixation was misleading due to dynamic nature of the fixation. After at least 2 years of follow-up, malreduction rates may slightly increase when using trans-syndesmotic screw fixation, but reduction was well maintained when fixed with TightRope. Neither the incidence of ankle joint osteoarthritis nor functional outcome significantly differed between the fixation methods.
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Review Multicenter Study
Outcomes following combined intramedullary nail and plate fixation for complex tibia fractures: A multi-centre study.
Concomitant plate fixation as an adjunct to intramedullary nailing (IMN) of proximal third tibia fractures is a proven technique. Benefits include its role as a minimally invasive reduction aid, allowing for minimal soft tissue disruption. Expanding its indications as adjunct fixation to IMN throughout the tibia, we aimed to study outcomes in a multi-centre initiative. ⋯ Combined IMN and plate fixation is a reliable tool not only in the treatment of fractures of the proximal tibia, but also for those fractures in the diaphysis and segmental fractures with proximal and/or distal metadiaphyseal extension with consistent ability to maintain high union rates and maintained alignment. However, longer-term follow-up and prospective trials will be necessary before coming to a definitive conclusion.
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Multicenter Study
Distal femoral fractures: The need to review the standard of care.
Hip fracture care has evolved, largely due to standardisation of practice, measurement of outcomes and the introduction of the Best Practice Tariff, leading to the sustained improvements documented by the National Hip Fracture Database (NHFD). The treatment of distal femoral fractures in this population has not had the same emphasis. This study defines the epidemiology, current practice and outcomes of distal femoral fractures in four English centres. ⋯ This study demonstrates that the distal femoral and hip fracture populations are similar, and highlights the current disparity in their management. The metrics and standards of care currently applied to hip fractures should be applied to the treatment of distal femoral fractures. Optimal operative treatment and rehabilitation remains unclear, and is in need of further research.