Injury
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In hip fracture surgery, the exact choice of implant often remains somewhat unclear for the individual surgeon, but the growing literature consensus has enabled publication of evidence-based surgical treatment pathways. The aim of this article was to review author pathways and national guidelines for hip fracture surgery and discuss a method for future pathway/guideline implementation and evaluation. ⋯ Surgical treatment pathways for proximal femoral fractures are available in literature and nationally with somewhat evidence based treatment consensus, but the scientific evaluation of the pathways them selves needs to be optimised.
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Review
Total elbow joint replacement for fractures in the elderly-Functional and radiological outcomes.
The purpose of this paper was to review the literature on the treatment of intra-articular fractures of the distal humerus in the elderly in order to evaluate the place for total elbow replacement (TER) in the light of our experience over the past 15 years. ⋯ TER is now the treatment of choice for unreconstructable fractures of the distal humerus in the elderly. This option should therefore be available at the time of surgery for all distal humeral fractures in this patient population. A surgical approach other than olecranon osteotomy, which would preclude TER is therefore required.
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Cortical onlay strut allografts, as the primary method of fixation or as a supplementary fixation when a plate is used, have been a common option to treat B1 and C type PFF in the past decades since the technique was described by Penenberg et al. in 1989. Strut grafts were described as a useful treatment option because they provide structural support to the internal fixation while increasing the host bone stock without the harvesting complications. ⋯ Other concerns are the role as disease carrier, immune reactions, incorporation to the host bone in the long term and, in some centres, the availability and costs. This article reviews the literature regarding the use of struts in PFF and provides an overview on the use of strut grafts with actual recommendations based on the authors experience and the data from literature.
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Randomized Controlled Trial
Precise placement of lag screws in operative treatment of trochanteric femoral fractures with a new guide system.
We assessed the accuracy of a new guide system that we developed to place lag screws in the proper position with the minimum number of attempts for operative treatment of trochanteric femoral fractures. ⋯ With this new guide system, we are able to insert lag screws successfully in the optimal position even in most unstable fractures. The present study indicated that this new guide system and nail facilitate accurate placement of lag screws in the appropriate position with the minimum number of attempts.
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Grade III open fractures of the tibia represent a serious injury. It is recognised that combined management of these cases by experienced orthopaedic and plastic surgeons improves outcomes. Previous studies have not considered the timing of definitive soft tissue cover in relation to the definitive orthopaedic management. This paper reviews the outcomes in patients treated in an orthoplastic unit where the emphasis was on undertaking the definitive orthopaedic and plastic surgical procedures in a single stage, following initial debridement and temporary stabilisation as necessary. ⋯ Joint orthoplastic operating lists facilitate simultaneous definitive fixation and cover that greatly reduces infection rates. Based on our experience presented in this paper, we believe that emphasis should be placed on timely transfer to a specialist centre, aiming for a single-stage combined orthoplastic procedure to achieve definitive fixation and soft tissue coverage and optimal outcomes.