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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We have used the principles of extracorporeal shock wave therapy (ESWT) in the treatment of nonunion of fractures in 44 patients (49 bones). There were 35 males and 9 females with a mean age of 34 years(range14-70). Clinical and radiological assessment was performed at regular time intervals with a minimum follow up of 18 months. ⋯ Failure in the remaining cases was due to more than 5mm gap, instability, compromised vascularity (type of bone) and deep low grade infection; which was discovered at the time of surgical intervention when no signs of radiological healing occurred after 6 months from treatment. Failing sites were shaft of femur, scaphoid, neck of humerus and neck of femur. No local complications were observed.
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Infected non-union is a devastating complication post fracture fixation. While its incidence is small, its management is lengthy, challenging and costly. Complex reconstruction surgery is often required with unpredictable outcomes despite the significant advances that have been made in diagnostics, surgical techniques and antibiotic protocols. In this article we present recent approaches to the surgical treatment of this condition.
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Review
Pain relief management following proximal femoral fractures: Options, issues and controversies.
The majority of proximal femoral fractures occur in the elderly population. Safe and adequate pain relief is an integral part of the overall management of hip fractures. ⋯ The pain management should start as soon as possible and special emphasis should be paid to contemporary methods of regional anaesthesia whilst a multimodal approach should be adopted in the perioperative period. The present review summarises the contemporary treatment options and controversies pertaining to the management of pain in elderly patients with proximal femoral fractures.
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To define the role of head computed tomography (CT) scans in the geriatric population with isolated low-energy femur fractures and describe the pertinent clinical variables which are associated with positive CT findings with the objective to decrease the number of unnecessary CT scans performed. ⋯ Prognostic level III. See instructions for authors for a complete description of levels of evidence.