Injury
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Multicenter Study
Delay to surgery does not affect survival following osteoporotic femoral fractures.
Fragility femoral fractures occur in a similar group of patients to hip fractures but they are not routinely managed along standardised guidelines. This study looked specifically at whether delay to surgery has an impact on mortality and morbidity. ⋯ Fragility femoral fractures have equivalent mortality to hip fractures but we found no link between delay to surgery and mortality. We believe it is safe to delay surgery, within reason, whilst their acute and chronic medical problems are optimised. We believe this information will help develop guidelines similar to hip fracture pathways.
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Comparative Study
Monosegmental vs bisegmental pedicle fixation for the treatment of thoracolumbar spine fractures.
The anatomy and biomechanics of the thoracolumbar spine place these segments at high risk of trauma injuries. Treatment options are either conservative or surgical, and there is a lack of consensus about the right indications. International scientific publications agree only on basic surgical principles: vertebral stability, deformity correction, protection of neurological structures and fast functional recovery. The most commonly used approach is the posterior approach, which allows the best management of most vertebral fracture patterns. The aim of this study was to compare clinical and radiological outcomes of monosegmental stabilisation with those of bisegmental stabilisation and fusion in the treatment of traumatic thoracolumbar spine fractures. ⋯ The results of this study confirm the validity of short and very short instrumentation for the treatment of well-selected type A and B vertebral fractures. In C type fractures correct surgical indication must be evaluated on an individual basis.
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Comparative Study
Is softcast (3M) strong enough for potentially unstable paediatric forearm fractures?
The majority of paediatric forearm fractures are treated using a circumferential splint, with prior manipulation as necessary. Plaster of Paris is often chosen for its ease of application, cost and proven reliability. Softcast is an alternative, providing a comfortable and water-resistant splint that can be removed without a plaster saw, and is in widespread use for immobilising buckle fractures. Softcast has not been recommended for acute unstable fractures. We established whether a Softcast splint could provide sufficient mechanical stability to control an unstable paediatric forearm fracture. ⋯ A 6-wrap Softcast splint provides adequate mechanical stability and protection for paediatric patients up to approximately 20kg, avoiding high-risk activities. The primary risk is not of fracture angulation and loss of position, but temporary indentation of the splint, causing discomfort or pain. Considering its ease of removal, Softcast may be preferable for younger paediatric patients. Its cost may be offset by reducing the number and duration of hospital visits.
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With an incidence of less than 0.2% of all pediatric fractures, pelvic ring injuries are rare. Historically they were conservatively treated, but because malunion and long-term morbidity are associated with unstable injuries, a trend towards operative treatment can be observed. The purpose was to determine clinical and radiographic outcomes following these complex pediatric pelvic ring injuries. ⋯ In pediatric patients with pelvic ring injuries, radiographic deformity persisted and did not remodel. Pelvic ring deformity occurred more commonly with complex unstable ring injuries. The complex displaced injuries have higher rates of operative intervention, residual deformity, and low back and SI joint pain.
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Anterior humeral line (AHL) location is commonly used to evaluate sagittal alignment after fracture reduction in children with supracondylar humeral fractures. However, the position of the AHL for acceptable fracture reduction has not been validated by clinical outcome. The purpose of this study was to investigate the relationship between the location of AHL and range of elbow motion. ⋯ These findings demonstrate that children with AHL crossing the middle and posterior thirds of the capitellum appear to have slightly better early elbow flexion and total range of elbow motion. AHL crossing the anterior third of the capitellum can be an underreduction that has similar elbow motion as AHL anterior to the capitellum. AHL posterior to the capitellum is a warning sign of overreduction and should be avoided.