Injury
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Comparative Study
Managing Vancouver B1 fractures by cerclage system compared to locking plate fixation - a biomechanical study.
With increasing life expectancy and number of total hip arthroplasties (THA), the need for revision surgery is increasing too. The aim of this study was to evaluate the optimal fracture treatment for a clinically characteristic Vancouver B1 fracture. We hypothesized that locking plate fixation has biomechanical advantages over fixation with a simple cerclage system. ⋯ In conclusion, the present biomechanical study indicates that periprosthetic Vancouver B1 fractures can be sufficiently fixed by simple cerclage systems. Revision with a long replacement stem provides a superior mechanical stability regardless of type of osteosynthesis fixation and is therefore a viable method in Vancouver B1 cases. A disadvantage of the cerclage system compared to plating is that an increased subsidence of the short stem was observed.
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Proximal tibiofibular joint (PTFJ) injuries are not uncommon but relatively understudied. This study evaluates the effectiveness of 2 radiographic methods in assessing the integrity of the PTFJ. ⋯ The direction in which the fibula is pointing and the percentage of tibiofibular overlap are highly specific radiographic methods useful in defining the PTFJ. The first method requires a weight-bearing view on AP assessment and >20 degrees of flexion on lateral assessment. True orthogonal AP and lateral views are required for the second method to be used.
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If a syndesmosis injury is not detected, or not treated appropriately, it can lead to pain and arthritis. Various techniques have been described to look for the presence of a syndemosis injury. If concern is raised regarding malreduction, the most recognised way of checking accuracy of the reduction (of the fibula into the incisura) is bilateral postoperative ankle CT scans. This not only exposes the patient to further radiation, but can normally only be done once the surgery is completed and so if adjustment is needed, this requires a further operation, encompassing further surgical risks. We developed a simple assessment, which both gives accurate intra-operative demonstration of an injury to the syndesmosis and also can check how well the fibula has been reduced (if required), without the need for further radiological investigation or surgical intervention. The objectives were to test how easy it was to perform the test and apply it to a number of different ankle fractures. ⋯ It has proved to be an easy and reliable adjunct to ankle fixation surgery and may have further indications.