Injury
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Comparative Study
Dual mobility cup in hip fracture: Indications and clinical results compared with bipolar hip arthroplasty.
The choice between hemiarthroplasty (HA) and total hip arthroplasty (THA) for displaced femoral neck fractures remains debated. There is increasing use in dual mobility cup total hip arthroplasty (DMC-THA) to prevent dislocations in these high-risk patients. Aim of this study is to retrospectively analyze patients treated in a single Center for femoral neck fracture comparing HA and DMC-THA in terms of: functional outcome, rate of complications and mortality. ⋯ DMC-THA offer better functional results than HA in elderly patients with femur neck fractures. The mean surgical time was longer in DMC-THA but this did not influence blood loss, time of discharge or one-year mortality. In our series dislocation never occurred in both groups.
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Comparative Study
Prevalence of atypical femoral fractures, a clinical update: A comparative retrospective study 7 years later.
Atypical femoral fractures (AFFs) are a rare type of subtrochanteric or diaphyseal fracture frequently associated with the use of bisphosphonates (BPs). They are a clinical entity often overlooked, for which a correct clinical-instrumental classification is essential for a successful treatment. Nowadays, there is no accurate data on their real incidence. The aim of this work is to evaluate the period prevalence of AFFs and their risk factors, and to compare actual results with a previous study conducted at the same Institution seven years previously. ⋯ The efficacy of BPs for the prevention of osteoporotic fractures is widely demonstrated. However, particularly prolonged use of these drugs may increase the risk of developing AFFs in some patients. The incidence of AFFs is higher than that reported in the literature, if evaluated only for the subtrochanteric and diaphyseal sites (essential diagnostic criterion in the definition of AFFs). In our study, the incidence of AFFs doubled after seven years. The present data also confirm the frequent association between the use of BPs and the onset of AFFs.
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Global surgery research efforts have been criticized for failure to transition from problem identification to intervention implementation. We developed a context-appropriate trauma quality improvement (TQI) bundle to ameliorate care gaps at a regional referral hospital in Cameroon. We determined associations between bundle implementation and improvement in trauma resuscitation practices. ⋯ The implementation of a context-appropriate TQI bundle was associated with significant improvements in previously identified trauma care deficits at a single regional hospital. Data-derived interventions targeting frontline capacity at the local level can bridge the gap between identifying care limitations and improvement in resource-limited settings.
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Residual axial and rotational deformities in tibial shaft fracture, after minimally invasive osteosynthesis (MIO) treatment, are widely described in literature. Nevertheless, there is still a lack of evidence about the malunion treatment strategies and results. The aim of our study is to present an innovative technique for tibial shaft malunion: a derotational proximal tibial osteotomy without removing the original plate (Plate-Retaining-Osteotomy: PR-Osteotomy). ⋯ To our knowledge, this is the first description of such surgical technique. Less invasiveness, fast recovery time and cost reductions are the foremost proposed benefits. Further larger case series with longer follow up are needed to assess the advantages of the proposed treatment strategy.
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Several studies have proven that ultrasound (US) can improve the efficiency of early diagnostics of anterior cruciate ligament (ACL) injuries. ACL US is mainly performed by sonologists or radiologists. We have very little data on how effective these tests are if they are performed by an orthopaedic surgeon. We also have no information on the applicability of ACL US in children and adolescents. In this retrospective study, we analysed the results of point of care ultrasound (POCUS), which were performed by orthopaedic surgeons on children with suspected ACL injury. ⋯ POCUS can indicate functional insufficiency caused by ACL injury in children and adolescents. The biggest advantage of the test is that it is quick and simple, non-invasive. Further prospective diagnostic tests and standardized examination protocols can confirm our favourable experiences.