Injury
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Multicenter Study
Treatment options for unstable posterior pelvic ring lesions: A multicenter retrospective cohort study of the Italian Society for the Traumatology of the Pelvis.
Posterior pelvic ring lesions are a common finding in patients with pelvic trauma, representing a challenging condition for trauma surgeons. Surgical options are different and there is not yet evidence about the best option. Aim of the study are: (i) to compare Lumbopelvic fixation (LPF) and ilio-sacral screw fixation (ISS) regarding clinical and radiological outcome in unstable posterior pelvic ring injuries, both as whole population and single similar fracture types according to Tile classification (C1vsC1, C2vsC2, C3vsC3); (ii) to analyze clinical outcomes and complications in lumbopelvic fixation group, comparing open and closed reduction technique. ⋯ ISS and LPF represent both good choices in posterior pelvic ring lesions, however some significant differences were noted. LPF seems to be preferable if the patient did not work before the trauma, due to better clinical outcome. In Tile C3 lesions, LPF have lower breakage rates. If LPF is chosen, CRIF provides better clinical outcomes, QoL and lower hospitalization.
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Usually ipsilateral fractures of the femur and tibia are not compatible with good results and require surgery. The unsatisfactory results are more likely due to complex patterns of fractures, compromised soft tissue, associated ligament injuries, and concomitant vital organ injuries. There are many classifications to describe this type of fracture but none of them is a prognostic classification. The aim of this study is to validate our classification according to prognostic terms. ⋯ The floating knee is not only the bone lesion but is above all the lesion of the soft tissues and the extensor apparatus that allow the correct functionality of the knee. These lesions do not always have favorable outcome, with respect to the nonseverity of the lesion as in Fraser's classification. Furthermore, on average these patients are subjected to an average of 6 surgical interventions; in some cases we have assisted to 23 surgical procedures. This study proved that this new classification system is prognostic, reliable and reproducible.
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Comparative Study
Comparison of biodegradable and metallic tension-band fixation for paediatric lateral condyle fracture of the elbow.
In our retrospective study we compared the outcomes of paediatric lateral condyle fractures of the elbow fixed by bioabsorbable pins and tension-band sutures or by metallic tension-band with K-wires. ⋯ We did not notice any difference between the complication rates of the two methods, so the real advantage of the absorbable implant technique is that no second intervention is necessary. The benefits of using biodegradable implants in various osteosynthesis techniques need further confirmation by randomised trials.
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Comparative Study
Length and offset restoration in partial hip arthroplasty (PHA) performed by resident surgeons: Comparison between preoperative planning and intraoperative X-ray.
Restoring of leg length and femoral offset in partial hip arthroplasty (PHA) performed by residents (level one of experience surgery) in the neck femoral fractures has a significant role in the clinical outcome. The aim of this study is to show the statistically significant differences in restoring hip geometric parameters using preoperative planning vs intraoperative X-ray. Authors compared the use of pre-operative planning with intra-operative radiography to restore the limb length and femoral offset, focused on the measurement of femoral offset and leg length discrepancy (LLD). ⋯ Statistical analyses did not find a statistically significant difference between the using of preoperative planning and intra-operative x-ray according to postoperative LLD (p = 0,06). Similarly, median change in the offset did not differ between the two groups (-2 mm vs. -1,5 mm; p = 0.69). In our experience, the combined use of pre- and intraoperative techniques appear to be viable and effective in order to restore femoral offset and minimize LLD.
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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.