Injury
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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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Surgical stabilization of rib fractures (SSRF) is increasingly performed, however the outcome of patients undergoing SSRF while on pre-injury antithrombotic therapy remains unknown. We compared surgical variables and outcomes of patients who were and were not on antithrombotic therapy. We hypothesize pre-injury anticoagulation is associated with delay in SSRF and worse outcomes. ⋯ Therapeutic/care management.
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Early treatment of elevated intracranial pressure (ICP) is a cornerstone of the therapy in severe traumatic brain injury (TBI) patients. Treatment of refractory high ICP however, remain challenging as only limited and risky third-tier therapeutic interventions are available. Controlled lumbar cerebrospinal fluid (CSF) drainage has been known as an efficient method of ICP reduction after TBI for decades, but it is not recommended in international guidelines because of low evidence background and safety issues. Our centre has a long-standing experience using this intervention for more than 15 years. Here we present our data about the safety and efficacy of controlled lumbar drainage to avoid further second- and third tier ICP lowering therapies and beneficially influence functional outcome. ⋯ Our results support the view that controlled lumbar drainage is a highly efficient method to manage intracranial hypertension and significantly decreases the need of further harmful ICP lowering therapies without altering functional outcome of severe TBI patients.
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Nowadays, an increasing number of Total Elbow Arthroplasty (TEA) surgeries have been selected as the primary intervention for distal humerus joint fractures. TEA has demonstrated favorable outcomes in elderly osteoporotic patients and has been associated with fewer complications and reduced stiffness when compared to Open Reduction Internal Fixation (ORIF) surgeries. This retrospective cohort study aimed to analyze differences in terms of functional outcomes, complications, and reoperation rates of distal fractures of the humerus treated with ORIF and TEA. ⋯ The results of the study, may guide in choosing a surgical option for distal humerus fractures in the elderly by considering TEA an alternative that is comparable to ORIF, and in selected cases an alternative that overall provides greater assurance than ORIF.
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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.