International orthopaedics
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Clinical Trial
Role of early Ilizarov ring fixator in the definitive management of type II, IIIA and IIIB open tibial shaft fractures.
We evaluated the results of patients with Gustilo types II, IIIA and IIIB open tibial fractures managed early with the Ilizarov external fixator (IEF). Sixty patients (51 males, nine females; age range 20-62 years; mean age 32.8 years) with type II (11 patients), type IIIA (13) and type IIIB (36) tibial diaphyseal fractures underwent emergency debridement and minimal bone fixation (with external fixator), followed by definite fixation with the IEF after three to five days. Average duration of the hospital stay was 8.6 days. ⋯ Most of the patients were able to achieve good knee and ankle range of motion. Early application of the Ilizarov fixator constitutes an excellent management of open tibial fractures, especially types II, IIIA and IIIB, due to good functional and radiological results. Despite the technical difficulties and some complications (which are mostly minor) IEF may be the preferred method in open tibial fractures, especially types II and III.
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Comparative Study
Tibial lengthening over humeral and tibial intramedullary nails in patients with sequelae of poliomyelitis: a comparative study.
Leg discrepancy is common after poliomyelitis. Tibial lengthening is an effective way to solve this problem. It is believed lengthening over a tibial intramedullary nail can provide a more comfortable lengthening process than by the conventional technique. ⋯ More patients encountered difficulty with the inserted intramedullary nail in the tibial nail group procedure. The complications did not show a statistically significant difference between the two techniques on follow-up. In conclusion, we found the humeral nail lengthening technique was more suitable in leg discrepancy patients with sequelae of poliomyelitis.
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The aim of this study was to evaluate the outcome of joint arthroplasty in obese and non-obese patients. We reviewed 2,026 consecutive primary total hip and 535 primary total knee arthroplasties performed for osteoarthritis. Patients were separated into two groups according to their body mass index (BMI): non-obese (BMI < 30) and obese (BMI ≥ 30). ⋯ The mid-term survival of total hip and knee arthroplasty is not adversely affected by obesity. Despite lower clinical scores, the obese patients were satisfied with the results of their surgery and have an equivalent mid-term survival rate. It would be unreasonable to deny patients arthroplasty surgery purely on the basis of a BMI indicating obesity.
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The World Health Organisation (WHO) recommends routine use of a surgical safety checklist prior to all surgical operations. The aim of this study was to prospectively audit checklist use in orthopaedic patients before and after implementation of an educational programme designed to increase use and correlate this with early complications, mortality and staff perceptions. Data was collected on 480 patients before the educational program and 485 patients after. ⋯ Seventy-seven percent thought the checklist improved team communication. Checklist use was not associated with a significant reduction in early complications and mortality in patients undergoing orthopaedic surgery. Education programs can significantly increase accurate use and staff perceptions following implementation.
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Fractures of the head and neck of the femur in children are very rare, occurring only after a high-velocity trauma, e.g. a fall from a height. This analysis shows the clinical course of traumatic femoral head and neck fractures in paediatric patients. Predisposing factors for poor outcome or fracture complications, such as non-union or femoral head necrosis, are described. ⋯ A single case was managed by "secondary" surgical treatment, two weeks after the initial trauma resulting in femoral head necrosis that healed without any subjective complaints. This case series confirms the importance of early surgical fixation of proximal femoral fractures in paediatric patients. An operative intervention later then 48 h after the initial trauma may increase the risk of complications such as femoral head necrosis, particularly in Delbet type I fractures (traumatic slipped capital femoral epiphysis).