International orthopaedics
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Comparative Study
Regional anaesthesia for hip fracture surgery is associated with significantly more peri-operative complications compared with general anaesthesia.
Although several studies have advocated the use of regional versus general anaesthesia as a means of reducing peri-operative complications from hip fracture surgery, the ideal method of anaesthesia remains controversial. Our purpose was to investigate the association between anaesthesia type and peri-operative complications in hip fracture surgery. ⋯ Using a large multi-centre database, we demonstrate that regional anaesthesia was associated with significantly greater odds of minor and total peri-operative complications compared with general anaesthesia. Our results challenge the notion that regional anaesthesia is the preferred method of anaesthesia for hip fractures in the elderly.
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Osteonecrosis of the femoral head (ONFH) is a very common complication after femoral neck fracture. The purpose of this study was to assess the femoral head vascularity after femoral neck fracture using single photon emission computerized tomography and computerized tomography (SPECT/CT), and to evaluate its value in predicting ONFH. ⋯ SPECT-CT proved to be reliable and valid for predicting ONFH after femoral neck fracture.
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Accurate evaluation of femoral offset is difficult with conventional anteroposterior (AP) X-rays. The EOS imaging system is a system that makes the acquisition of simultaneous and orthogonal AP and lateral images of the patient in the standing position possible. These two-dimensional (2D) images are equivalent to standard plane X-rays. Three-dimensional (3D) reconstructions are obtained from these paired images according to a validated protocol. This prospective study explores the value of the EOS imaging system for comparing measurements of femoral offset from these 2D images and the 3D reconstructions. ⋯ This study points out the limitations of 2D measurements of femoral offset on standard plane X-rays. The reliability of the EOS 3D models has been previously demonstrated with CT scan reconstructions as a reference. The EOS imaging system could be an option for obtaining accurate and reliable offset measurements while significantly limiting the patient's exposure to radiation.
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Comparative Study
Surgical treatment of aseptic forearm nonunion with plate and opposite bone graft strut. Autograft or allograft?
Adequate treatment of forearm nonunion should achieve both biological stimulation of the bone and mechanical stability. The use of bone graft could enhance the healing of a nonunion providing osteogenic, osteoconductive and osteoinductive stimulation and an optimal stability of the fixation. We retrospectively reviewed two cohorts of patients affected by forearm nonunion and treated with plate and opposite bone graft to determine whether the use of autograft versus allograft differs in terms of (1) rate of healing of the nonunion and (2) time of healing. ⋯ The use of plate and opposite bone graft demonstrated to be effective in promoting the healing of forearm nonunions, without significant differences in terms of rate and time of healing in the two groups. Considering the higher surgical time and the comorbidity of the donor site, if a bone bank is available, we suggest to use homologous cortical bone strut graft with opposite plate and screw fixation for the treatment of aseptic forearm nonunion rather than autograft.
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Clinical Trial
Dislocation of bipolar hip hemiarthroplasty through a postero-lateral approach for femoral neck fractures: A cohort study.
To analyze postoperative global femoral offset (FO), leg length discrepancy (LLD) and Wiberg angle as risk factors for prosthetic dislocation after treatment with bipolar hemiarthoplasty (HA) through a postero-lateral approach for femoral neck fracture (FNF). ⋯ Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.