International orthopaedics
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Review Meta Analysis Comparative Study
Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures in the healthy elderly: a meta-analysis and systematic review of randomized trials.
Displaced femoral neck fractures in healthy elderly patients have traditionally been managed with hemiarthroplasty (HA). Recent data suggest that total hip arthroplasty (THA) may be a better alternative. ⋯ Total hip arthroplasty for displaced femoral neck fractures in the fit elderly may lead to higher patient-based outcomes but has higher dislocation rates compared with hemiarthroplasty. Further high-quality randomized clinical trails are needed to provide robust evidence and to definitively answer this clinical question.
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Bone drilling causes an increase in bone temperature, and a temperature above 47°C is critical because it causes thermal bone necrosis. Thermal osteonecrosis is common with the drill diameter of ≥4.5 mm without cooling. The aim of this study was to determine the increase of bone temperature during drilling using newly contructed two-step and internally cooled drills. ⋯ A two-step drill does not have any advantages over a standard twist drill of the same diameter. An internally cooled drill causes a significantly smaller increase of bone temperature during drilling with water of 24°C. An internally cooled drill is currently the 'ideal' drill for traumatology/orthopaedics because it produces the smallest increase in bone drilling temperature. If internal cooling is used the regulation of other drilling parameters is of no importance.
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Displaced type 2 lateral end clavicle fractures have a tendency to delayed union or non-union. Various methods of stabilisation of the displaced lateral end fractures are described. The increasing use of implants to fix such fractures also necessitates extensive dissection for implant retrieval. Adequate reduction and minimal tissue trauma during implant placement and removal would be ideal modalities for fixation of such fractures. ⋯ The clinico-radiological outcomes with our modified tension band fixation for displaced type 2 lateral end clavicle fractures were encouraging and comparable with earlier studies.
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Long-term studies evaluating risk factors for development of ankle osteoarthritis (OA) following malleolar fractures are sparse. ⋯ Advanced radiographic OA was common 12-22 years after malleolar fracture. The probability of developing post-traumatic OA among patients having three or more risk factors was 60-70%.
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Comparative Study
Periprosthetic bone mineral density with a cementless triple tapered stem is dependent on daily activity.
Periprosthetic bone loss around the femoral stem is frequently found after total hip arthroplasty. We have shown that periprosthetic bone mineral density (BMD) loss using the triple tapered stem is consistently much less in comparison with the straight type component. In this study, we compared periprosthetic BMD change with clinical factors. ⋯ The cementless triple tapered stem maintains periprosthetic bone mineral density. Activity may reflect improving periprosthetic bone quality after THA using a triple tapered stem.