International orthopaedics
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The aim of this study was to establish whether or not to cement the hemiarthroplasty for displaced intracapsular femoral neck fractures in the elderly. Consecutive patients treated by hemiarthroplasty in adjacent hospitals were reviewed. The same monoblock prosthesis was used; in hospital A they were uncemented (121 patients), and in hospital B they were cemented (123 patients). ⋯ There was no difference in general complication or mortality rates. There was a highly statistically significant greater deterioration in pain ( P=0.003), walking ability ( P=0.002), use of walking aids ( P=0.003) and activities of daily living ( P=0.009) in the uncemented group. Our findings support the use of cemented hemiarthroplasty in the elderly.
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We treated 31 femoral shaft fractures in 28 children with a mean age of 6.7 (5-10) years with retrograde flexible intramedullary nailing. There were 16 isolated fractures, while 12 children had associated injuries. ⋯ At follow-up after a mean time lapse of 27 months there was no limb-length inequality exceeding 1 cm and no malunion. We feel that femoral fractures in patients aged 5-10 years can be safely treated with retrograde flexible intramedullary nailing with minimal risk of surgical complications.
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Randomized Controlled Trial Comparative Study Clinical Trial
Cryotherapy compared with Robert Jones bandage after total knee replacement: a prospective randomized trial.
Sixty patients undergoing total knee replacement were randomized to receive either a cold compression dressing (Cryo/Cuff, Aircast, UK) or a modified Robert Jones bandage immediately after surgery. The cold compression dressing was used for a minimum of 6 h per day throughout the hospital stay, and the modified Robert Jones bandage remained in place for 48 h from the time of operation. ⋯ No difference was found between the 2 groups except for less blood loss in the surgical drains in the cold compression group (P < 0.05). Postoperative complications were seen in both groups, but no complication was associated with either the cold compression dressing or the modified Robert Jones bandage.
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The relationship between the peroneal nerves and the anatomical structures near the fibular head were studied in 20 cadavers. It was the purpose to define the boundaries of a "safe" area when performing a biopsy of the fibular head. The distances between the proximal end of the fibular head and the deep peroneal nerve (26+/-0.32 mm) and the intermuscular septum (15+/-0.19 mm) were measured, as well as the angle between the deep peroneal nerve and the fibula as seen in the A-P view (23.5+/-3.5 degrees). We considered that biopsies should be performed with an anterolateral approach in the safe area formed by the fibular head and the deep peroneal nerve in the anterior compartment.
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This is a retrospective study of eight consecutive patients of mean age 19 (13-27) years with severe Scheuermann's kyphosis who underwent anterior and/or posterior fusion using the Cotrel-Dubousset (CD) instrumentation. In two an anterior release and fusion with rib grafts had been previously performed. The mean follow-up was 5 years. ⋯ The average loss of correction was 4.6 degrees (1 degrees - 12 degrees). The lumbar hyperlordosis spontaneously improved from -67 degrees to -48 degrees. Two patients, who had chronic back pain refractory to conservative treatment, improved considerably after surgery.