International orthopaedics
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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.
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Peri-radicular injection is a widely used procedure for treating lumbar radicular pain, but it remains unclear what types of lumbar pathologies respond well to this treatment. We aimed to investigate the efficacy of peri-radicular injection for degenerative lumbar disorders and to determine what types of pathologies respond well to this treatment. ⋯ This study demonstrated that 51.7% of patients with degenerative lumbar pathologies were successfully treated by peri-radicular injection. Efficacy was limited in cases of herniated disc with spinal stenosis, foraminal disc herniation, recurrent disc herniation and failed back surgery with instability.
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Adequate comorbidity risk adjustment is central for reliable outcome prediction and provider performance evaluation. The two most commonly employed risk-adjustment methods in orthopaedic surgery were not originally validated in this patient population. We sought (1) to develop a single numeric comorbidity score for predicting inpatient mortality in patients undergoing orthopaedic surgery by combining and reweighting the conditions included in the Charlson and Elixhauser measures, and to compare its predictive performance to each of the separate component scores. We also (2) evaluated the new score separately for spine surgery, adult reconstruction, hip fracture, and musculoskeletal oncology admissions. ⋯ A single numeric comorbidity score combining conditions from the Charlson and Elixhauser models provided better discrimination of inpatient mortality than either of its constituent scores. Future research should test this score in other populations and data settings.
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The efficacy of immediate full weight bearing in accelerating bone regeneration after medial opening wedge high tibial osteotomy (HTO) was evaluated in patients operated with the Limmed system (locked plate fixation) that allows dynamisation of the site of the osteotomy. ⋯ The Limmed medial opening wedge HTO system with immediate full weight bearing accelerates bone graft substitute osseointegration and bone healing as compared with controls without full weight bearing.