International orthopaedics
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Randomized Controlled Trial Comparative Study
Management of distal third tibial fractures: comparison of combined internal and external fixation with minimally invasive percutaneous plate osteosynthesis.
The objective of this study was to compare combined internal and external fixation (CIEF) with minimally invasive percutaneous plate osteosynthesis (MIPPO) in the treatment of distal third tibial fractures, and explore the benefits and defects of these two techniques. ⋯ Our results indicated that both CIEF and MIPPO were all efficient methods for treating distal third tibial fractures. However, CIEF had the advantages of a shorter operating and radiation time, less wound complication and ankle pain, less secondary operations for implant removal and easier removal of the implants.
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A prospective study was conducted to detect whether a relationship exists between metal allergy and post-operative pain in total hip and knee arthroplasty patients. We postulated that to some extent a relationship does exist between them. ⋯ Pain caused by metal allergy usually presents as persistent and recurrent pain. The white cell count, C-reactive protein, erythrocyte sedimentation rate and postoperative radiographs were not affected. Currently, patch testing and lymphocyte transforming tests are used for metal allergy diagnosis. We deemed that a relationship between post-surgery pain and metal allergy in total hip and knee patients may exist to some extent. Larger samples and longer follow-up time are essential for further study.
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Drilling into cartilage/bone is often required for orthopaedic surgery. While drilling into bone has been studied, the response of cartilage has received little attention. We have measured cartilage and drill bit temperatures during drilling and quantified the zone of chondrocyte death (ZCD) around the hole in the presence/absence of irrigation solutions. ⋯ Reducing temperature during drilling by irrigation markedly suppressed, but did not abolish chondrocyte death. Optimising the irrigation solution by raising osmolarity and reducing Ca(2+) content significantly reduced chondrocyte death during drilling and may be clinically beneficial.
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Case Reports
Effectiveness of exchange nailing and augmentation plating for femoral shaft nonunion after nailing.
We assessed indications and outcomes of exchange nailing and augmentation plating for femoral shaft nonunion following femoral nail failure. ⋯ Exchange nailing and augment plating coupled with decortication and bone graft is an effective treatment option for femoral shaft nonunion and has more indications and higher union rate than the popular exchange nailing treatment.
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Fragility hip fractures represent a major health and social burden. To date, there are no reports regarding mortality and factors that influence outcomes after osteoporotic hip fractures in Romania. ⋯ Increased age, extracapsular fractures and delayed surgery have worse outcomes. Regarding gender, even if not significant at the 0.05 level, probability of survival for females is higher for all time intervals. Updated, regional studies could be used in patient management to improve outcomes whilst decreasing costs.