International orthopaedics
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The purpose of this study was to characterise the biomechanical properties of the seven hole superior anterior clavicle LCP (locking compression plate) and to compare these with the properties of commonly applied implants used for the stabilisation of clavicular midshaft fractures such as the locking 7- and ten hole reconstruction plate. ⋯ The results indicate that the clavicle LCP, as compared to the reconstruction plates, leads to superior biomechanical stability in the treatment of midshaft clavicle fractures.
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The Surgical Apgar Score (SAS) is a simple tally based on intra-operative heart rate, blood pressure and blood loss; it predicts 30-day major postoperative complications and mortality in different surgical fields, but no validation has been performed in general orthopaedic surgery. ⋯ The SAS does not predict 30-day major complications and death in patients undergoing general orthopaedic surgery, but it is useful in the subgroup of patients undergoing spine surgery.
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Due to increasing life expectancy we see a rising number of joint replacements. Along with the proximal prosthesis in the femur, more and more people have a second implant on the distal ipsilateral side. This might be a retrograde nail or a locking plate to treat distal femur fractures or a constrained knee prosthesis in the case of severe arthrosis. All these constructs can lead to fractures between the implants. The goal of this study was to evaluate the risk of stress risers for interprosthetic fractures of the femur. ⋯ The highest risk for a fracture in the femur with an existing hip prosthesis comes with a retrograde nail. A distal locking plate for the treatment of supracondylar fractures leads to a higher required fracture force. The implantation of a constrained knee prosthesis that is not loosened on the ipsilateral side does not increase the risk for a fracture.
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Multicenter Study
Predictors for moderate to severe acute postoperative pain after total hip and knee replacement.
The ability to identify and focus care to patients at higher risk of moderate to severe postoperative pain should improve analgesia and patient satisfaction, and may affect reimbursement. We undertook this multi-centre cross-sectional study to identify preoperative risk factors for moderate to severe pain after total hip (THR) and knee (TKR) replacement. ⋯ Our findings provide clinical guidance for preoperative stratification of patients for more intensive management potentially including education, nursing staffing, and referral to specialised pain management.
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Hemiarthroplasty (HA) is an established treatment for femoral neck fractures of the elderly. Several surgical approaches are currently used including dorsal and transgluteal. It is still unclear whether one approach may be advantageous. We compared early complication rates after dorsal and transgluteal approaches. ⋯ The rate of early surgical complications after dorsal and transgluteal approaches is not significantly different. However, the dorsal approach predisposed to dislocation, whereas the transgluteal approach predisposed to haematoma.