Journal of orthopaedic trauma
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To understand the influence of obesity on the morbidity and mortality outcomes of patients who have sustained fractures of the femur and tibia. ⋯ Obese patients are significantly more likely to have more severe distal femur fractures compared with nonobese when involved in motor vehicle crashes. In this study, there was no statistically significant difference in length of stay, complications, or mortality in obese patients.
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To determine if there is a difference in morbidity and mortality in orthopaedic trauma patients with femoral shaft fractures undergoing early definitive care with intramedullary (IM) nails in the supine versus the lateral position. ⋯ For polytrauma patients with femoral shaft fractures, surgical stabilization using IM nails inserted with reaming of the femoral canal in the lateral position is not associated with an increased risk of mortality or ICU admission.
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Large displaced fractures of the femoral head require open reduction and internal fixation. If the displaced fragments are small, open reduction may not be possible and excision of the fragment or nonoperative care may be the treatment of choice. Surgical approaches that have been used for open reduction and internal fixation include the Smith-Petersen approach, Watson-Jones approach, Kocher-Langenbeck approach, a posterior approach with a trochanteric flip osteotomy, and surgical dislocation of the hip. Here, we describe the use of the modified Heuter direct anterior approach for open reduction and internal fixation of femoral head fractures in 2 patients.
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Randomized Controlled Trial
Comparison of knee function after antegrade and retrograde intramedullary nailing for diaphyseal femoral fractures: results of isokinetic evaluation.
To evaluate knee function in patients having femoral diaphyseal fractures treated with antegrade or retrograde intramedullary nail insertion. ⋯ Knee function seems to have similar clinical results after either antegrade or retrograde nail insertion for femoral diaphyseal fractures when knee range of motion, Lysholm Scores, and isokinetic knee evaluation are considered as outcome measures. With increasing patient age, a decrease in knee functioning should be anticipated in patients with femoral fractures treated with intramedullary nails regardless of technique.
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Comparative Study
Biomechanical comparison of proximal locking plates and blade plates for the treatment of comminuted subtrochanteric femoral fractures.
The 95 degrees angled blade plate is an accepted standard for plating subtrochanteric femoral fractures but can be technically demanding and often requires extensive soft tissue exposure. Proximal femoral locking plates (PFLPs) have been developed for subtrochanteric and pertrochanteric fractures and are potentially easier to apply with less soft tissue dissection. Clinical experience has raised concerns regarding the strength of the PFLP. The purpose of our study was to compare the relative stability of two designs of PFLP with the 95 degrees angled blade plate under loads simulating the first 3 months of progressive weight bearing after fracture fixation. ⋯ In the model studied, N-PFLPs were shown to have biomechanical properties that were at least equivalent to those of the blade plate. The fatigue failures of O-PFLPs mirrored our clinical experience. Use of the N-PFLP might be a viable alternative fixation method for comminuted subtrochanteric femoral fractures that currently are treated with blade plates.