Journal of orthopaedic trauma
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Comparative Study
Early surgical stabilization of flail chest with locked plate fixation.
To compare the results of surgical stabilization with locked plating to nonoperative care of flail chest injuries. ⋯ This study demonstrates the potential benefits of surgical stabilization of flail chest with locked plate fixation. When compared with case-matched controls, operatively managed patients demonstrated improved clinical outcomes. Locked plate fixation seems to be safe as no complications associated with hardware failure, plate prominence, wound infection, or nonunion were noted.
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To assess surgical and functional results after corrective reconstruction of malunited, scapula neck or body fractures in patients who presented with chronic pain, limited range of motion, weakness, and gross deformity of the shoulder. ⋯ Malunion after nonoperative treatment of a displaced scapula fracture may be associated with poor functional and cosmetic outcomes. Operative reconstruction can yield good surgical and functional results.
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Hospitals and providers that accept transfer patients risk lower ratings on publically reported quality measures that are inadequately adjusted for infirmity and complexity. We compared the outcomes of transferred patients and nontransferred patients after treatment of a hip fracture and sought to determine if expected outcomes based on an expansion of All Patient Refined-Diagnosis Related Groups (APR-DRGs) norms are accurately adjusted for transfer status. ⋯ Patients 65 years and older transferred to a tertiary care facility for treatment of an acute hip fracture have worse outcome than nontransfer patients. Unadjusted data such as in-hospital mortality may be misleading, but risk adjustment using the APR-DRG methodology and additional correction for transfer status may provide meaningful benchmarks.
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Fixation plate positioning remains controversial in clavicle fracture reconstruction. Biomechanical studies favor a superior plate placement and clinical series report very low mechanical complications for anteroinferior plate placement. To clarify this apparent discrepancy, a biomechanical finite element analysis of the deformation mode, stress patterns, and peak stresses involved with superior and anteroinferior clavicle plate fixation was performed. ⋯ Anterorinferior plating is generally preferable, because it induces deformation modes similar to the intact clavicle and is less likely to fail during normal physiological loading (cantilever bending). Superior placement of the reconstruction plate may be recommended for a patient with a high risk of shoulder impacts (axial compression). Design improvements in the bridging area of the plate and special attention to obtain a good fixation around the fracture could reduce plate failures and provide a stiffer construct.
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To examine the anatomic relationships of the major neurovascular structures at the midshaft clavicle region as they pertain to plate osteosynthesis in the treatment of midshaft clavicle fractures. ⋯ Caution must be exercised when instrumenting midshaft clavicle fractures regardless of chosen plate position. Limb abduction to 90° provides an added measure of safety during clavicle instrumentation.