Journal of orthopaedic trauma
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Although locked plating has been shown to have advantages for diaphyseal and metaphyseal fracture fixation, its benefits for pubic symphyseal disruption have not been established. With traditional plate fixation of the disrupted pubic symphysis, normal physiological symphyseal pelvic motion eventually results in plate breakage, screw breakage, and loosening of screws. A concern exists that common modes of locked plate construct failure could result in abrupt and complete loss of symphyseal fixation. The purposes of this study were to determine, using an open-book pelvic injury model, whether locked plating of the pubic symphysis 1) offers any advantage over standard unlocked plating; and 2) results in a potential increased risk of abrupt fixation failure. ⋯ No abrupt failures occurred in either plating group. Consequently, any fear of catastrophic (ie, abrupt and complete) failure of locked symphyseal plates appears to be unfounded for open-book injuries treated in patients with low bone density. However, minor loss of the symphyseal reduction was evident in all pelvises regardless of the fixation method. Therefore, locked plating of the pubic symphysis does not appear to offer any advantage over the standard unlocked technique for an AO/Orthopaedic Trauma Association 61-B3.1 partially stable open-book pelvic injury pattern in osteopenic bone.
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Review Meta Analysis Comparative Study
External fixation versus internal fixation for unstable distal radius fractures: a systematic review and meta-analysis of comparative clinical trials.
There is no consensus on the surgical management of unstable distal radius fractures. In this systematic review and meta-analysis, we pool data from trials comparing external fixation and open reduction and internal fixation (ORIF) for this injury. ⋯ Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Case Reports Multicenter Study
Failure of locked design-specific plate fixation of the pubic symphysis: a report of six cases.
Physiological pelvic motion has been known to lead to eventual loosening of screws, screw breakage, and plate breakage in conventional plate fixation of the disrupted pubic symphysis. Locked plating has been shown to have advantages for fracture fixation, especially in osteoporotic bone. Although design-specific locked symphyseal plates are now available, to our knowledge, their clinical use has not been evaluated and there exists a general concern that common modes of failure of the locked plate construct (such as pullout of the entire plate and screws) could result in complete and abrupt loss of fixation. The purpose of this study was to describe fixation failure of this implant in the acute clinical setting. ⋯ Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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To examine the correlation between syndesmotic malreduction and functional outcome. ⋯ Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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To evaluate the midterm functional outcomes of patients with isolated operatively treated patella fractures. ⋯ Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.