Journal of orthopaedic trauma
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The incidence of osteoporotic proximal tibial fractures has increased during the last 2 decades. A promising approach in osteoporotic fracture fixation is polymethylmethacrylate-based cement augmentation of implants to gain better implant purchase in the bone. This study investigates the biomechanical benefits of screw augmentation in less invasive stabilization system-proximal lateral tibial (LISS-PLT) plates in cadaveric extraarticular comminuted proximal tibial fractures (OTA-41-A3.3). ⋯ This biomechanical study showed that cement augmentation of the LISS-PLT plate screws in osteoporotic proximal extraarticular tibial fractures significantly lowers the propensity toward screw migration and secondary varus displacement.
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The aim of this investigation was to perform a biomechanical comparison between 1- and 2-screw systems used for the treatment of intertrochanteric fractures for centralized and decentralized placement of femoral neck screws of failure loads, stiffness, survival rates, tip apex distance (TAD), and failure mode. ⋯ Based on these data, it is clear that both the nail systems showed a higher biomechanical stability with a lower TAD. The 2 specimens that failed with the Intertan in the cyclic tests had a TAD ≥49 mm. The cutout failures that we detected during cyclic testing in the Gamma system had a TAD ≥30 mm. Thus, it is clear that the TAD affects failure independent of the implant used. With a less than ideal lag screw placement, however, the Intertan system with 2 integrated screws was able to withstand higher loads in this study.
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To evaluate the clinical and radiographic results associated with the use of a percutaneous suprapatellar (SP) portal and accompanying instrumentation for tibial intramedullary nail (IMN) insertion using a semiextended approach. ⋯ Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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To systematically review and compare nonoperative and operative treatments for the management of periprosthetic distal femur fractures adjacent to total knee arthroplasties. Specific operative interventions compared included locked plating, retrograde intramedullary nailing (RIMN), and conventional (nonlocked) plating. Where possible, data were pooled to arrive at summary estimates of treatment effect [odds ratios (ORs) with associated 95% confidence intervals (CIs)]. ⋯ Locked plating and RIMN offer significant advantages over nonoperative treatment and conventional (nonlocked) plating techniques in the management of periprosthetic femur fractures above total knee arthroplasties. Locked plating demonstrated a trend toward increased nonunion rates when compared with RIMN. Malunion was significantly higher with RIMN compared with locked plating.
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Comparative Study
Operating room efficiency: benefits of an orthopaedic traumatologist at a level II trauma center.
Fellowship-trained orthopaedic traumatologists are presumably taught skill sets leading to "best practice" outcomes and more efficient use of hospital resources. This should result in more favorable economic opportunities when compared with general orthopaedic surgeons (GOSs) providing similar clinical services. The purpose of our study was to compare the operating room utilization and financial data of traumatologists versus GOSs at a level II trauma center. ⋯ Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.