Journal of orthopaedic trauma
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This study looks at the treatment of 16 cases of infection in long bone fractures that had an adverse effect on healing. The goal was to find a method that may be effective in getting these most difficult injuries to heal. The use of reinforced antibiotic-impregnated bone cement rods was studied to see if this could be an effective form of treatment. The use of such devices makes sense because they provide stability that the fractures need for healing while also providing a high concentration of antibiotics locally. The concept was to reduce the amount of metal used for stability while still giving the fracture the correct milieu for healing. ⋯ Therapeutic Level IV. See page 128 for a complete description of levels of evidence.
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Randomized Controlled Trial
Surgical treatment with an angular stable plate for complex displaced proximal humeral fractures in elderly patients: a randomized controlled trial.
The objective of the study was to evaluate functional outcome, patient self-assessment, and radiographic outcome at 1 year in displaced three- and four-part proximal humeral fractures (OTA group 11-B2 and 11-C2). ⋯ There is no evidence of a difference in functional outcome at 1-year follow-up between surgical treatment and conservative treatment of displaced proximal humeral fractures in elderly patients.
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The purpose of this study was to determine if immediate full weightbearing after surgical treatment for periprosthetic femur fractures can decrease perioperative and total mortality. ⋯ Treatment of periprosthetic femur fractures with femoral component exchange to a modular prosthetic nail that allows immediate postoperative full weightbearing may decrease mortality.
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The purpose of this study was to determine whether overlap between temporary external fixator pins and definitive plate fixation correlates with infection in high-energy tibial plateau fractures. ⋯ Fears of definitive fracture fixation site contamination from external fixator pins do not appear to be clinically grounded. When needed, we recommend the use of a temporary external fixation construct with pin placement that provides for the best reduction and stability of the fracture, regardless of plans for future surgery.
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Addition of epidural anesthesia to general anesthesia is theorized to reduce hospital length of stay, improve postoperative pain control, reduce time to mobilization, and reduce intraoperative blood loss for operative treatment of acetabular fractures. Our hypothesis was that epidural anesthesia would result in improvement in short-term outcomes and therefore justify any associated increases in anesthesia induction time, treatment costs, or risks. ⋯ Although addition of epidural anesthesia added an average of 19 minutes to the anesthesia time (P < 0.01), we found no advantage to CEGA regarding length of stay, pain scores, or time to rehabilitation. Mean decrease of blood loss of less than 100 mL in the CEGA group is unlikely to be of clinical significance. Our results contrast findings in support of CEGA in the hip arthroplasty literature and question the use of CEGA for posterior wall acetabular fractures.