Journal of orthopaedic trauma
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Periprosthetic fractures around the shoulder and elbow are rare and are often difficult to treat. Treatment options depend on the stability of the prosthesis, the location of the fracture, and the bone quality. ⋯ In cases of nonunion, surgical treatment is recommended. This article describes the current literature related to periprosthetic fractures around the shoulder and the elbow.
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To compare hospital charges and length of stay in a series of adult patients with isolated, otherwise uncomplicated tibia fractures with and without acute compartment syndrome (ACS). ⋯ The cost of ACS is significant, resulting in hospital stays that are increased threefold and hospital charges that are more than doubled in this cohort of patients. The impact of compartment syndrome on these factors was more important than whether the fracture was open or closed. In addition to the obvious benefit to the patient, methods that decrease the incidence of compartment syndrome and need for fasciotomy such as improved diagnosis to prevent unnecessary fasciotomy and methods to reduce intramuscular pressure and avoid fasciotomy in cases of incipient ACS would also be of value in reducing medical costs.
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We conducted a study to evaluate the functional outcomes of elderly patients after open reduction internal fixation of intra-articular distal humerus fractures. ⋯ Intra-articular distal humerus fractures are severely disabling injuries, particularly in the elderly population. Good results can be achieved with stable fixation and fracture union. Despite reasonable range of motion, patient-directed questionnaires revealed persistent pain and functional limitations.
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Results of hemiarthroplasty for complex four-part proximal humerus fractures in the elderly have been unreliable. Although patients often achieve pain relief, return of above-shoulder level function can be challenging, because tuberosity nonunion, malunion, and/or resorption is quite common. The reverse shoulder replacement has been advocated as a reliable alternative for these patients. ⋯ Subjective satisfaction ratings were excellent for four patients, and good for two, and satisfactory for one. No patients were unsatisfied with their outcomes. The horseshoe graft technique provides a reliable means for anatomic restoration of the tuberosities, facilitating the return of shoulder function in elderly patients with complex four-part proximal humerus fractures treated with a reverse total shoulder.
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We report three cases of a closed Hawkins III talar neck fracture in which the posteromedially dislocated talar body was irreducible even with combined anteromedial and anterolateral approaches. Our intraoperative solution was to proceed with a medial malleolar osteotomy, which resulted in an easy reduction. The combined incisions provided excellent exposure for anatomic reduction and rigid internal fixation. At a mean follow-up of 4 years, all fractures had healed with no evidence of avascular necrosis or talar dome collapse.