Journal of orthopaedic trauma
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Randomized Controlled Trial Multicenter Study
Is surgery for displaced, midshaft clavicle fractures in adults cost-effective? Results based on a multicenter randomized, controlled trial.
To determine the cost-effectiveness of open reduction internal fixation (ORIF) of displaced, midshaft clavicle fractures in adults. ⋯ The cost-effectiveness of ORIF after acute clavicle fracture depended on the durability of functional advantage for ORIF compared with nonoperative treatment. When functional benefits persisted for more than 9 years, ORIF had a favorable value compared with many accepted health interventions.
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Multicenter Study Comparative Study
Is ulnar nerve transposition beneficial during open reduction internal fixation of distal humerus fractures?
The purpose of this study was to compare the incidence of ulnar neuritis with and without ulnar nerve transposition during open reduction and internal fixation (ORIF) of distal humerus fractures. ⋯ Patients who underwent ulnar nerve transposition at the time of ORIF of distal humerus fractures had almost four times the incidence of ulnar neuritis than those without transposition. We do not recommend routine transposition of the ulnar nerve at the time of ORIF of distal humerus fractures.
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To evaluate the results after closed reduction and percutaneous fixation of displaced fractures of the proximal humerus with the Humerusblock system. ⋯ The Humerusblock system allows reliable minimally invasive fixation of selected displaced proximal humerus fractures, even in elderly patients with potentially reduced bone mass. In this study, postoperative rates of avascular necrosis were lower than that which has been reported after conservative treatment and open anatomic reduction and internal fixation. The overall unplanned re-operation rate of 40% was high, comparable with what has been reported for conventional percutaneous pinning. However, clinical outcome was good in 77% of the patients, and reduction could be held in 91% successfully, including elderly patients with potentially reduced bone mass.
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Immediate external fixation and planned conversion to internal fixation of humeral shaft fractures is an option in the treatment of associated severe soft-tissue injuries and severely injured patients. The purpose of this study was to evaluate the outcome and complications of patients who sustained humeral shaft fractures and were treated with initial unilateral external fixation followed by plate fixation. ⋯ Immediate external fixation with planned conversion to plate fixation within 2 weeks proved to be a safe and effective approach for the management of humeral shaft fractures in selected patients with multiple injuries or severe soft-tissue injuries that preclude early plate fixation.
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Comparative Study
Stabilization of adolescent both-bone forearm fractures: a comparison of intramedullary nailing versus open reduction and internal fixation.
To compare flexible intramedullary (IM) nailing with open reduction and internal fixation (ORIF) with plates and screws in the treatment of adolescent both-bone forearm fractures. ⋯ Flexible IM nailing of both-bone form fractures in adolescents was safe and effective in our small series; we had less complications when compared with conventional ORIF. Although flexible IM nailing results in distal translation of the radial bow, forearm rotation is not compromised.