Journal of orthopaedic trauma
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Randomized Controlled Trial
Negative pressure wound therapy after severe open fractures: a prospective randomized study.
To evaluate the impact of negative pressure wound therapy (NPWT) after severe open fractures on deep infection. ⋯ Control patients developed 2 acute infections (8%) and 5 delayed infections (20%), for a total of 7 deep infections (28%), whereas NPWT patients developed 0 acute infections, 2 delayed infections (5.4%), for a total of 2 deep infections (5.4%). There is a significant difference between the groups for total infections (P = 0.024). The relative risk ratio is 0.199 (95% confidence interval: 0.045-0.874), suggesting that patients treated with NPWT were only one-fifth as likely to have an infection compared with patients randomized to the control group. NPWT represents a promising new therapy for severe open fractures after high-energy trauma.
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Two 90-degree configurations of locking reconstruction plates with different numbers of screws in the distal ulnar column segment of distal extra-articular humeral fractures with metaphyseal comminution (A3) were biomechanically investigated. ⋯ Under static and cyclic bending conditions, stiffness in group 2 was significantly lower than that in group 1. Nevertheless, both implant configurations showed no failure of the constructs. Based on these data, when applying locked plates in the clinical setting, more than 1 locked screw applied into the distal ulnar column of the articular segment is recommended.
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To describe the technique and to determine the outcome of operatively treated displaced scapular body or glenoid neck fractures using minifragment fixation through a modified Judet approach. ⋯ The modified Judet approach allows for excellent scapular and glenoid fracture visualization and reduction while preserving rotator cuff function. Minifragment fixation along the lateral scapular border provides excellent plate position, screw length, and fracture stability.
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Case Reports
Reoperative surgical stabilization of a painful nonunited rib fracture using bone grafting and a metal plate.
We report a case of a nonunited sixth rib in a patient with multiple rib fractures who underwent internal fixation using a wire and Judet strut 3 times. During the following 3 years, the patient continued to complain of pain and instability. ⋯ A longitudinal gutter crossing the fracture site was fashioned and splinted with an inlay block of cancellous bone grafted from the iliac crest; stabilization was accomplished with a reconstruction plate and screws. The following 2 years of follow-up demonstrated no instability or pain.
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The management of acromioclavicular (AC) injuries has long been debated. We analyzed our results in treating such cases using hook plates and ligament suture. ⋯ The hook plate is a reliable fixation tool for complete AC joint dislocations, ensuring immediate stability and allowing early mobilization with good functional and cosmetic results. Routine plate removal should however be reevaluated.