Journal of orthopaedic trauma
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Multicenter Study Clinical Trial
Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate: a prospective multicenter analysis.
The goal of this study is to evaluate the incidence of complications and the functional outcome after open reduction and internal fixation with the proximal humeral locking plate (Philos). ⋯ Fixation with Philos plates preserves achieved reduction, and a good functional outcome can be expected. However, complication incidence proportions are high, particularly due to primary and secondary screw perforations into the glenohumeral joint, with an overall complication rate of 35%. More accurate length measurement and shorter screw selection should prevent primary screw perforation. Awareness of obtaining anatomic reduction of the tubercles and restoring the medial support should reduce the incidence of secondary screw perforations, even in osteopenic bone.
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To analyze the long-term (5-27 years) functional and radiologic results of surgically treated tibial spine fractures. ⋯ Surgical treatment of tibial spine fractures offers the possibility to regain full stability of the knee joint and good long-term results after open reduction and internal fixation with low infection rates. Knee function is adequately restored in most patients with a minimal risk of developing secondary osteoarthritis.
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The aim of this study was to assess the ability to extract surgically relevant information from plain radiographs in trimalleolar fractures and to compare this with the information gathered from computed tomography (CT). ⋯ Only the extent of the posterior fragment can be measured reliably, reproducibly, and accurately on plain radiographs. Comminution and impaction of the posterior fracture are underestimated by far. Surgically relevant information is missed, which can lead to intraoperative inability to properly reduce the fracture. Preoperative CT evaluation is recommended in all patients with trimalleolar fractures, independent of the size of the posterior fragment.
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The purpose of this study was to review the outcome of late revision surgery in a series of patients with posterior wall fractures having recurrent hip instability after failed initial open reduction and internal fixation. ⋯ Patients are likely to experience poor clinical outcome, ultimately requiring total hip arthroplasty, when salvage procedures are delayed by more than 3 weeks. In older patients, failure occurs rapidly; in younger patients, total hip replacement surgery may be delayed. Therefore, in older patients, particularly if there is concomitant damage to the femoral head, late revision fracture fixation surgery is ill advised and total hip arthroplasty seems to be the most appropriate secondary surgery. However, late revision fracture fixation surgery may provide young, active patients a limited number of years of satisfactory function before total hip arthroplasty is required.
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Randomized Controlled Trial Comparative Study
Elastic stable intramedullary nailing versus nonoperative treatment of displaced midshaft clavicular fractures-a randomized, controlled, clinical trial.
To compare elastic stable intramedullary nailing (ESIN) with nonoperative treatment of fully displaced midshaft clavicular fractures in adults. ⋯ ESIN of displaced midshaft clavicular fractures resulted in a lower rate of nonunion and delayed union, a faster return to daily activities, and a better functional outcome. Clavicular shortening was significantly lower, and overall satisfaction was higher in the operative group.