Journal of orthopaedic trauma
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The use of locked plates in repairing osteopenic 3- and 4-part proximal humerus fractures remains controversial. The purpose of this article was to report the outcomes of open reduction and internal fixation in low-energy proximal humerus fractures treated with locked plating in patients older than 55 years and stratify risk of failure or complication based on initial radiographic features. ⋯ Neer 3- and 4-part proximal humeral fractures in older patients with initial varus angulation of the humeral head had a significantly worse clinical outcome and higher complication rate than similar fracture patterns with initial valgus angulation. Two factors had significant influence on final outcome in these fracture patterns: initial direction of the humeral head angulation and length of the intact metaphyseal segment attached to the articular fragment. The best clinical outcomes were obtained in valgus impacted fractures with a metaphyseal segment length of greater than 2 mm, and this was independent of Neer fracture type. Humeral head angulation had the greatest effect on final outcomes (P < 0.001), whereas metaphyseal segment length of less than 2 mm was predictive of developing avascular necrosis (P < 0.001).
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A new device for the treatment of intertrochanteric fractures that uses 2 cephalocervical screws in an integrated mechanism allowing linear intraoperative compression and rotational stability of the head/neck fragment has been developed. The aim of this study was to describe the results using this device for the treatment of stable and unstable intertrochanteric fractures. ⋯ The InterTan device appears to be a reliable implant for the treatment of intertrochanteric femoral fractures. Its design provides for stability against rotation and minimizes neck malunions (shortening) through linear intraoperative compression of the head/neck segment to the shaft. As a result of the negligible complication rate and improved clinical outcomes, this implant is now the standard treatment for all intertrochanteric fractures at our institution.
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Multicenter Study
Quality of life after a stable trochanteric fracture--a prospective cohort study on 148 patients.
The aim of this study was to report the long-term outcome for patients with stable trochanteric fractures, especially regarding the health-related quality of life (HRQoL). ⋯ Besides the expected mortality rate, the results of the study confirm a low reoperation rate and a good outcome regarding pain at the hip and only limited deterioration in HRQoL after a stable trochanteric fracture. However, a considerable number of the patients experienced deterioration in their walking ability and ADL function. The data on HRQoL obtained in this study can be used in future healthcare evaluations and to calculate quality-adjusted life years.
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Multicenter Study
Complications following limb-threatening lower extremity trauma.
Our objective is to report the nature and incidence of major complications after severe lower extremity trauma. ⋯ Patients with severe lower extremity injuries can expect a significant number of complications, most notably wound infection, nonunion, wound necrosis, and osteomyelitis. A large portion of these will require additional inpatient or operative treatment. Patients electing for reconstruction can expect a higher risk of complications.
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Studies using 2-dimensional computed tomography-derived criteria indicate that, in general, posterior wall fractures involving less than 20% of the posterior wall are stable and able to withstand physiologic loads, whereas those involving greater than 40%-50% are unstable, leaving a wide range of posterior wall fractures classified as indeterminate. The purpose of this study was to assess the ability of static measurement of posterior acetabular wall fragment size using computed tomography to predict hip stability status, as determined by dynamic stress examination under anesthesia. ⋯ The alternative method is the only reliable technique that is predictive of hip stability for small fracture fragments while also being predictive of instability for large fracture fragments. However, these findings are based on small patient numbers, and there remain a substantial number of fractures involving 20% or more of the posterior wall that are both stable and unstable by examination under anesthesia. Therefore, given the low risk of the stress examination and the inherent problems making the computed tomography measurements, dynamic fluoroscopic stress testing under general anesthesia should be the preferred method for the determination of hip stability status after posterior wall fractures of the acetabulum.