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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The objectives of this study were to provide computed tomography (CT)-based description of the anatomic specifics of lateral compression (LC)-1 pelvic ring disruptions and to describe injury severity to other body systems and their correlation with fracture anatomy. ⋯ LC-1 fractures of the pelvic ring represent a spectrum of injuries, with a large proportion having complete disruption of the sacrum. This complete injury of the sacrum is predicted by Denis type, severity of anterior ring disruption, abdominal AIS, and potentially location of rami fracture and ISS. CT scanning best defines these injuries.