Journal of orthopaedic trauma
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The optimal duration of perioperative antibiotic prophylaxis (PAP) for open fractures remains controversial because of heterogeneous or unclear guidelines and highly variable prophylactic regimens in clinical practice. We aimed at testing different PAP durations under controlled conditions in a contaminated rabbit fracture model. ⋯ When contamination with high bacterial loads is likely (eg, in an open fracture situation), a 72-hour course of intravenous cefuroxime seems to be superior in preventing fracture-related infection in our rabbit model compared with a single-shot or 24-hour antibiotic regimen.
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Subtrochanteric femur fractures remain a challenge for surgeons to obtain and maintain adequate reduction and stable fixation. For this reason, multiple techniques have been described, but we are unaware of a detailed contemporary description of the combination of provisional plating before intramedullary fixation in the lateral decubitus position. We present our technique as it was used from 2011 to 2015 to treat 22 fractures and how it compared clinically to the other 48 subtrochanteric femur fractures treated during that period. ⋯ The operative time was shorter when no open reduction was used but open cases showed no significant difference when using a provisional plate. Those patients treated with provisional plating were shown to have higher blood loss values and longer operative times, but when looking at the outcomes, the rate of malunion, which was defined as >5 degrees of angulation on postoperative radiographs, was significantly lower at 0% in the provision plating in the lateral decubitus position subset compared with the remaining subtrochanteric fractures, 27.7% (P = 0.013). As the quality of reduction and stability of fixation are the most significant factors in determining outcomes of subtrochanteric femur fractures, this study shows that this technique is a valuable tool in an orthopaedist's armamentarium and present it as such.
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To determine the impact of anesthesia type on in-hospital mortality and morbidity for geriatric fragility hip fracture surgery. ⋯ Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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To determine if ligamentous and meniscal injuries as determined by initial magnetic resonance imaging altered clinical outcomes after the fixation of tibial plateau fractures. ⋯ Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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To document in-hospital and 1-year mortality rates after high-energy pelvic fracture in patients 65 years of age or older as compared to a younger cohort. ⋯ Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.