Journal of orthopaedic trauma
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Comparative Study
A modified hip screw incorporating injected cement for the fixation of osteoporotic trochanteric fractures.
To evaluate a modified sliding hip screw for the fixation of trochanteric fractures that provides increased fixation strength in osteoporotic bones and allows for the safe intraoperative application of bone cement. ⋯ This modified hip screw augmented with bone cement can significantly enhance the initial fixation stability of trochanteric fractures in osteoporotic femurs.
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Clinical Trial
Treatment of complex acetabular fractures through a modified extended iliofemoral approach.
To assess the rate of anatomic reconstructions as well as approach-related morbidity and complications in the treatment of complex acetabular fractures through a modified extended iliofemoral approach. ⋯ The modified extended iliofemoral approach proved to be appropriate to achieve anatomic reduction in complex acetabular fractures. The high rate of approach-related morbidity has to be considered carefully and may lead to a decreased incidence of extended approaches.
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Comparative Study
Second generation intramedullary nailing of subtrochanteric femur fractures: a biomechanical study of fracture site motion.
To compare fracture site motion between different second-generation intramedullary nails used to fix subtrochanteric fractures of the proximal femur with and without femoral neck fractures. ⋯ For simple, well-reduced fractures the choice of implant is not critical. As fracture severity increased (comminution, gap, and combined neck fracture), the choice of implant, particularly with reference to proximal nail dimensions and implant materials, was a significant factor in reducing fracture site motion. Therefore, our laboratory data suggest that when subtrochanteric fractures are unstable (e.g., comminution, segmental bone loss) and early weight bearing is desirable, the choice of implant is critical and should be restricted to implants that allow minimal fracture site motion (Long Gamma and Russell-Taylor).
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To measure the late morbidity of nailed isolated tibial fractures, using both a generic health score and disease-specific scores. To determine the correlation between the two types of outcome measure. ⋯ After tibial nailing, mild deficits registered by Iowa scores are associated with a significant disability and unhappiness as registered by the SF-36. According to the patient-oriented outcomes tool, 31% of late results are "unsatisfactory."
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Review
State of the art review: techniques to avoid pin loosening and infection in external fixation.
The purpose of this manuscript is to review techniques of optimizing the interface between the bone and pin in external fixation to minimize pin loosening and infection. ⋯ Among the different techniques to improve the bone-pin interface in external fixation, coating the pins with hydroxyapatite proved to be the most effective. In a highly loaded animal study, three pin types were compared. Type A remained uncoated, type B was coated with hydroxyapatite, and Type C was coated with titanium. Radiographic rarefaction of the bone pin tract was lower in type B pins. Extraction torque was thirteen times higher in type B pins compared to type A and two times higher compared to type C pins. Extraction torque was significantly lower compared to the corresponding insertion torque in both types A and C. In contrast, in the hydroxyapatite coated pins there was no difference between extraction and insertion torque. At sixty times magnification, bone pin contact of type B and C pins was significantly higher than type A. At 10,000 times magnification direct bone pin contact was found only in type B pins. In a clinical study the pin insertion and extraction torque forces were measured in a study of seventy-six external fixation pins in nineteen patients treated with hemicallotasis for osteoarthritis of the medial side of the knee. The patients were randomized to be treated with either standard tapered pins or tapered pins coated with hydroxyapatite. Extraction torque of the hydroxyapatite coated pins was higher than the standard ones in both cancellous and cortical bone. These studies show that in hydroxyapatite coated pins there is no deterioration of the bone-pin interface strength and there is optimal bone-pin contact. Among the various pin types coated with hydroxyapatite, the best results were obtained with the tapered pins.