Journal of orthopaedic trauma
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To determine factors associated with angular malalignment of femoral shaft fractures treated with intramedullary nails and to determine differences in the incidence of angular malalignment based on fracture location, fracture comminution, and method of treatment (i.e., antegrade or retrograde). ⋯ Patients with fractures of the proximal third of the femoral shaft treated with intramedullary nails are at highest risk for malalignment. Proximal fracture location, distal fracture location, and unstable fracture pattern are associated with increasing fracture angulation.
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The management of femoral shaft fractures by retrograde intramedullary nailing is becoming more widespread. There have been no reported intraoperative neurovascular injuries to the surrounding anatomy using the retrograde femoral nailing technique. We report a case of injury to a branch of the profunda femoris artery during placement of the anteroposterior proximal locking screw.
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Comparative Study
Outcome after hip fracture in individuals ninety years of age and older.
To assess outcome after hip fracture in patients ninety years of age and older, as compared with a population of the same age and sex in the United States and younger patients with hip fractures. ⋯ The mean patient age was 79.7 years (range 65 to 105 years). Seventy-six (8.9 percent) patients were ninety years of age and older. Patients who were ninety years of age and older had significantly longer mean hospital lengths of stay than younger individuals (p = 0.01). People ninety years of age and older were more likely to die during the hospital stay (p = 0.001) and within one year of surgery (p = 0.001). Patients who were ninety years of age and older were more likely to have a decrease in their basic activities of daily living status (p = 0.03) and ambulation level (p = 0.01). Younger individuals had a higher standard mortality ratio (1.48) than did patients who were ninety years of age and older (1.24). Being ninety years of age and older was not predictive of having a postoperative complication, of being placed in a skilled nursing facility at discharge or at one-year follow-up, or recovering of prefracture independence in instrumental activities of daily living.
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Randomized Controlled Trial Comparative Study Clinical Trial
Prospective randomized study of reamed versus unreamed femoral intramedullary nailing: an assessment of procedures.
To determine whether the procedure of unreamed femoral nailing is simpler, faster, and safer than reamed femoral intramedullary nailing. ⋯ Unreamed femoral intramedullary nailing involves fewer steps and is significantly faster with less intraoperative blood loss than reamed intramedullary nailing. The unreamed technique, however, was associated with a higher incidence of perioperative complications, although the difference was not statistically significant (p = 0.5).
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Two cases of carpal scaphoid fractures associated with distal radius epiphysiolysis are presented. Only three cases of this unlikely combination were found in the English literature. One of the scaphoid fractures had to be confirmed by bone scan. Conservative treatment after gentle reduction of the radius fracture gave excellent results.