Journal of orthopaedic trauma
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This study was designed to investigate the specific type and incidence of implant failure in patients with a proximal femur fracture treated with a proximal femoral nail antirotation. This device has a helical-shaped blade as a neck-head holding device, instead of the lag screw used in other intramedullary nails. The advantage of the blade is believed to originate from bone impaction and a larger bone-implant interface in comparison with the lag screw design, with consequential greater mechanical resistance to torsion in the cancellous bone. ⋯ Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Plunging when drilling can be a detrimental factor in patient care. There is, although, a general lack of information regarding the surgeon's performance in this skill. The aim of this study was to determine the effect that using sharp or blunt instruments had on the drill bit's soft tissue penetration, using a simulator. ⋯ Our study showed a significant difference in plunging depth when sharp or bunt drill bit was being used. Surgeons, regardless of their experience level, penetrate over 20 mm in normal bone and over 10 mm in osteoporotic bone.
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Although locked plating has been shown to have advantages for diaphyseal and metaphyseal fracture fixation, its benefits for pubic symphyseal disruption have not been established. With traditional plate fixation of the disrupted pubic symphysis, normal physiological symphyseal pelvic motion eventually results in plate breakage, screw breakage, and loosening of screws. A concern exists that common modes of locked plate construct failure could result in abrupt and complete loss of symphyseal fixation. The purposes of this study were to determine, using an open-book pelvic injury model, whether locked plating of the pubic symphysis 1) offers any advantage over standard unlocked plating; and 2) results in a potential increased risk of abrupt fixation failure. ⋯ No abrupt failures occurred in either plating group. Consequently, any fear of catastrophic (ie, abrupt and complete) failure of locked symphyseal plates appears to be unfounded for open-book injuries treated in patients with low bone density. However, minor loss of the symphyseal reduction was evident in all pelvises regardless of the fixation method. Therefore, locked plating of the pubic symphysis does not appear to offer any advantage over the standard unlocked technique for an AO/Orthopaedic Trauma Association 61-B3.1 partially stable open-book pelvic injury pattern in osteopenic bone.
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Review Meta Analysis Comparative Study
External fixation versus internal fixation for unstable distal radius fractures: a systematic review and meta-analysis of comparative clinical trials.
There is no consensus on the surgical management of unstable distal radius fractures. In this systematic review and meta-analysis, we pool data from trials comparing external fixation and open reduction and internal fixation (ORIF) for this injury. ⋯ Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Case Reports Multicenter Study
Failure of locked design-specific plate fixation of the pubic symphysis: a report of six cases.
Physiological pelvic motion has been known to lead to eventual loosening of screws, screw breakage, and plate breakage in conventional plate fixation of the disrupted pubic symphysis. Locked plating has been shown to have advantages for fracture fixation, especially in osteoporotic bone. Although design-specific locked symphyseal plates are now available, to our knowledge, their clinical use has not been evaluated and there exists a general concern that common modes of failure of the locked plate construct (such as pullout of the entire plate and screws) could result in complete and abrupt loss of fixation. The purpose of this study was to describe fixation failure of this implant in the acute clinical setting. ⋯ Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.