Archives of orthopaedic and trauma surgery
-
Arch Orthop Trauma Surg · Jan 1999
Outcome after palliative posterior surgery for metastatic disease of the spine--evaluation of 106 consecutive patients after decompression and stabilisation with the Cotrel-Dubousset instrumentation.
From 1987 to 1996, 106 consecutive patients with metastatic disease of the spine who underwent palliative decompression from a dorsal approach and subsequent stabilisation with Cotrel-Dubousset instrumentation (CDI) were followed prospectively, and independent of the surgeons. Parameters evaluated were neurological function, perioperative complications, survival and rehabilitation. Following the Frankel system for the assessment of neurological disorder, 33 patients had a major deficit (grade A, B or C), 23 a minor deficit (grade D) and 50 no deficit. ⋯ Overall survival time was 19.2 months, with 5 patients still alive. Six patients required re-operation for tumour recurrence at the same or at a new level. The results of this study show that neurological function, pain level and mobility can be enhanced by decompression and stabilisation through a posterior approach.
-
Arch Orthop Trauma Surg · Jan 1999
Randomized Controlled Trial Comparative Study Clinical TrialProspective randomized comparison of gliding nail and gamma nail in the therapy of trochanteric fractures.
In a prospective randomized study, we compared the new intramedullary implant of the gliding nail to the gamma nail in the fixation of 80 unstable trochanteric fractures in elderly patients. The preconditions of both groups were comparable. ⋯ Also, the anatomic reconstruction and the long-term function according to the Merle d'Aubigne score were comparable. Regarding postoperative complications, the gliding nail showed a minor tendency of cutting out; this we attribute to the special design of the dynamic blade and regard it as the most favourable advantage of this new implant.
-
Arch Orthop Trauma Surg · Jan 1999
Clinical TrialNo effective prophylaxis of heterotopic ossification with short-term ibuprofen.
Ninety-five patients underwent primary total hip arthroplasty and routinely received ibuprofen for 5 days as prophylaxis for heterotopic ossification. This group was compared with a group of 99 patients who received indomethacin for 7 days as prophylaxis. ⋯ The widespread ossification, Brooker grades III and IV, was prevented better by indomethacin than by ibuprofen. We conclude that ibuprofen for 5 days is not effective as prophylaxis for heterotopic ossification after primary total hip arthroplasty.
-
Arch Orthop Trauma Surg · Jan 1999
Randomized Controlled Trial Clinical TrialDeep vein thrombosis in elderly Hong Kong Chinese with hip fractures detected with compression ultrasound and Doppler imaging: incidence and effect of low molecular weight heparin.
Seventy-eight patients of average age 78 years suffering from an unilateral non-pathological hip fracture underwent compression ultrasound and pulsed and colour Doppler examination of both legs. Twenty-three patients were randomly placed on low molecular weight heparin (LMWH). Twenty-nine (37%) suffered deep venous thrombosis (DVT). ⋯ There was no statistically significant difference in overall incidence of DVT between patients on prophylactic heparin and the control group. Patients on prophylactic heparin had no thigh DVTs in comparison to the control group. LMWH may thus be effective in preventing thigh DVTs and pulmonary emboli.
-
Arch Orthop Trauma Surg · Jan 1999
Comparative StudyEarly complications of surgically managed ankle fractures related to the AO classification.A review of 118 ankle fractures treated with open reduction and internal fixation.
The charts of 118 consecutive ankle fractures were reviewed. The patients' age, sex, energy of trauma, hospital stay, need for traction therapy, syndesmosis fixation and soft-tissue problems were related to the various types of fractures according to the AO classification. An interobserver check study revealed an agreement of 0.61 (kappa), which is considered good. ⋯ The energy of trauma was not related to perioperative problems. The period of hospitalisation was significantly longer in the patients with B2/B3 type fractures (P < 0.001). Judging by the significantly higher incidence of perioperative complications, longer hospital stay, and predominance of instability and skin damage in the AO B2 and B3 type fractures, these fractures may benefit from more attentive and urgent care.