Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Mar 2004
Review Meta AnalysisThe reliability of clinical examination in detecting pelvic fractures in blunt trauma patients: a meta-analysis.
Several studies have recently questioned whether routine radiographic screening for pelvic fractures is necessary in the initial evaluation of blunt trauma patients. Therefore, we assessed how sensitive and specific the clinical examination is in detecting fractures of the pelvis. ⋯ In stable and alert trauma patients, a thorough clinical examination will detect pelvic fractures with nearly 100% sensitivity, thus rendering initial radiography unnecessary in this group of patients.
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Arch Orthop Trauma Surg · Mar 2004
Comparative StudyDifference in metallic wear distribution released from commercially pure titanium compared with stainless steel plates.
Stainless steel and commercially pure titanium are widely used materials in orthopedic implants. However, it is still being controversially discussed whether there are significant differences in tissue reaction and metallic release, which should result in a recommendation for preferred use in clinical practice. ⋯ We conclude from the increased release of toxic, allergic, and potentially carcinogenic ions adjacent to stainless steel that commercially pure Ti should be treated as the preferred material for osteosyntheses if a removal of the implant is not intended. However, neither material provoked a foreign-body reaction in the local tissues, thus cpTi cannot be recommend as the 'golden standard' for osteosynthesis material in general.
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Arch Orthop Trauma Surg · Mar 2004
New concepts in the treatment of ankle joint fractures. The IP-XS (XSL) and IP-XXS (XXSL) nail in the treatment of ankle joint fractures.
The most important factor in the treatment of ankle joint fractures is stable anatomical reconstruction of the syndesmosis and joint surface. In the course of this, attention must be paid to soft-tissue damage with the risk of deep infections. Early functional therapy and exercise tolerance must be called for. The choice of surgical access route, in particular in the case of critical arterial circulation, and the possible irritation of the soft tissue by the osteosynthesis material prompted us to seek alternative osteosynthesis techniques. ⋯ The XS nail which is introduced here fulfils the requirements made of an implant as regards maximum protection of soft tissue, secure fracture fixation and early exercise tolerance, including ankle fractures. No implant dislocation, no deep infection and no re-osteosynthesis were observed. Its advantages over conventional techniques lie precisely in the treatment of complex fractures and for patients with poor bone, vascular and soft-tissue situations.
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Infection and exposure of the implant may occur in 1-12% of patients operated on for arthroplasty or osteosynthesis. Variables such as tissue viability, presence of infection, exposure of osteosynthesis material and patient-related factors contribute to the lack of general consensus regarding the management of these defects. ⋯ We conclude that the earlier coverage with vital tissue is obtained, the lower the incidence of infection. Early consultation by a plastic surgeon will increase a positive outcome of treatment of complex tissue defects.