Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jun 2009
Review Comparative StudyShaft fractures of the clavicle: current concepts.
Fractures of the clavicle are common and have been typically addressed to nonoperative treatment. Favorable results, which predominantly were achieved in the young and adolescents, were supposed to be usual in midshaft clavicular fractures. However, in the presence of comminution or complete displacement, especially when occurring in females or elderly patients, there is a marked risk of nonunion, malunion, and poor outcome. ⋯ Plate fixation and intramedullary stabilization seem to be equally favored. Though, indications for operative management remain controversial. Further prospective randomized comparative clinical trials are necessary for a well-founded risk-benefit analysis.
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Arch Orthop Trauma Surg · Jun 2009
Stability changes after cryosurgery in long tubular bones in correlation to histological results: an animal trial.
Pathologic bone fractures in cryosurgery of bone tumors have been described in literature. This study utilizing a sheep model should prove the possible reduction of potential fracture while using a new miniature cryoprobe minimizing tissue damage and providing accurate control of the ablation process. Furthermore, postoperative histological changes should be investigated and the results correlated with the stability trials. ⋯ A thorough control of the freezing process and the low iatrogenous weakening of the bone due to placing the probe when modern miniature cryoprobes are used can minimize the risk of pathological postoperative fractures. However, at least 2 months after operation there is histological proof of bone healing with appropriate reduction of bone stability, which should be considered for the clinical application of this new technique.
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Arch Orthop Trauma Surg · Jun 2009
Comparative StudyHigh revision rate after treatment of femoral neck fractures with an optionally (un)cemented stem.
The advantages of uncemented and cemented components in hip arthroplasty have been subject of debate. We have studied on a hemiprosthesis, which can be optionally implanted with or without cement. Since the stem geometry and surface in cemented arthroplasty differs from the uncemented one and cannot be fused into one general design, we hypothesised that this hemiprosthesis used without cement has a considerable high revision rate, based on aseptic loosening. ⋯ Because of the rather high revision rate, the authors advice not to use this hemiprosthesis without cement.
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Arch Orthop Trauma Surg · Jun 2009
Anterior knee pain following the lateral parapatellar approach for tibial nailing.
Anterior knee pain after intramedullary nailing of tibial shaft fractures is a common clinical problem, with various etiologies. We have used a lateral parapatellar approach with atraumatic elevation of the infrapatellar fat pad to expose the starting point. Our hypothesis was that this approach leads to a low incidence of knee pain. ⋯ The modified lateral parapatellar approach with careful dissection of the fat pad may significantly reduce anterior knee pain after intramedullary nailing of the tibial shaft.
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Arch Orthop Trauma Surg · Jun 2009
Closing lateral wedge valgus osteotomy with dynamic hip screw for the treatment of varus nonunion of pertrochanteric fracture: can restoration of biomechanics and stabilization alone heal?
Nonunion of pertrochanteric fracture is rare and its occurrence especially without prior surgical intervention has been hardly ever reported. Hence there is not much literature describing the best way to treat them. Nonunion of pertrochanteric fracture collapses in to varus by virtue of deforming action of muscles and thus deranging the biomechanics of the hip and indirectly preventing fracture union further. Hence it is very important to re-orient the abductor lever arm to biomechanically advantageous normal configuration favoring fracture healing. In general, principles of treatment of nonunion like open reduction of the fracture with freshening of fracture fragments, stabilization and bone grafting are very difficult to the surgeon and the patient. ⋯ All fractures and osteotomies had healed uneventfully at the last follow-up with good functional outcome. Harris Hip score had improved from 34 +/- 6 (range 22-47) to 89 +/- 4 (range 83-95) at an average of 11 months (range 7-13 months) follow-up. Valgus osteotomy converts shear forces across the fracture site into compressive forces thus achieving union.