Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jun 2011
Comparative StudyBiomechanical analysis of bicortical versus unicortical locked plating of mid-clavicular fractures.
Operative fixation of displaced mid-shaft clavicle fractures has been shown to improve the functional outcomes and decrease the likelihood of non-union; however, little is known about the need for locking screws versus traditional screws. We, therefore, evaluated the strength of unicortical locked plating versus traditional bicortical non-locking fixation methods. ⋯ Unicortical fixation using pre-contoured plates and locking screws has a similar biomechanical profile compared to gold standard non-locked bicortical screws in cyclic axial compression and axial load to failure. Non-locking constructs were stiffer under rotational testing. This technique may provide a suitable biomechanical environment for bony healing. This may also improve the safety of clavicle plating by protecting infraclavicular structures from injury during drilling or screw penetration as it obviates the need for bicortical fixation.
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Arch Orthop Trauma Surg · Jun 2011
How to evaluate the quality of fracture reduction and fixation of the wrist and ankle in clinical practice: a Delphi consensus.
A Delphi study was conducted to obtain consensus on the most important criteria for the radiological evaluation of the reduction and fixation of the wrist and ankle. The Delphi study consisted of a bipartite online questionnaire, focusing on the interpretation of radiographs and CT scans of the wrist and the ankle. Questions addressed imaging techniques, aspects of the anatomy and fracture reduction and fixation. Agreement was expressed as the percentage of respondents with similar answers. Consensus was defined as an agreement of at least 90%. ⋯ In three Delphi rounds, respectively, 64, 74 and 62 specialists, consisting of radiologists, trauma and orthopaedic surgeons from the Netherlands responded. After three Delphi rounds, consensus was reached for three out of 14 (21%) imaging techniques proposed, 11 out of the 13 (85%) anatomical aspects and 13 of the 22 (59%) items for the fracture reduction and fixation. This Delphi consensus differs from existing scoring protocols in terms of the greater number of anatomical aspects and aspects of fracture fixation requiring evaluation and is more suitable in clinical practice due to a lower emphasis on measurements.
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Arch Orthop Trauma Surg · Jun 2011
Pedicle subtraction osteotomy for rigid kyphosis of the dorsolumbar spine.
Pedicle subtraction osteotomy is one of the well established and popular techniques for kyphosis correction. 52 patients with dorsolumbar kyphosis followed up for a minimum period of 2 years after pedicle subtraction osteotomy were assessed prospectively for clinico-radiological and functional outcomes. Unacceptable cosmesis and severe back pain were the chief complaints preoperatively. ⋯ A greater degree of kyphosis correction (>40°) can be obtained with a single pedicle subtraction osteotomy at the dorsolumbar level with minimal neurological complications.
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Arch Orthop Trauma Surg · Jun 2011
Percutaneous iliosacral screw fixation in S1 and S2 for posterior pelvic ring injuries: technique and perioperative complications.
Percutaneous iliosacral screw placement allows for minimally invasive fixation of posterior pelvic ring instabilities. The objective of this study was to describe the technique for screws in S1 and S2 using conventional C-arm and to evaluate perioperative complications. ⋯ Percutaneous iliosacral screw fixation is a rapid and definitive treatment for posterior pelvic ring injuries with a low risk of secondary bleeding during posterior pelvic stabilization. The technique using standard C-arm fluoroscopy was also found to be safe for screws placed in S2.
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Arch Orthop Trauma Surg · Jun 2011
Femoral malrotation following intramedullary nailing in bilateral femoral shaft fractures.
This study was designed to evaluate the incidence of femoral malrotation in bilateral femoral shaft fractures. ⋯ Bilateral femoral shaft fractures are associated with a high incidence of clinically relevant femoral malrotation over 15°. Measurement of intraoperative femoral antetorsion in bilateral femoral shaft fractures is quite difficult and currently only feasible postoperatively.