Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jul 2013
Meta AnalysisDo we really need tranexamic acid in total hip arthroplasty? A meta-analysis of nineteen randomized controlled trials.
Studies have shown that tranexamic acid reduces blood loss and transfusion need in patients undergoing total hip arthroplasty. However, no to date, no study has been large enough to determine definitively whether the drug is safe and effective. We examined whether intravenous tranexamic acid, when compared with placebo, was safe and effective in total hip arthroplasty. ⋯ The data from this meta-analysis indicate that intravenous tranexamic acid may reduce blood loss and transfusion need in patients undergoing total hip arthroplasty without increasing the risk of complications. However, high-quality randomized controlled trials are required to validate the results.
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Arch Orthop Trauma Surg · Jul 2013
Osteitis pubis and adductor tendinopathy in athletes: a novel arthroscopic pubic symphysis curettage and adductor reattachment.
Various surgical treatment options have been described in athletes with degenerative osteitis pubis who fail to respond to conservative treatment modalities. Although adductor longus tendinopathy often represents an additional pain generator in chronic groin pain associated with osteitis pubis, this has not been acknowledged in the surgical literature, to our knowledge. We present the results of a novel surgical technique for combined degenerative lesions of the pubic symphysis joint and the adjacent adductor longus tendon in a series of athletes with osteitis pubis. ⋯ This novel surgical technique combines successfully stability-preserving arthroscopic pubic symphysis curettage with adductor debridement and reattachment in well-selected cases of athletes suffering from degenerative osteitis pubis and concomitant adductor pathology, being refractory to conservative treatment. Diligent preoperative evaluation of the specific pathology will lead to successful outcome.
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Arch Orthop Trauma Surg · Jul 2013
ReviewManagement of acute acromioclavicular joint dislocations: current concepts.
Acromioclavicular joint (ACJ) injuries represent a common injury to the shoulder girdle. In the management algorithm of acute ACJ injuries complete radiological evaluation represents the key to a successful therapy. According to the classification of Rockwood the presence of a horizontal component in addition to vertical instability has to be detected. ⋯ Out from the literature, non-operative treatment of type III injuries results to provide at least equal functional outcomes as compared to surgical treatment associated with less complications and earlier return to professional and sports activities. If surgical treatment is indicated, open surgical procedures using pins, PDS-slings or hook plates are still widely used concurring with recently raising minimally invasive, arthroscopic techniques using new implants designed to remain in situ. Combined coracoclavicular and acromioclavicular repair are gaining in importance to restore horizontal as well as vertical ACJ stability.
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Arch Orthop Trauma Surg · Jul 2013
Case ReportsAtypical forearm fractures associated with long-term use of bisphosphonate.
Recent reports on atypical femoral fracture have raised concerns about the long-term use of bisphosphonate. More recent case series focus specifically on the subtrochanteric fractures. But, there is relatively rarity and unawareness of atypical fracture in upper extremity. ⋯ The other woman had a fracture in the radial shaft. This report suggests atypical fractures associated long-term use of bisphosphonate could occur in bones other than femur. More study is required to identify the magnitude of clinical features of this emerging concern.
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Arch Orthop Trauma Surg · Jul 2013
How bilateral iliolumbar fusion increases the stability of horizontal osteosynthesis in unstable pelvic ring injuries?
In type C pelvic ring injuries, the operative stabilization of the posterior ring is absolutely indicated. There exist four different types of operative methods: iliosacral screw fixation, transsacral plate synthesis, ventral plate fixation (primarily for sacroiliac luxations), and local plate synthesis performed on the dorsal cortex of the sacrum. In our current article, we analyzed the stability of fixation methods used together with bilateral iliolumbar techniques. ⋯ In unilateral pelvis injuries, if a non-weight bearing status cannot be achieved on the injured side, unilateral iliolumbar fusion reinforcement is justified, since the contralateral lower limb must also be non-weight bearing due to the pelvis injury itself. In the case of the most unstable sacrum fracture--"jumper's fracture", bilateral iliolumbar fusion is necessary, in which case the patient will be able to bear weight during the early postoperative period.