Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Sep 2014
Randomized Controlled TrialUni- and bipolar hemiarthroplasty with a modern cemented femoral component provides elderly patients with displaced femoral neck fractures with equal functional outcome and survivorship at medium-term follow-up.
The choice between unipolar and bipolar hemiarthroplasty for treatment of displaced intracapsular femoral neck fractures in elderly patients still remains controversial. Our objective was to compare series of elderly individuals with a displaced femoral neck fracture treated with either a cemented, modular unipolar or bipolar prosthesis with the same femoral component. ⋯ Unipolar hemiarthroplasty group had a significantly higher dislocation rate when compared with bipolar hemiarthroplasty group. However, both provide elderly patients with equal ambulatory ability and low revision rate at medium-term follow-up.
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Arch Orthop Trauma Surg · Sep 2014
Comparative StudySubchondral insufficiency fracture of the femoral head in males.
Subchondral insufficiency fracture of the femoral head (SIF) has been reported to be observed mainly in the elderly osteoporotic females and most of the studies on SIF have been made based on female patients. The purpose of this study is to document the clinical characteristics of SIF observed in male patients. ⋯ SIF in male is observed mainly in their 40s, and their prognosis seems to be good as compared to that in females.
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Arch Orthop Trauma Surg · Sep 2014
Clinical TrialOrthogeriatric care pathway: a prospective survey of impact on length of stay, mortality and institutionalisation.
Care pathways for elderly hip fracture patients are increasingly implemented but there has been only limited evaluation of their use. Our objective was to investigate the impact of such a care pathway on the use of healthcare resources and on patients' outcomes. ⋯ A care pathway for elderly hip fracture patients allowed decreased LoS without affecting mortality or change of residential status 1 year after fracture compared to prefracture baseline.
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Arch Orthop Trauma Surg · Sep 2014
Comparative StudyAcromioclavicular joint dislocations: radiological correlation between Rockwood classification system and injury patterns in human cadaver species.
The classification system of Rockwood and Young is a commonly used classification for acromioclavicular joint separations subdividing types I-VI. This classification hypothesizes specific lesions to anatomical structures (acromioclavicular and coracoclavicular ligaments, capsule, attached muscles) leading to the injury. In recent literature, our understanding for anatomical correlates leading to the radiological-based Rockwood classification is questioned. The goal of this experimental-based investigation was to approve the correlation between the anatomical injury pattern and the Rockwood classification. ⋯ Trauma with intact coracoclavicular ligaments did not result in acromioclavicular joint lesions higher than Rockwood type I and II. The clinical consequence for reconstruction of low-grade injuries might be a solely surgical approach for the acromioclavicular ligaments or conservative treatment. High-grade injuries were always based on additional structural damage to the coracoclavicular ligaments. Rockwood type V lesions occurred while muscle attachments were intact.
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Arch Orthop Trauma Surg · Sep 2014
High complication rate after total knee and hip replacement due to perioperative bridging of anticoagulant therapy based on the 2012 ACCP guideline.
An increasing amount of patients receiving total joint replacement require bridging of long-term anticoagulants. Guidelines, aimed at preventing complications, focus on thromboembolic events but not on bleeding complications. In this retrospective observational study, bleeding and thromboemoblic (TE) complications were evaluated in patients requiring perioperative heparin bridging of antithrombotic therapy during primary unilateral total hip or knee arthroplasty (THA and TKA). ⋯ This study shows an alarmingly high complication rate in patients receiving LMWH bridging during elective TKA or THA surgery. All complications seem to be caused by, or secondary to bleeding. Patients need to be consulted about the risk of bleeding complications, and the risk of bleeding needs to be balanced over the risk of TE complications.