Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jun 2017
Randomized Controlled Trial Multicenter StudyRelationship between size of disc and early postoperative outcomes after lumbar discectomy.
Previous studies suggest that patients with larger disc herniations (greater than 6 mm) will have better outcomes following discectomy. This has not been validated in a large series of patients. ⋯ While patients with larger disc herniations on average might have a greater likelihood of superior clinical outcomes, the previously suggested "6 mm rule" was not supported.
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Arch Orthop Trauma Surg · Jun 2017
A modified Matti-Russe technique of grafting scaphoid non-unions.
In treatment of scaphoid non-union bone healing requires beside vital tissue and stability, enduring compression and a good interface between the graft and scaphoid fragments. While fixation techniques show a good primary stability, they reduce sintering and thus compression of fragments in the long term. Therefore, a modified technique optimising the cancellous interface between graft and scaphoid but still providing enough stability without fixating implants should be evaluated. ⋯ The modified technique of Matti-Russe provided a good contact of the cancellous part of the bone graft to the scaphoid in grafting a scaphoid pseudarthrosis with a high healing rate. However, since age, previous failed surgery and a proximal fracture line are the most important handicaps for bone healing in this study, for patients at risk gadolinium-enhanced MRI scan could be helpful to estimate vascularisation preoperatively. In cases of poor vitality, vascularised bone grafting should be considered.
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Arch Orthop Trauma Surg · Jun 2017
Femoral neck fracture osteosynthesis by the biplane double-supported screw fixation method (BDSF) reduces the risk of fixation failure: clinical outcomes in 207 patients.
Osteosynthesis of femoral neck fractures is related up to 46% rate of complications. The novel method of biplane double-supported screw fixation (BDSF; Filipov's method) offers better stability using three medially diverging cannulated screws with two of them buttressed on the calcar. Biomechanically, the most effective component is the distal screw placed at steeper angle and supported on a large area along the distal and posterior cortex of the femoral neck following its spiral anterior curve. Thereby, BDSF achieves the strongest possible distal-posterior cortical support for the fixation construct, which allows for immediate full weight-bearing. The aim of this study was to evaluate the outcomes from the first 5-year period of BDSF clinical application. ⋯ By providing additional cortical support, the novel BDSF method enhances femoral neck fracture fixation strength.
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Arch Orthop Trauma Surg · Jun 2017
ReviewTreatment and outcome with traumatic lesions of the olecranon and prepatellar bursa: a literature review apropos a retrospective analysis including 552 cases.
Traumatic lesions of the olecranon bursa (OB) and prepatellar bursa (PB) are injuries commonly seen in orthopaedic trauma units. These injuries are associated with a high rate of complications. At present, only little is known about the incidence, complication rate, and treatment approaches in patients with acute open bursae. ⋯ Traumatic lesions of the OB and PB are associated with a high risk of complications. Prophylactic antibiotic therapy can potentially reduce the risk of infection and the need for revision surgery.
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Arch Orthop Trauma Surg · Jun 2017
Using an anatomically preshaped low-profile locking plate system leads to reliable results in comminuted radial head fractures.
For comminuted and displaced fractures of the radial head open reduction and internal fixation (ORIF) is recommended nowadays as the treatment of choice. Due to the development of locking plates the possibilities of ORIF in complex fracture types were extended. The purpose of this retrospective survey therefore was to review the preliminary subjective and objective results in patients treated by anatomically preshaped locked plating. A reliable fracture healing for these recently introduced plating devices was hypothesized. ⋯ The treatment of comminuted radial head fractures using anatomically preshaped locking radial head plates represents a reliable and safe surgical approach, leading to good to excellent functional results. Being aware of the importance of the radial head for elbow stability, open reduction and internal fixation should be preferred prior to radial head resection or replacement in complex radial head fractures. Further trials with a higher number of patients are needed to confirm the advantages of preshaped radial head plates.