Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Aug 2023
The role of an augmentative plating in the management of femoral subtrochanteric nonunion.
Owing to its distinct biomechanical properties, nonunion is common (7-20%) after intramedullary (IM) nailing of subtrochanteric femoral fractures. Unlike diaphyseal nonunion, it is difficult to provide sufficient stability by exchanging nailing alone in subtrochanteric nonunion. This study investigated the clinical outcomes of femoral subtrochanteric nonunion initially treated with an IM nail and subsequently managed with minimally invasive augmentative plate fixation. ⋯ Additional plate augmentation over a retained IM nail yields satisfactory outcomes in terms of the bony union in subtrochanteric nonunion. Given its expected biomechanical superiority and relatively easy surgical technique, it may be a reasonable option for the management of femoral subtrochanteric nonunion.
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Arch Orthop Trauma Surg · Aug 2023
Streamlining orthopaedic trauma surgical care: do all patients need medical clearance?
Preoperative medical optimization is necessary for safe and efficient care of the orthopaedic trauma patient. To improve care quality and value, a preoperative matrix was created to more appropriately utilize subspecialty consultation and avoid unnecessary consults, testing, and operating room delays. Our study compares surgical variables before and after implementation of the matrix to assess its utility. ⋯ Use of an orthopaedic surgical matrix to predict preoperative subspecialty consultation is easy to implement and allows for better care utilization without a corresponding increase in complications and readmissions. Follow-up studies are needed to reassess the relationships between matrix use and a potential decrease in ER to OR time, and validate its use.
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Arch Orthop Trauma Surg · Aug 2023
Dual plate has better biomechanical stability than hook plate or superior single plate for the fixation of unstable distal clavicle fractures: a finite element analysis.
A variety of surgical techniques have been addressed for distal clavicle fractures, while none of these is considered to be gold standard fixation. Currently, dual plate fixation has been proposed and achieved satisfying clinical results. However, the biomechanical study about dual plate technique in treating unstable distal clavicle fractures is limited. Thus, the purpose of this study was to investigate the biomechanical properties of this technique by finite element analysis. ⋯ Dual plate fixation has better biomechanical stability with lower risk of implant failure. Thus, dual plate fixation is an alternative technique for unstable distal clavicle fracture. The complication of peri-implant fracture of dual plate technique should also be cautious in clinical practice, and more clinical evidence is needed.
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Arch Orthop Trauma Surg · Aug 2023
Avascular necrosis of the femoral head: three-dimensional measurement of drilling precision reveals high accuracy and no difference between fluoroscopically controlled core decompression and cancellous bone grafting.
Avascular osteonecrosis of the femoral head (AVN) is a widespread disease affecting mostly young and active people, often exacerbating in progressive stages, ending in joint replacement. The most common joint preserving operative therapy for early stages is core decompression (CD), optional with cancellous bone grafting (CBG). For success it is vital that the necrotic area is hit and the sclerotic rim is broken by drilling into the defect zone to relieve intraosseous pressure. The aim of this study was to investigate if both techniques are precise enough to hit the center of the necrosis and if there is a difference in precision between drilling with small pins (CD) and the trephine (CBG). ⋯ Concerning the most important difference between the two procedures-the surgical higher demanding technique of CBG-we suggest applying the less invasive technique of CD alone.
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Arch Orthop Trauma Surg · Aug 2023
Titanium niobium nitride knee implants are not inferior to chrome cobalt components for primary total knee arthroplasty at medium-term follow-up.
Oxidized zirconium (Oxinium), titanium nitride (TiN) or titanium niobium nitride (TiNbN) coated implants became in recent years available for an increasing amount of total knee arthroplasty (TKA) systems. The hypothesis of this study was that the use of TiNbN-coated components would not lead to inferior results compared to conventional implants and that none of the metal hypersensitivity patients receiving TiNbN-coated implants would require revision for metal allergy. ⋯ The use of titanium niobium nitride coated implants for primary knee osteoarthritis in self-reported metal hypersensitivity patients shows similar outcomes and survivorship rates as conventional chrome cobalt TKA, with no revisions for allergy at medium-term follow-up.