Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Mar 2020
Intramedullary nailing of abnormally bowed atypical femoral shaft fractures: surgical technique.
The treatment of atypical femoral shaft fractures with abnormal bowing provides a unique challenge for surgeons. Whilst intramedullary fixation of atypical femoral shaft fractures affords both mechanical and biological benefits, the mismatch between standard intramedullary devices and the abnormal femoral bowing in these patients makes this method of fixation challenging for the surgeon. ⋯ The critical factors we identified include lateral positioning of the patient for reduction, the use of a piriformis-start nail, and an entry point that was anterior in the sagittal profile and lateral in the coronal profile. This technique was easily replicable, facilitated more anatomical reduction and aided in avoiding complications.
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Arch Orthop Trauma Surg · Mar 2020
Inducing life-like distal radius fractures in human cadaveric specimens: a tool for enhanced surgical training.
Surgical education consists often times of a discrepancy between necessary amount of provided operative teaching and amount of organizational and ward duties. Operative education is often cut to a minimum. As public awareness toward surgical competence raises, so must the educational system. Courses that provide pre-fractured cadaveric specimens can facilitate surgical teaching realistically, prior to operating on living patients. The aim of this study is to introduce a realistic distal radius fracture simulation setup. ⋯ A high energetic impulse induced by a custom-made drop-test bench can successfully simulate realistic distal radius fractures in cadaveric specimens with intact soft tissue. Furthermore, these pre-fractured specimens can be utilized in surgical education to provide a teaching experience as realistic as possible without harming living patients.
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Arch Orthop Trauma Surg · Mar 2020
Total hip arthroplasty without subtrochanteric femoral osteotomy is possible in patients with Crowe III/IV developmental dysplasia: total hip arthroplasty without femoral osteotomy.
We aimed to present our THA technique without femoral shortening osteotomy that we perform for the treatment of coxarthrosis on Crowe type III/IV developmental dysplasia of the hip and to present the early clinical outcomes of our patients. ⋯ Total hip arthroplasty without femoral osteotomy can be considered as a successful method in selected patients with Crowe III/IV coxarthrosis. It provides good clinical outcomes in the early period, reduces surgery duration, has acceptable complication rates, has high prosthesis survival rates.
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Arch Orthop Trauma Surg · Mar 2020
Direct anterior decompression of L4 and L5 nerve root in sacral fractures using the pararectus approach: a technical note.
To describe a new surgical technique for neurolysis and decompression of L4 and L5 nerve root entrapment after vertical sacral fractures via the pararectus approach for acetabular fractures, and to present four case examples. ⋯ The pararectus approach allows for sufficient visualisation and direct decompression and neurolysis of the L4 and L5 nerve root entrapped in vertical sacral fractures. Although neurologic recovery was not achieved in all patients in this small case series, the approach may be a suitable alternative to posterior approaches and other anterior approaches such as the lateral window of the ilioinguinal approach.
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Arch Orthop Trauma Surg · Mar 2020
Observational StudyLow acceptance of osteoanabolic therapy with parathyroid hormone in patients with fragility fracture of the pelvis in routine clinical practice: a retrospective observational cohort study.
A recent randomized controlled trial has reported full patient compliance and no adverse events from therapy with parathyroid hormone (PTH) for osteoporosis and accelerated healing of fragility fractures of the pelvis. The purpose of the presented study was to evaluate if similar results can be achieved with comprehensive PTH therapy in routine clinical practice. We hypothesised that patients' burden of PTH therapy is underestimated in the literature. ⋯ The experiences with PTH therapy in FFP patients with respect to, implementation rate, frequency of side effects and of pathological findings in laboratory controls as reported from a previous RCT could not be reproduced in routine clinical practice.