Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Dec 2024
Randomized Controlled TrialEfficacy of preemptive multimodal analgesia initiated at various time points before total knee arthroplasty: a prospective, double-blind randomized controlled trial.
Preemptive multimodal analgesia (PMA) is commonly employed for pain control after total knee arthroplasty (TKA). However, the optimal timing for initiating PMA remains unclear. This study aimed to compare the efficacy of PMA administered at different time points before TKA. ⋯ In comparison with PMA starting at 1 h preoperatively, initiating PMA at 24 and 48 h preoperatively provided better postoperative pain relief. Considering the aim of minimizing the amount of ineffective medication received by patients, initiating PMA at 24 h preoperatively may be a more favorable option for patients undergoing TKA. However, the clinical significance of our results and the optimal starting time for PMA require further investigation.
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Arch Orthop Trauma Surg · Dec 2024
ReviewDo we need standardized postoperative radiographs after locking plate fixation of distal radius fractures - A retrospective analysis of 664 patients.
After surgical treatment of fractures of the distal radius, radiographs in 2 planes are routinely performed postoperatively as a standard procedure to verify anatomic reduction and implant positioning. However, the postoperative radiological examinations rarely has a consequence. Therefore, the purpose of this study was to evaluate the frequency of treatment plan changes based on standardized postoperative radiographs. Secondarily, abnormalities, already being present in the intraoperative radiographs, were examined. ⋯ Considering the low incidence of treatment plan changes, routinely performed radiographs after surgical treatment of distal radius fractures must be critically questioned.
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As the number of primary total hip arthroplasty (THA) procedures continues to increase, so too does the demand for revision surgery, with a 43-70% rise in revision THA anticipated by 2030. Femoral stem extraction in revision THA is particularly challenging and may lead to complications like femoral bone loss or fractures. However, increasing catalogue of femoral stems available for primary and revision THA has led technological advances in extraction devices to potentially overcome these limitations. This review aims to discuss the identification of femoral implants and the various femoral stem extraction devices currently available. ⋯ Efficient femoral stem extraction in rTHA is essential for managing complications and preserving bone stock. While traditional tools remain valuable, the development of specialized extraction systems offers improved precision and efficiency. Preoperative planning, including accurate implant identification, and the selection of appropriate extraction devices are crucial for successful outcomes in revision hip arthroplasty.
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Arch Orthop Trauma Surg · Dec 2024
ReviewIndications and outcomes of the Coonrad-Morrey total elbow arthroplasty: a systematic review.
The Coonrad-Morrey prosthesis (CMP) is a widely applied semi-constrained implant that effectively counteracts compression and thrust on the hinge. The aim of this systematic review was to evaluate the indications and outcomes of CMP across different aetiologies for which it was implanted. ⋯ CMP showed favourable medium- to long-term clinical outcomes for patients with RA and FR, especially when osteosynthesis is not deemed feasible in elderly patients with low joint workload. Although CMP offered restored range of motion and functional improvements, the implant's low overall survival rate and high complication rate require careful consideration, especially in assessing individual patient factors which are then necessary to determine the suitability of CMP as a therapeutic option.
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Impactions of the articular surface are relevant prognostic parameters in the treatment of acetabular fractures. Posterior marginal impactions and acetabular dome impactions may occur depending on the direction of the force vectors during trauma. Posterior marginal impactions are mainly observed in posterior fracture dislocations, while acetabular dome impactions are frequently seen in the elderly with the hip joint in extension during trauma. ⋯ Acetabular dome impactions may be reduced using the fracture lines or by creating a cortical window. Reduction is followed by filling the void with bone or bone substitutes supported by raft screws. No clear treatment recommendations for femoral head impactions are given in the literature.