Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jul 2009
A novel model to study metaphyseal bone healing under defined biomechanical conditions.
Experimental studies on metaphyseal fractures are rare and do not control the biomechanical conditions in the healing zone. This study aimed to develop an improved experimental model, which characterizes and controls the biomechanical condition in the fracture gap of a metaphyseal fracture. ⋯ This metaphyseal bone-healing model provides defined and adjustable biomechanical conditions. The histological images demonstrated intramembranous and endochondral bone healing in the osteotomy gap without callus formation. The model therefore seems appropriate to study metaphyseal bone healing under differing mechanical conditions.
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Arch Orthop Trauma Surg · Jul 2009
Surgical treatment for local control of extremity and trunk desmoid tumors.
Surgical treatment has been the mainstay for extremity and trunk desmoid tumors with a negative surgical margin. However, even when resection with a wide surgical margin is achieved, the local recurrence rate remains high. The purpose of this study was to analyze the clinical outcome of patients with extremity and trunk desmoid tumors after surgical treatment and to determine the factors influencing local recurrence. ⋯ These results suggest that radical surgical treatment causing severe functional impairment should be avoided in selected cases on the basis of patient characteristics, and that other novel therapeutic tools may be necessary for patients in whom a higher risk of local recurrence is assumed or severe complications after surgical treatment are predicted.
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Arch Orthop Trauma Surg · Jun 2009
Review Comparative StudyShaft fractures of the clavicle: current concepts.
Fractures of the clavicle are common and have been typically addressed to nonoperative treatment. Favorable results, which predominantly were achieved in the young and adolescents, were supposed to be usual in midshaft clavicular fractures. However, in the presence of comminution or complete displacement, especially when occurring in females or elderly patients, there is a marked risk of nonunion, malunion, and poor outcome. ⋯ Plate fixation and intramedullary stabilization seem to be equally favored. Though, indications for operative management remain controversial. Further prospective randomized comparative clinical trials are necessary for a well-founded risk-benefit analysis.
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Arch Orthop Trauma Surg · Jun 2009
Comparative StudyHigh revision rate after treatment of femoral neck fractures with an optionally (un)cemented stem.
The advantages of uncemented and cemented components in hip arthroplasty have been subject of debate. We have studied on a hemiprosthesis, which can be optionally implanted with or without cement. Since the stem geometry and surface in cemented arthroplasty differs from the uncemented one and cannot be fused into one general design, we hypothesised that this hemiprosthesis used without cement has a considerable high revision rate, based on aseptic loosening. ⋯ Because of the rather high revision rate, the authors advice not to use this hemiprosthesis without cement.
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Arch Orthop Trauma Surg · Jun 2009
Anterior knee pain following the lateral parapatellar approach for tibial nailing.
Anterior knee pain after intramedullary nailing of tibial shaft fractures is a common clinical problem, with various etiologies. We have used a lateral parapatellar approach with atraumatic elevation of the infrapatellar fat pad to expose the starting point. Our hypothesis was that this approach leads to a low incidence of knee pain. ⋯ The modified lateral parapatellar approach with careful dissection of the fat pad may significantly reduce anterior knee pain after intramedullary nailing of the tibial shaft.