Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Dec 2007
Comparative StudyTrochanteric fractures in the elderly: the influence of primary hip arthroplasty on 1-year mortality.
The aim of the study was to compare the mortality risk and complication rate after operative treatment of pertrochanteric fractures with primary arthroplasty, dynamic hip screw (DHS) or proximal femoral nail (PFN). ⋯ For stable fractures a dynamic hip screw (DHS) and for unstable fractures a short proximal femoral nail (PFN) can be recommended. The mortality risk of primary cemented arthroplasty did not differ significantly from the other treatment groups and because of its low complication rate it is a viable treatment option for trochanteric fractures if osteoporosis prevents from full weight bearing or if osteoarthritis makes further operations likely. Primary total hip replacement should be handled with care due to its significantly higher dislocation rate compared with hemiarthroplasty especially in unstable fractures.
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Arch Orthop Trauma Surg · Dec 2007
Angular and sliding stable antegrade nailing (Targon PH) for the treatment of proximal humeral fractures.
The optimal surgical treatment for displaced proximal humeral fractures continues to be controversial. Different treatment modalities are available. Mechanical implant-related problems, however, and the preservation of the biological integrity of the humeral head remain unsolved. New implants providing angular stability are expected to maintain the intraoperative result of reduction until definitive healing. The purpose of this study was to evaluate the functional outcome and the complication rate of an angular and sliding stable antegrade interlocking nail for the treatment of displaced proximal humeral fractures. ⋯ The treatment of displaced proximal humeral fractures with an angular and sliding stable antegrade nail (Targon-PH) led to good functional results, especially in 2- and 3-part fractures. There exists a substantial risk for postoperative complications and bad motor function in Neer IV/4 fractures. Lateral backing out of screws was abolished by implant modifications (PEEK-inlay) from 2003 onwards. Additional tension wire banding of the major tubercle may further reduce the risk of secondary displacement.
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Arch Orthop Trauma Surg · Dec 2007
Use of antibiotic cement rod to treat intramedullary infection after nailing: preliminary study in 19 patients.
The treatment of intramedullary infections after nailing usually includes removal of the nail, debridement, and, in some cases, insertion of antibiotic-impregnated cement beads. We use this self-made antibiotic cement rod to treat intramedullary infections. Compared with the beads, it provides some limited mechanical support and can be preserved in the canal for a long time. ⋯ One patient had nonunion and one patient underwent amputation because of severe primary trauma and long-term infection. The rod was removed between 35 and 123 days after implantation. We conclude that the antibiotic cement rods could be a relatively effective, simple and inexpensive method of treating intramedullary infections after nailing.
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Arch Orthop Trauma Surg · Dec 2007
Intra-articular hip viscosupplementation with synthetic hyaluronic acid for osteoarthritis: efficacy, safety and relation to pre-injection radiographs.
The aim of this study was to determine the efficacy and safety of viscosupplementation with synthetic hyaluronic acid to the hip joint and to determine if there was any relation to pre-injection radiographic changes of osteoarthritis (OA). ⋯ Viscosupplementation performed under fluoroscopic guidance is an effective and safe method of treating hip OA and appears to be more efficacious in those with less radiographic changes of OA.
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Arch Orthop Trauma Surg · Dec 2007
The role of sacroiliac joint dysfunction in the genesis of low back pain: the obvious is not always right.
It is a common practice to the link low back pain with protruding disc even when neurological signs are absent. Because pain caused by sacroiliac joint dysfunction can mimic discogenic or radicular low back pain, we assumed that the diagnosis of sacroiliac joint dysfunction is frequently overlooked. ⋯ Sacroiliac joint dysfunction should be considered strongly in the differential diagnosis of low back pain in this group of patients.