The American journal of orthopedics
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Proximal humeral fractures can safely and effectively be treated with minimally-invasive plate osteosynthesis (MIPO). Twenty-one patients treated with MIPO for 2-, 3-, and 4-part proximal humerus fractures were treated at a mean 6.8 days (range, 1-24 days) after injury and followed for a mean of 24 months (range, 5-38 months). All fractures healed by 8 weeks postoperatively, with reductions "good" in 18 (86%) of patients and "fair" in 3 (14%). ⋯ The mean Disability of the Arm, Shoulder, and Hand (DASH) score was 25.95 (range, 0-80). Excluding patients with associated injuries, a statistically significant difference (P<.05) was found in the DASH scores for those patients with greater tuberosity displacements between 3 mm and 8 mm and those patients with greater tuberosity displacement greater than 8 mm inferior to the articular surface. Clinical outcomes depended upon reduction of the greater tuberosity, which is facilitated by the MIPO technique.
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Comparative Study
Comparison of functional outcomes of total elbow arthroplasty vs plate fixation for distal humerus fractures in osteoporotic elbows.
Treating intra-articular fractures about the osteoporotic distal humerus poses a significant challenge. The purpose of this retrospective study was to evaluate functional outcomes for distal humeral fractures treated with total elbow arthroplasty (TEA) or open reduction and internal fixation (ORIF) in a nonarthritic elderly population with osteoporosis. We reviewed the records of all women older than age 60 who had undergone surgical treatment for intraarticular distal humerus fractures (Orthopaedic Trauma Association types 13B and 13C) by 1 of 2 surgeons. ⋯ Many factors come into play in the treatment of intra-articular distal humerus fractures in patients with osteoporosis. Implant selection must be based on bone quality, expected outcome, and surgeon experience. For these injuries, good outcomes may be obtained with either TEA or ORIF.
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Review Case Reports
Total hip arthroplasty in above-knee amputees: a case report.
There are previous case reports in the literature that describe total knee and total hip arthroplasty (THA) in below-knee amputees, but we could find no case reports on above-knee amputees (AKAs) who have severe osteoarthritis of the hip. We present a case involving an AKA who developed severe osteoarthritis of the ipsilateral hip. Out patient underwent THA with a satisfactory postoperative outcome. Technical considerations for AKAs undergoing THA are also reviewed.
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Case Reports
Talar neck fractures treated with closed reduction and percutaneous screw fixation:a case series.
Talus fractures are relatively rare injuries, accounting for approximately 3% of all foot fractures. Fractures of the talar neck account for almost 50% of all talus fractures. Diagnosis and treatment of these fractures play an important role in patients' outcomes. ⋯ Choosing which treatment to perform depends on injury severity, associated injuries, and surgeon experience and preference. In this article, we report on our retrospective review of all talar neck fractures treated with closed reduction and percutaneous fixation between 1996 and 2001 at the Pennsylvania State University Milton S. Hershey Medical Center.
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Quadriceps injuries, ranging from simple strains to disabling muscle ruptures, are common athletic injuries. The rectus femoris is the most commonly injure portion of the quadriceps musculature. ⋯ Several key factors must be considered and carefully assessed when determining the appropriate course of management (ie, deciding between operative and nonoperative treatment): amount of distal retraction of the tendon, severity of associated soft-tissue trauma, physical examination, and postoperative goals (eg, return to elite-level competitive sports involving running or kicking vs resuming basic activities of daily living). We believe that these factors in our elite, high-performance athlete dictated an operative course of management.