Acta Orthop Belg
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Reliability of observer assessment of thermographic images in complex regional pain syndrome type 1.
This study aimed at evaluating the sensitivity, specificity, reliability and repeatability of observer assessment of thermographic images taken from Complex Regional Pain Syndrome (CRPS) type 1. A computer program was developed to let observers rate the difference between randomly presented thermographic images of pairs of hands of individuals. The sensitivity and specificity, and potential learning effects were measured. ⋯ There was a significant correlation between the colour pallet and the rating (r = 0.76). Although the colour pallet used partly explained the variance in the rating scores, this study shows that observer assessment of thermographic images may distinguish between CRPS1 patients and healthy controls. However, the reliability and repeatability of this assessment was rather low.
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We discuss the appropriate assessment and treatment options available for proximal humeral fractures. Important factors to consider are the fracture pattern, the bone quality and any co-morbidities. These are common injuries and are increasing in incidence due to an ageing population. ⋯ The ideal is anatomic reduction and stable internal fixation of the fractures especially the tuberosities to allow early mobilisation. The recent introduction of fixed angle locking plates allows stable fixation even in markedly osteoporotic bone. The early results are encouraging however there are presently no randomised trials comparing these devices to conservative treatment, conventional plating or hemiarthroplasty.
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Post-traumatic bone defects usually occur from severe high-velocity injuries due to road traffic accidents; they may be difficult to fill. We have managed defects of long bones by the use of free non-vascularised fibular grafts harvested subperiosteally and held by screw fixation of the fibular strut ends to the ends of the bone defect, combined with an external fixator in 8 tibial defects and with a plate and screws in 2 ulnae and 2 humeri. Twelve patients, eleven male and one female, with a mean average age of 25 years (range 12-40), underwent this procedure. ⋯ The defect lengths averaged 7 cm (range from 6 to 10 cm). The long-term follow-up showed complete 'tibialisation' of the fibula. Non-vascularised fibular graft, compared to microvascular reconstruction and Ilizarov techniques, is a simple procedure that is still valid to bridge bone defects successfully in selected cases.
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The Locking Compression Plate (LCP) and the Less Invasive Stabilisation System (LISS) are new implants with angular stability developed by the AO/ASIF. They offer an alternative for internal fixation in complex intra-articular fractures and high-energy diaphyseal fractures of the long bones. The new system was used in a prospective study to treat 113 patients (76 women, 37 men; average age: 53.1 years) with 122 injuries (multifragment shaft fractures or complex intra-articular, delayed/ non-union, malunion) from October 2002. ⋯ We found the new internal fixator system to be a safe and reliable procedure. It offers numerous fixation possibilities and has proven its value in complex fracture situations and in revision operations. A good knowledge of biomechanics is essential as well as precise preoperative planning.
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We describe a modification of the classical Essex-Lopresti manoeuvre for the indirect reduction and stabilisation of displaced intra-articular fractures of the calcaneus. The radiological and functional results achieved using this technique in 15 patients is presented. Ten tongue-shaped and 8 joint depression type fractures were treated by the new method, incorporating the use of an additional traction pin. ⋯ At a mean follow-up of 28 months the joint depression group scored 51/100 on the foot score, and the tongue shaped fracture group 77/100. The mean correction achieved as well as the mean overall functional scores were significantly better in the tongue shaped group. The technique described has much promise in the management of selected displaced intra-articular fractures of the calcaneus (true tongue shaped / Sanders II), and may also have a limited role in other fracture types in patients with significant co-morbidities, soft tissue compromise and poor healing potential.