Acta Orthop Belg
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Revision of the unstable stem of a total hip replacement following a peri-prosthetic fracture of the femur is a complex procedure with a high complication rate. With this study we aim to describe the radiologic findings of a specific fracture around polished tapered cemented stems and we present the results of a two- stage treatment plan for non-displaced Vancouver type B2 fractures. Eight male patients with a cemented polished, tapered stem presented after a fall. ⋯ Normal radiographs of a post-traumatic and painful polished tapered stem do not exclude a Vancouver type B2 fracture and should be followed by a CT-scan. Cement cracks, eccentric gaps and subsidence are highly suspicious signs for a non-displaced fracture pattern. Conservative treatment remains an option for these fractures and can be followed by a cement- in-cement stem revision after fracture healing, if this is still required.
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Comparative Study
Biomechanical and clinical comparison of single lateral plate and double plating of comminuted supracondylar femoral fractures.
This study was to compare the relative strength of fixation and clinical outcomes of single lateral plate and double plating of comminuted supracondylar femoral fractures. Eight matched pairs of embalmed cadaveric femurs were selected. A gap osteotomy was created to stimulate an AO/OTA A3 comminuted distal femoral fracture. ⋯ However, there was no significant difference between the SPG and the DPG in terms of blood loss, time to union, complication rate, VAS, ROM and Neer knee score. Double plating proved stronger than single lateral plate in biomechanical testing; however, double plating was not superior to traditional lateral plating in clinical outcomes. Therefore, we do not recommend double plating as a routine fixation of comminuted supracondylar femoral fractures.
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Comparative Study
A comparison of the InterTan nail and proximal femoral fail antirotation in the treatment of reverse intertrochanteric femoral fractures.
The aim of this study was to compare the clinical and radiological results of InterTan nail and proximal femoral nail antirotation (PFNA) in the treatment of reverse intertrochanteric fractures (AO/OTA 31-A3). The study included a total of consecutive patients who presented at trauma centre with a reverse intertrochanteric fracture between in the last 7 years. Treatment was applied with PFNA in 33 patients and with InterTan nail in 36. ⋯ Cut-out was observed in 4 cases of the PFNA group and in none of the InterTan group. No statistically significant difference was determined between the groups in respect of time to union and functional scores (p = 0.573 and p = 0.294). The use of InterTan nailing in the fixation of reverse intertrochanteric fractures provided better clinical and radiological results compared to PFNA in terms of less telescoping, less change in the neck shaft angle and lower complication rates.
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Case Reports
Diagnostic pitfalls in the differentiation between pyoderma gangrenosum and necrotizing fasciitis.
Pyoderma gangrenosum and necrotizing fasciitis are two rare pathologic entities with a similar clinical image, but a who require a very different management. In general physicians, orthopedics, dermatologists, plastic surgeons will hardly ever see it, but when they do it is very important to distinguish between both. In this paper with the focus on the practical approach ,we expose the diagnostic pitfalls in the differential diagnosis, explain how to prevent them and summarize the evidence on therapeutic management. To achieve this we use a case where the diagnosis was rather difficult and utilize reviews where the clinical features, early diagnostic tools and treatment options are explained.
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The infected non union of the long bones in the presence of the intramedullary nail is a dreaded complication of fracture management. Around 7% patients may develop an infected non union of the long bones in intramedullary nailing. Amongst the various grades of infection, grade three infection is the most difficult to cure and manage as it involves an osteomyelitic bone. ⋯ We used an Ilizarov threaded rod coated with antibiotic impregnated cement to replace the intramedullary nail with the idea of delivering higher concentration of antibiotic locally as well as provide stability. We achieved a union rate of 91% in a relatively small number of patients with this single procedure. The antibiotic impregnated cement coated Ilizarov rod that we used in our study achieves both infection control and union simultaneously and does not allow cement debonding at removal.