Acta Orthop Belg
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Orthopaedic surgeons frequently have to deal with osteoporotic fractures of the distal radius, hip and proximal humerus. Low bone mineral density is not only associated with an increased fracture risk but also with more fracture displacement and reduction loss. The specific problems and main treatment options for these fragility fractures are reviewed.
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Treatment of rigid and severe spinal deformities is challenging and risky. Preoperative halo-gravity traction can be used to progressively reduce the deformity before spinal fusion. The aim of this study was to evaluate the effectiveness of halo-gravity traction for the correction of severe spinal deformities. ⋯ One patient with a pre-existing neurological deficit developed paraplegia. According to the literature congenital curves with associated kyphosis are exposed to paraplegia. Halo-gravity traction is effective and is usually tolerated better than other techniques of traction using the halo device.
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Severe posttraumatic elbow stiffness represents a significant invalidity. Between 1990 and 2005 two surgeons performed open elbow arthrolysis in 30 adult patients (6 women, 24 men, mean age 30.8 years). All cases resulted from severe initial trauma, which had occurred on average 15.5 months previously. ⋯ However, full restoration of motion is rare; only 18% of the patients regained the functional arcs of motion reported by Morrey, but the majority were satisfied, given their preoperative degree of elbow stiffness. The ultimate result from both the patient's and the surgeon's perspectives is strongly dependent on persisting pain, which was frequent in this series and influenced the DASH, MEPI and the SF-36 scores. Arthrolysis did not address the issue, if pain was the chief complaint.
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The widespread use of minimally invasive and other spinal procedures raises concern about the peroperative radiation exposure to surgeon and patient. The authors noted the fluoroscopy time and the radiation dose, as read from the image amplifier, in 95 spinal procedures. The results of this prospective study varied widely between different operations. ⋯ Preventive measures for the surgeon, such as lead aprons and gloves, thyroid shields, radioprotective glasses and staying away from the beam are recommended. Still from the surgeon's view-point, source inferior positioning of the image amplifier is indicated for the AP view, as well as monitoring of the radiation exposure. Finally, the difference in fluoroscopy time and radiation exposure between surgeons for the same procedure stresses the fact that peroperative radiation may be reduced by simple awareness and by training.
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This study aimed at assessing the effectiveness of open reduction and plate fixation combined with autogenous bone grafting in the treatment of non-united fractures of the humeral shaft. Forty six patients (27 men, 19 women; mean age, 35.6 years; range, 23-53 years) were operated on for non-union of a diaphyseal fracture of the humerus. Sixteen patients had surgical treatments and 30 patients had non-surgical treatments prior to operation. ⋯ Elbow range of motion was excellent in 30 patients (65.2%), moderate in 14 patients (30.4%) and poor in 2 patients (4.4%). Functional results were excellent in 24 patients (522%), good in 14 patients (30.4%), fair in 6 patients and poor in 2 patients (04.4%). In this study, plate fixation combined with autogenous bone grafting appeared as a safe and effective option in non-infected non-union of the humeral shaft.