Acta Orthop Belg
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The treatment of supracondylar fractures of the femur with an intramedullary nail presents some theoretical advantages. Compared to plate osteosynthesis, intramedullary fixation requires less extensive dissection and is biomechanically more favorable. In the elderly patient, these characteristics seem important since bone quality, extensive procedures and bone grafting remain problematic. ⋯ When previous hip or knee surgery precludes the use of antegrade nailing techniques or when the fracture extends into the intercondylar region, retrograde supracondylar nailing offers some advantages compared to conservative treatment or plate osteosynthesis. On the other hand in young patients, anatomic reduction and alignment should be the goal, and open reduction with plate osteosynthesis, supplemented by bone grafting if needed, should remain the gold standard. When this seems technically impossible, the antegrade or retrograde insertion of an intramedullary nail with intraoperative assessment of length and fracture alignment is an interesting alternative.
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The indications for conservative and surgical management of fractures of the thoracolumbar spine are reviewed, based upon the morphology of the lesions, which is assessed by meticulous analysis of radiographs, CT scan and in some cases MRI. The author advocates using the AO classification, which considers several subtypes of fractures: compression fractures, distraction fractures and fractures with multidirectional displacement. The indication for treatment is based upon morphological analysis of the lesions, while other factors such as the general condition of the patient or the locally available surgical environment must also be taken into consideration. Up to 50% of thoracolumbar fractures can benefit from surgical management, with posterior or anterior stabilisation, the latter performed through thorascoscopy in selected cases.
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Tibiotalar dislocations without fracture are extremely rare lesions. This series included 16 patients, 12 of whom have been examined clinically and radiographically. The purpose of this study was to specify the injury mechanism of the various anatomical types and to assess the long term outcome. ⋯ One should favor orthopedic treatment. The absence of tibiotalar instability argues against carrying out emergency ligamentous repair. Evolution towards degenerative arthritis is to be anticipated in 25% of cases, especially following open dislocations, or if transplantar pinning was required due to instability of the initial reduction.
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The authors report their results on 36 patients with advanced stages of complex regional pain syndrome. They were treated with either spinal cord stimulation, or peripheral nerve stimulation, and in some cases with both modalities. ⋯ Analgesic consumption decreased by about 50% or was reportedly more effective. The authors conclude that in late stages of complex regional pain syndrome, neuroaugmentation is a reasonable option when alternative therapies have failed.