Eur J Orthop Surg Tr
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Spinal osteotomies are used to treat partially flexible and fixed deformities. Fixed thoracic spinal deformities have been traditionally treated with anterior release and posterior correction with fusion. In recent decades, it has been shown that posterior-only osteotomies might be sufficient to achieve proper deformity correction with lower complication rates than with combined anterior and posterior procedures. ⋯ They can also be performed in the thoracic spine in the setting of rigid thoracic deformity. A progressive increase in complications has been reported with more aggressive osteotomies. The aim of this article was to describe the most common posterior spinal osteotomies used to treat adult thoracic spinal deformities, with special emphasis on the technical aspects, complications and outcomes, based on current publications and European Spine Study Group (ESSG) data.
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Eur J Orthop Surg Tr · Jul 2014
Randomized Controlled TrialStudy protocol: trial of inflation osteoplasty in the management of tibial plateau fractures.
Restoration of articular congruency is a key factor in preventing post-traumatic osteoarthritis following tibial plateau fractures. Current surgical techniques using a bone tamp carry the risk of joint perforation and comminution of the depressed fragments which affect patient outcome. Successful use of inflation osteoplasty has been reported in both in vitro studies (Broome et al. in J Orthopaed Traumatol 13(2):89-95, 2012; Mauffrey et al. in Patient Saf Surg 6:6, 2012) and case reports in the management of fractures of the calcaneus, cuboid, distal radius, tibial plateau and acetabulum (Gupta et al. in Foot Ankle Int 32(2):205-210, 2011; Heim et al. in Foot Ankle Int 29(11):1154-1157, 2008; Konig et al. in Case Rep Unfallchirurg 109(4):328-331, 2006; Reiley in J Orthop Trauma 17:141-163, 2006). The aim of our study is to assess whether the use of the balloon osteoplasty improves the quality of reduction of a depressed tibial plateau fracture when compared to traditional methods of fracture reduction. ⋯ This is a single-centred randomised trial. We will recruit 24 adult patients admitted with either a depressed or split depressed tibial plateau fracture (medial or lateral) requiring surgical intervention. Consenting patients will be randomly allocated to the two treatment groups. Patients with concomitant injuries influencing the management of the tibial plateau fracture will be excluded from our study. The primary outcome measure is the quality of reduction based on the post-operative CT scan. Secondary outcome measures will be any surgical complication and patient satisfaction, measured using the Oxford Knee score and SF12 questionnaire at 3, 6 and 12 months. Principal analysis will be for the success of fracture reduction from the two techniques and the effect the operative technique had on patient satisfaction and the prevalence of surgical complications.
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Eur J Orthop Surg Tr · Jul 2014
Observational StudyOperative delay and mortality in elderly patients with hip fracture: an observational study.
Hip fracture is the third cause of death among the elderly and appears to be increasingly frequent. We analysed the influence of the major variables in hip fracture management in relation to 30-day mortality. ⋯ Our data support the policy envisaging fracture repair within 48 h in stable patients and delayed surgery (>48 h) in those with comorbidity conditions requiring stabilization.
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Eur J Orthop Surg Tr · Jul 2014
Randomized Controlled Trial Comparative StudyPlate osteosynthesis versus intramedullary nailing for both forearm bones fractures.
Given the continuing improvements in nail implants, intramedullary nailing could become an alternative treatment option to osteosynthesis for the treatment of fractures in both forearm bones, with the proper indication. The aim of this prospective study was to evaluate and compare the results of plate osteosynthesis and intramedullary nailing for the treatment of diaphyseal fractures in both forearm bones. ⋯ Based on the significant differences in the ratio of the contralateral side, plate osteosynthesis resulted in a more excellent extent of restoration to the conditions prior to the injury. Nevertheless, such significant differences in the restoration of the bow had no effect on the final clinical outcome. If the indication is properly selected, our results suggested intramedullary nailing can be acceptable and effective treatment options for fractures in both forearm bones.
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Eur J Orthop Surg Tr · Jul 2014
Comparative StudyThe efficacy of epiduroscopic neural decompression with Ho:YAG laser ablation in lumbar spinal stenosis.
Although epiduroscopy is one of the popular interventions for the management of lumbar spinal stenosis (LSS), only a part of these patients show improvement in pain and functional level. Consequently, the authors thought that holmium:YAG (Ho:YAG) laser can be a reasonable alternative as an adjunct of epiduroscopic procedure, but has not been thoroughly determined yet which influence is resulted by it. This study was conducted to evaluate and compare the efficacy of epiduroscopic neural decompression (END) and END with Ho:YAG laser (ELND) in patients with LSS. ⋯ ELND could produce significant improvement of low back pain (LBP) at the last follow-up time (p = 0.01), but radiating pain of leg could not be improved significantly (p = 0.09). In conclusion, the current study suggests that performing Ho:YAG laser ablation concurrently with END could produce more decreased intensity of pain and prolonged effect of pain relief compared with END in LSS patients. LSS patients with LBP would be an ideal candidate for ELND, but radiating pain of LSS might not be managed effectively with ELND.