J Bone Joint Surg Br
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J Bone Joint Surg Br · Nov 1995
Randomized Controlled Trial Comparative Study Clinical TrialThe repair of a ruptured deltoid ligament is not necessary in ankle fractures.
We randomised 50 patients with ankle fractures of Weber types B and C and a ruptured deltoid ligament treated by open reduction and internal fixation to two treatment groups to examine the influence of the repair of a ruptured deltoid ligament. No differences were found except for a longer duration of surgery in the repair group. Our findings suggest that a ruptured deltoid ligament can be left unexplored without any effect either on early mobilisation or on the long-term result.
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J Bone Joint Surg Br · Nov 1995
Randomized Controlled Trial Comparative Study Clinical TrialFemoral nerve block in extracapsular femoral neck fractures.
We randomised 50 patients with extracapsular fractures of the femoral neck to receive either a bupivacaine femoral nerve block or systemic analgesia alone. A femoral nerve block was found to be an easy and effective procedure which significantly reduced perioperative analgesic requirements and postoperative morbidity.
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J Bone Joint Surg Br · Nov 1995
Scheuermann's kyphosis. The Portuguese technique of surgical treatment.
Between 1969 and 1989, we performed posterior segmental instrumentation on 38 patients with thoracic Scheuermann's kyphosis. We used a dynamic system without sublaminar fixation, and a kyphosis of 50 degrees was the main indication for surgery. The mean initial angle was 68 degrees (50 to 100) and the mean final kyphosis was 43 degrees at five-year follow-up, with a mean final loss after surgery of 3.7 degrees. ⋯ There were no medical complications. There were three cases of loss of correction by more than 10 degrees and one of rod fracture with pseudarthrosis. The role of non-operative treatment is evaluated and early surgical treatment is advocated.
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J Bone Joint Surg Br · Sep 1995
Distal metaphyseal fractures of the tibia with minimal involvement of the ankle. Classification and treatment by locked intramedullary nailing.
We reviewed 63 patients with fractures of the distal tibial metaphysis, with or without minimally displaced extension into the ankle joint. The fractures had been caused by two distinct mechanisms, either a direct bending force or a twisting injury. This influenced the pattern of the fracture and its time to union. ⋯ At a mean of 46 months, all but five patients had a satisfactory functional outcome. The poor outcomes were associated with either technical error or the presence of other injuries. We conclude that closed intramedullary nailing is a safe and effective method of managing these fractures.
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J Bone Joint Surg Br · Sep 1995
Percutaneous Kirschner-wire pinning for severely displaced distal radial fractures in children. A report of 157 cases.
Distal radial fractures are common in children. Recent outcome studies have cast doubt on the success of treatment by closed reduction and application of plaster. The most important risk factor for poor outcome is translation of the fracture. ⋯ We performed percutaneous Kirschner-wire pinning on 157 such high-risk distal radial fractures in children under 16 years of age. The predicted early and late failure rate was reduced from 60% to 14% and only 1.5% of patients had significant limitation of forearm movement of more than 15 degrees in the final assessment at a mean of 31 months after operation. There were no cases of early physeal closure or deep infection.