Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca
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Acta Chir Orthop Traumatol Cech · Jan 2014
ReviewFemoral shaft fractures in adults: treatment options and controversies.
Antegrade reamed femoral nailing via the piriformis entry point is the technique of choice in treating femoral shaft fractures, with retrograde nailing as an alternative. The supine position is favored to reduce complications, especially rotational malalignment. With navigation and robotic assistance fracture reduction can be supported and the rate of rotational, axis and length malalignement can potentially further reduced. ⋯ In multiply injured patients reamed nailing can be safely integrated in the DCO- or ETC-concept and can be performed in the majority of patients, even when additional severe chest and head injuries are present. Initial resuscitation should focus on general stabilization before definitive femur fixation. Plate osteosynthesis of the femur can be an option in selected patients.
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Acta Chir Orthop Traumatol Cech · Jan 2014
ReviewBiomechanical and biological aspects of defect treatment in fractures using helical plates.
The clinical case of figure 1 through figure 11 shows a series of impressive failures of plate fixation. The plates were repeatedly applied bridging a comminuted bone segment in a heavy patient. The biomechanical analysis elaborates why this happened and proposes an unconventional procedure to prevent this failure with a minimally invasive procedure. ⋯ A. D. Fernandez.
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Acta Chir Orthop Traumatol Cech · Jan 2014
ReviewFracture healing: fracture healing understood as the result of a fascinating cascade of physical and biological interactions. Part I. An Attempt to Integrate Observations from 30 Years AO Research.
The choice of best procedure in fracture treatment relies on a proper understanding of tissue reactions to the prevailing mechanical and biological conditions. Investing time and effort is rewarding as it opens up access to a fascinating world and improves fracture treatment based on logical decision making. An intact bony skeleton enables mechanical functions of the human body such as locomotion. ⋯ The following paper addresses a fascinating interplay between physical and biological processes that enable fractured bone to bridge solidly and remodel to regain its "pre-fracture" function and structure. no one of the different treatment modalities or healing patterns is best on its own. for a given situation the goal is to recover the function of the bone, limb and patient early and permanently by choosing the optimal procedure and implant. Understanding bone reactions permits a rational choice and replaces subjective predilection and monomania. The stability of the fiation and the blood supply are priority considerations, which must often be weighed against each other.
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Acta Chir Orthop Traumatol Cech · Jan 2014
Randomized Controlled Trial[Surgical treatment of humeral diaphyseal fractures].
The aim of the study was to compare two surgical methods of treating diaphyseal fractures of the humerus. ⋯ Intramedullary nailing has not yet shown such good outcomes in humeral as in tibial fractures. The results of metaanalysis have indicated that humeral fractures treated by plate osteosynthesis have fewer complications and require repeat surgery less frequently. However, as shown by most recent studies, this difference is getting smaller. The MIPO technique was adopted at our department several years ago and the aim was to compare our results with those of other centres. The studies so far published have show that MIPO and conventional open plate osteosynthesis give comparable outcomes. CONCLUSIONS The statistical evaluation using the unpaired t-test did not show any significant differences in either the functional results or the number of complications between the two methods. Both achieved about 90% of excellent and good results and had 26% of complications. The only significant difference was found in the length of operative time (136 min in MIPO versus 117 min in EHN). With use of the Chi-Square test, a significant correlation between AO fracture type and treatment outcome in the MIPO group was found, i.e., no poor result was recorded for type A fractures, as assessed by the CM/LES score. No such correlation between the fracture type and the functional outcome was seen in the EHN group.
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Acta Chir Orthop Traumatol Cech · Jan 2014
Randomized Controlled Trial[Metal staples versus conventional suture for wound closure in total knee arthroplasty].
Surgical incision closure, as well as total joint replacement itself, plays a key role in the overall outcome of an arthroplasty procedure. Uncomplicated wound healing is the essential condition of successful rehabilitation and the patient's return to normal activities. Although there are many innovative suturing techniques which offer advantages, their safety is still being discussed. The aim of this prospective non-blind randomised study was to evaluate wound healing and complications in relation to skin incision closure with either conventional suture or metal staples. ⋯ Correctly performed skin suturing by means of metal staples is not associated with a higher complication rate and is therefore a simple, rapid, efficient and economical alternative to the conventional suture technique.