Annales chirurgiae et gynaecologiae
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The purpose of the study was to find out the consequences of malunion of tibial shaft fracture. ⋯ Malunion of tibial shaft fracture seems to be especially harmful in distal fractures, in fractures with marked primary displacement, in fractures caused by high energy injury, and among patients less than 45 years of age.
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Randomized Controlled Trial Clinical Trial
Fixation of displaced femoral neck fractures with a sliding screw plate and a cancellous screw or two Olmed screws. A prospective, randomized study of 225 elderly patients with a 3-year follow-up.
To analyse the importance of fixation method in displaced femoral neck fractures and to identify factors predictive of failure of the fixation. ⋯ Operation and anaesthesia time was considerably longer for the SSP system. The risk of failure was significantly increased (odds ratio 6.6) for patients operated with SSP outside ordinary working time. Poor reduction was recognized as a risk factor of failure for both types of fixation (odds ratio 3.1). The rate of reoperation within 3 months was 18.5% in the SSP group and 9.4% in the Olmed screw group. The rates of nonunion were 6.2% and 8.5%, respectively. The rates of late segmental collapse, 18.0% and 19.5% of all united fractures, respectively, decreased with increasing age (odds ratio 0.88). Salvage operations (replacement with bipolar or total hip prosthesis) were made in 30.6% and 26.5% of the cases, and the total rates of reoperation were 37.0% and 29.1%, respectively. We conclude that both treatment methods result in an unacceptably high rate of failures and reoperations, and that alternative treatment, prosthesis replacement, should be considered in selected cases.
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Meta Analysis
Concurrent ipsilateral fractures of the hip and shaft of the femur. A systematic review of 722 cases.
Ipsilateral fracture of the hip and femoral shaft is encountered in high-energy trauma, and warrants special diagnostic and therapeutic considerations, which are not available in any single report. Therefore, a meta-analysis was performed. ⋯ Early diagnosis of all injuries and operative treatment of all fracture components are the key factors in reducing complications and improving the outcome in ipsilateral hip and shaft fractures. Locked nails and hip screws yield improved results compared with plates and unlocked nails combined with hip screws. Cephalo-medullary nails have yielded results similar to the first-generation locked nails.