Annales chirurgiae et gynaecologiae
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The incidence of achilles tendon (AT) ruptures is increasing. The aim of the present study was to evaluate annual incidence, aetiology, operative complications and direct hospital costs of AT ruptures. ⋯ The incidence of AT ruptures is increasing in South-East Finland. The rate of major surgical complication was low (4.5%) and comparable with earlier studies.
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Open reduction and internal fixation of an extensively swollen ankle may lead to wound closure problems, blistering, wound edge necrosis and infection. Accordingly, internal fixation should be accomplished either before or after the period of critical soft tissue swelling. The object of the study was to investigate if the timing of surgery had any influence upon soft tissue complications and hospital stay. ⋯ Delayed surgery of closed ankle fractures increases the risk of soft tissue complications and prolongs hospital stay. Immediate surgery is particularly indicated in the severely displaced ankle fracture, and if not achievable, temporary reduction and immobilization is recommended.
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Administration of protamine might cause serious complications especially in patients treated preoperatively with NPH insulin. ⋯ Administration of protamine sulphate caused fatal anaphylactic reaction to a diabetic patient undergoing femoropopliteal by-pass surgery. Care should be taken when administering protamine to a patient treated preoperatively with NPH insulin and the possibility of an anaphylactid reaction to protamine have to be kept in mind.
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Randomized Controlled Trial Comparative Study Clinical Trial
Cannulated screws versus hemiarthroplasty for displaced intracapsular femoral neck fractures in demented patients.
There are no randomised trials comparing internal fixation and hemiarthroplasty for a displaced intracapsular femoral neck fracture in relation to mental state. ⋯ Postoperative mortality is high and the chance of successful rehabilitation very small for both types of treatment in this group of patients. In our opinion, demented patients should not be treated with a major surgical procedure like hemiarthroplasty. Internal fixation should be considered the treatment of choice, because it is a smaller operation than prosthetic replacement, with less morbidity. If adequate reduction can not be achieved, a primary hemiarthroplasty should be performed.
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In ankle fractures with separation of the tibiofibular mortise a metallic syndesmosis screw is generally used. As a rule, this transfixing screw is removed by a separate operation 6 to 8 weeks later. Usually the fracture fixation implants are removed by a second operation later on. In order to eliminate separate removal of the transfixing screw, we used a biodegradable syndesmosis screw in a pilot clinical study. ⋯ All the patients ended up with an acceptable result and stable ankle mortise. One of the ankles, which was the only one fixed by two transfixing PGA screws instead of one screw, had transient sinus formation and intraosseal osteolysis. The final result was good also in this case. The ankle mortise can be fixed safely by biodegradable screws in connection with metallic osteosynthesis of malleolar fractures. Thus a separate removal of the transfixing material is possible to eliminate.