Acta orthopaedica Scandinavica
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We evaluated the value of dedicated extremity magnetic resonance imaging (E-MRI) in patients with clinical suspicion of a scaphoid fracture and normal initial radiographs. 52 patients underwent E-MRI within a mean of 4 (2-10) days after trauma. Follow-up radiographs were performed at average 11 (8-14) weeks after trauma, and these images were used as the "gold standard". A T1-weighted turbo gradient echo 3D and a tau short inversion recovery STIR were performed, both in coronal planes. ⋯ However, these fractures and bone lesions could not be confirmed by the follow-up radiographs. The agreement between the two examiners was high (kappa = 0.8) for E-MRI detection of fractures. E-MRI seems to be better than radiographs in the early diagnosis of occult fractures of the scaphoid bone and the wrist.
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We treated 14 patients having a symptomatic mid-shaft clavicular nonunion with intramedullary Rushpin fixation and autogenous bone grafting. 13 nonunions healed within 4 months. There were no complications related to the operation. After a mean follow-up of 40 (4-156) months, shoulder function (Constant-Murley score) was 90 (44-100)%, compared to the contralateral shoulder. Rushpin fixation with autogenous bone grafting is a simple and reliable method for treating nonunions of the midshaft of the clavicle.
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Randomized Controlled Trial Clinical Trial
Postoperative mental impairment in hip fracture patients. A randomized study of reorientation measures in 223 patients.
Mental impairment is a common and serious complication in geriatric surgery. We studied 223 hip fracture patients. They were over 64 years of age (mean 81), with no history of mental deterioration and acutely admitted to hospital from independent living conditions. ⋯ However, no difference in mental status was noted when we compared the two groups. The conclusion is that attributes were less important than the psychological environment for postoperative mental deterioration. The mean total continuous hospitalization (transfers between departments and hospitals included) in the reorientation group was 22 (95% CI: 17-43) days, the corresponding figures for the controls were 30 (14-29) days.
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We lengthened 9 tibial segments over a nail to reduce the time in the external fixator in 5 patients with constitutional shortness. The median lengthening was 7 (5.5-7.3) cm and the external Ilizarov frame was removed after median 99 (63-125) days. ⋯ In 1 patient, a deep intramedullary infection occurred. After the experience of these major complications we have returned to the traditional callotasis lengthening method described by Ilizarov.