Acta orthopaedica Scandinavica
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Randomized Controlled Trial Clinical Trial
Repair of the triangular ligament in Colles' fracture. No effect in a prospective randomized study.
We present a prospective and randomized study of two different treatments of extraarticular Colles' fracture with a fractured ulnar styloid. The study comprised 41 patients with 2 years' follow-up; 22 patients were treated with closed manipulation and an above-the-elbow plaster cast, whereas in 19 patients the avulsed ulnar styloid was transfixed and/or the triangular ligament was repaired after closed reduction of the fractured radius. In all the operated on patients, a complete rupture of the triangular ligament was found. ⋯ At follow-up the alignment had deteriorated, with no difference between the two treatment groups. Neither did the findings in the wrist arthrograms differ between the two groups nor did the subjective complaints of the patients. We conclude that repair of the ruptured triangular ligament in extraarticular fractures of the distal radius is not better than conventional treatment.
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Randomized Controlled Trial Comparative Study Clinical Trial
Less pain with epidural morphine after knee arthroplasty.
Twenty-two patients were randomly allocated to systemic opioids or epidural morphine the first 10 days after total knee arthroplasty. Pain was recorded daily in a visual analogue scale, and knee motion was measured on Day 10. Pain was lower in the epidural group, with no difference in knee flexion or range of motion.
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Function and radiographic position were evaluated 2.5 years after a displaced distal radial fracture had been reduced and treated by external fixation in 40 patients as compared with immobilization in a below-the-elbow cast in 91 patients. Wrist function was better after external fixation associated with less residual displacement. ⋯ The rate of complications after external fixation was higher than after immobilization in a plaster cast, notably sensory disturbances in the thumb. This complication can probably be eliminated by modifying the surgical technique.
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Radiographic and functional results of external fixation of 32 Colles' fractures were compared with the results of plaster fixation of 189 Colles' fractures. Despite the fact that the fractures treated with the external device were more unstable and comminuted, the final results were equal in both groups, and the radiographic outcome of external fixation was superior. Pin loosening decreased with predrilling rather than self-tapping. We recommend external fixation for unstable fractures of the distal forearm.
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Two series of patients with a hip fracture, sustained at home, were assessed regarding utilization of rehabilitation resources before and after adoption of an active policy favoring rehabilitation at home. Out of 86 consecutive patients in 1985 (Series I), 22 were discharged directly to their home versus 44 out of 84 in 1986 (Series II). ⋯ Twenty of the 77 surviving patients in Series I were permanently institutionalized compared with 14 of 77 in Series II. We conclude that an active attitude towards home rehabilitation after a hip fracture benefits patients and the community alike.