Journal of clinical orthopaedics and trauma
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J Clin Orthop Trauma · Oct 2019
Plate-and-bone-strut fixation of distal third humeral shaft aseptic non-unions: A consecutive case series.
Non-union after humeral shaft fractures are seen frequently in clinical practice. The incidence is 2-10% after conservative management and up to 30% after surgical treatment. The purpose of this study is to evaluate the outcomes of plate-and-bone-strut-allograft technique with bone chip augmentation for aseptic non-unions of the distal third of the humerus. ⋯ The plate-and-bone-strut-allograft technique with bone chip augmentation in distal humeral shaft for aseptic non-unions resulted in union of all cases. No adverse events related to the surgery or the materials used were documented.
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J Clin Orthop Trauma · Oct 2019
No increased risk of acute osteomyelitis associated with closed or open long bone shaft fracture.
Osteomyelitis of the long bones can result from hematogenous spread, direct inoculation or from a contiguous focus of infection. The association of osteomyelitis after long bone fractures has widely been believed to be true by practicing surgeons since the 1950s, even though the evidence has been poor. We hypothesized that long bone shaft fracture and major bone surgery are independent risk factors for osteomyelitis in adult trauma patients. ⋯ Long bone shaft fractures are not independently associated with increased risk for osteomyelitis. Major extremity surgery on the humerus and tibia/fibula, but not femur, are independent risk factors for osteomyelitis. However, the strongest risk factor is non-pseudomonas bacteremia.
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J Clin Orthop Trauma · Oct 2019
Circular external fixation as definitive treatment for open or comminuted femoral fractures: Radiologic and functional outcomes.
Ring external fixation can be a definitive treatment of high energy femoral fractures. A retrospective analysis of outcomes is presented. ⋯ Circular external fixation can achieve reliable rates of union and good to excellent functional outcome in open or comminuted femoral fractures. A strict rehabilitation protocol was effective in preserving knee joint function.
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J Clin Orthop Trauma · Oct 2019
Tip-apex distance and other predictors of outcome in cephalomedullary nailing of unstable trochanteric fractures.
Cephalomedullary nails are presently the gold standard in management of unstable trochanteric fractures. The tip-apex distance (TAD) is one of the most important factors that determines success or failure of fixation, but was described originally in context of an extramedullary hip screw. Cephalomedullary nails use a different biomechanical approach to fixation; and it is hypothesized that the TAD rule may not apply similarly with these. The aim of this study is to assess whether a high TAD correlates with poor outcomes with cephalomedullary nails, and to elucidate other factors that may predict such outcome. ⋯ As with extramedullary devices, TAD, along with sub-optimal device positioning and poor restoration of neck-shaft angle is a useful predictor of cut-out even with cephalomedullary nails, negating the initial hypothesis. The above factors in combination have a more significant effect than any one factor in isolation to cause varus collapse and implant cut-out. However these do not affect Z effect, reverse Z effect or other types of device migration seen especially with dual-screw nails.