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1.
Objective
Surgical management of bicondylar tibial plateau fractures, which is frequently associate with high wound complication rates and functional impairment, remains a challenge for orthopedic surgeons. Recently, the emergence of three-dimension(3D) printing provided orthopedic surgeons with a new technology which has revolutionary impacts on surgical planning, operative guidance and custom-made implants manufacture. The aim of this study is to explore the clinical feasibility and application value of 3D printing in the surgical management of bicondylar tibial plateau fractures.Method
Data of this retrospective study was collected from 11 patients suffering bicondylar tibial plateau fracture from October 2015 to August 2016. All of them underwent surgical treatment with the assistance of 3D printing technology. Real-size solid models and screw guide templates were printed for preoperative planning, surgical simulation and intraoperative guidance. Patients’ Demographics, surgery duration, intraoperative blood loss, the accuracy of preoperative planning were recorded and evaluated.Result
The 3D printed models successfully provided the omni-directional exhibition of the fracture morphology. Model-based surgical simulation procedures and pre-selection of implants were generally consistent with the results of actual surgeries. There were no significant differences between the length of the osteosynthesis screws and that of actual surgeries (59.43?±?11.13?mm vs 60.14?±?12.05?mm). Beyond that, other parameters, such as surgical duration, intraoperative blood loss and HSS scores was satisfactory according to the surgical records and follow-up.Conclusions
According to our experience, the assistance of 3D printing technology in the surgical management of bicondylar tibial plateau fractures provides a comprehensive understanding of fracture features, an accurate patient-specific preoperative planning and an intraoperative guidance for real surgeries, thus leading to the optimization of clinical outcomes. 相似文献2.
3.
Abdulhamit Misir Turan Bilge Kizkapan Kadir Ilker Yildiz Erdal Uzun Mustafa Ozcamdalli 《Injury》2019,50(2):332-336
Background
Standard radiographs are limited in the evaluation of fracture characteristics and preoperative planning of OTA/AO 43C3 fractures. Therefore, CT imaging is an accepted as a useful method. CT is however expensive and has high radiation, and traction radiographs could be an alternative. This study aimed to compare fracture fragment and comminution zone visualization between traction radiographs and CT and any potentially resulting differences in consecutive treatment and surgical approach recommendations.Methods
Twenty orthopaedic surgeons assessed traction radiographs and CT images of 12 OTA/AO 43C3 type fractures. Each observer was required to identify the anterolateral, posterolateral, and medial malleolus fragments and the lateral, central, and medial shoulder comminution zones. They then had to recommend treatment (nonoperative, ORIF, closed reduction and external fixation, percutaneous screw fixation, or primary tibiotalar arthrodesis) with the best surgical approach (medial, anterolateral, posterolateral, posteromedial, or combined). Intra- and interobserver reliability, correct identification of fracture fragments and comminution zones on both images, and consistency of treatment recommendations and surgical approaches were analyzed.Results
The agreement of each observer’s assessment of the presence or absence of specific fracture fragments and comminution zones was substantially increased for CT as compared to traction radiographs, particularly for the posterolateral (p?=?0.000) and anterolateral fragment (p?=?0.000), and the lateral (p?=?0.000), central (p?=?0.000), and medial shoulder comminution zone (p?=?0.000). The interobserver reliability when assessing the three fracture fragments and comminution zones on the traction radiographs was moderate, whereas it was substantial when assessing these characteristics on CT. The medial malleolus fragment was more often correctly identified on traction radiographs than CT images (p?=?0.001). The ability to correctly identify lateral, central, and medial shoulder comminution zones was higher for CT than traction radiographs (p?=?0.000). The treatment and surgical approach recommendations after traction radiograph and CT evaluation were similar (p?<?0.05).Conclusions
Traction radiographs may be a useful alternative to CT imaging in the preoperative planning of pilon fracture repair. Despite less reliable fracture fragment and comminution zone identification on traction radiographs, treatment recommendations and surgical approach were not influenced. 相似文献4.
Akira Hara Toshiya Kudo Satoshi Ichihara Hideaki Iwase Masashi Nagao Yuichiro Maruyama Kazuo Kaneko 《Injury》2019,50(2):256-262
Introduction
Intra-articular distal humeral fractures involving both columns require double-plate fixation. In orthogonal plate fixation, screws from the medial plate reach the radial column, while screws from the dorsolateral plate run posterior–anterior, not creating interdigitation. The Synthes LCP-DHP system has an orthogonal plate configuration that enables dorsolateral plating with support, as the radial and ulnar columns are linked via interdigitation of the distal screws. We hypothesized that the transcondylar screw from the posterolateral plate, which interdigitates with screws from the medial plate, enables more rigid stabilization of orthogonal plating in distal humeral AO type C fractures.Methods
A previous study reported the biomechanical properties of orthogonal plate fixation using an AO type 13-C2.3 intra-articular fracture model with a 1-cm supracondylar gap using artificial bones (Kudo et al., Injury, 2016). We performed a biomechanical study of the dorsolateral plate with support, and inserted one 2.7-mm locking screw through the support in the lateral-to-medial direction, creating interdigitation of the distal screws. A 0–200?N axial load was applied separately to the radial and ulnar columns. We calculated the stiffness of both columns, and the anterior displacement of the condylar fragment. We compared the biomechanical properties of orthogonal plating with versus without interdigitation.Results
There were no significant differences between the two groups in radial or ulnar axial compression. The ulnar column was stiffer than the radial column in both groups. There were no significant differences between groups in the angular displacements of the capitellum or trochlea. The capitellum moved more anteriorly than the trochlea during axial compression in both groups.Discussion
The radial and ulnar columns were linked via interdigitation of the distal screws by adding one transcondylar screw from the dorsolateral plate, which did not affect radial column stiffness or capitellar anterior movement under axial compression. In the orthogonal configuration, axial compression induced more anterior displacement of the capitellum than the trochlea, which may induce secondary fragment or screw dislocation on the dorsolateral plate or nonunion at the supracondylar level.Conclusions
The transcondylar screw from the dorsolateral plate did not affect axial compression of the radial column or capitellar anterior displacement. 相似文献5.
Background
The main purpose of this study is to introduce our surgical technique and report surgical outcomes for percutaneous cable fixation in the treatment of subtrochanteric femoral fractures.Methods
Between May 2013 and April 2017, 51 patients with subtrochanteric femoral fractures treated with closed intramedullary nailing and percutaneous cable fixation were enrolled in this study. Postoperative angulation, union rate, time from injury to union, and femoral shortening were also evaluated to assess radiologic outcomes. Clinical outcomes, including range of hip flexion, walking ability, and Harris hip score at the last follow-up were evaluated.Results
Average coronal and sagittal angulation after surgery were 0.9 (range 0–5) and 0.3 (range 0–5), respectively. There was no postoperative angulation of more than 5°. Average shortening of the femur at 1-year follow-up was 2.7?mm (range 0–15). Bone union was achieved in 50 patients (98.0%) and average time to union was 18.6 weeks (range 12–48). Hip flexion, walking ability and Harris hip score at the last follow up were 115.6° (90–120), 7.9 (5–9), and 88.3 (65–100), respectively.Conclusion
Percutaneous cerclage cable fixation can provide a greater likelihood of achieving anatomical reduction and increased stability of fracture, while preserving biology around the fracture site. Thus, percutaneous cerclage cable fixation can be an effective surgical technique for the treatment of complex subtrochanteric fractures. 相似文献6.
Background and purpose
The treatment of paediatric distal radius diaphyseal metaphyseal junction (DRDMJ) fractures is a challenge. The purpose of this study was to introduce a new operative approach at the proximal “safe zone” of the posterior interosseous nerve (PIN) to treat paediatric DRDMJ fractures and analyse the safety and efficacy of antegrade elastic stable intramedullary nail (ESIN) fixation.Methods
Thirty paediatric patients with unstable and displaced DRDMJ fractures were treated by antegrade ESIN fixation from November 2015 to September 2017. We created the entrance site at the posterolateral side of the proximal radius and 2?4?cm distal to the articular surface of the radius, using the ESIN to immobilise the fractures. In the study, we reviewed patient demographics, complications, time until removal, and intraoperative time for hardware removal.Results
Complete fracture healing was achieved between 6 and 12 weeks after surgery. Except for 3 patients presenting with irritation of the skin, we did not observe any complications. Radiologically, no secondary displacement, nail migration, loss of fixation, consolidation delay, non-union, or refracture was noted.Conclusions
The antegrade ESIN fixation is a minimally invasive, easy-to-learn, alternative operative method to treat paediatric DRDMJ fractures.Level of evidence
Therapeutic Level IV. 相似文献7.
Jordi Salvador Samer Amhaz-Escanlar Pablo Castillón Iban Clares Saioa Quintas Martí Bernaus Francesc Anglés Alberto Jorge-Mora 《Injury》2019,50(2):415-419
Purpose
Antegrade intramedullary nailing is an alternative for humeral shaft fracture treatment. This surgical technique can be especially demanding in some fracture patterns, leading to problems like malunion and non-union. The purpose of our study is to demonstrate that the use of a nail with cerclage wires could be a safe procedure that facilitate reduction, specially in fractures with abduction of the proximal fragment.Materials and methods
Fifty-six patients were included, from January 2007 to March 2016. In this cohort forty-two patients were females and eighteen males; mean age was sixty-seven (32–89). The fractures were reduced using a cerclage wire through a small lateral or anterior approach, then, antegrade intramedullary nailing was performed. Fracture healing was established by clinical and radiographic evaluation. Shoulder function was assessed using the Constant Score.Results
Fifty-three patients healed (94.6%) adequately. Two patients developed a non-union (3.5%). One patient developed an infection (1.8%). Transient radial nerve palsy was observed in two patients (3.5%). The mean Constant Score at the end of the study was 70 points (range from 34 to 98 points).Conclusions
Surgical treatment of humeral shaft fractures with cerclage wire and intramedullary nailing is a safe technique to improve fracture reduction. The use of cerclage wires leads to better bone contact while minimizing malunions. The rate of non-union in our study is lower than the rate reported in the literature for humeral shaft fractures treated by intramedullary nailing alone. 相似文献8.
Anton A. Semenistyy Elena A. Litvina EA Anna G. Fedotova Chukwuweike Gwam Andrey N. Mironov 《Injury》2019,50(2):515-520
Background
Intramedullary nailing is considered a “gold standard” for treatment of tibial shaft fractures. However, some types of fractures are typically considered as “difficult for nailing”. This group includes the periarticular fractures, fractures of both bones at the same level, comminuted and segmental fractures of the tibia. Fixator-assisted nailing (FAN) is an effective method treatment of these types of fractures. The main requirements for the ideal reduction device are an ease of its installation and an ability of multiplanar fracture reduction. Fixator-assisted nailing (FAN) with the use of two perpendicular to each other monolateral tubular frames perfectly meets these requirements. In this study we present this new surgical technique and the analysis of first 30 cases.Methods
A prospective analysis was conducted for 30 patients with “difficult for nailing” tibial fractures treated with fixator-assisted nailing in our institution between September 1st, 2017, and March 1st, 2018. The duration of surgery and its different stages, the time of fluoroscopy, difficulties encountered during surgery, were analyzed. Clinical and radiological methods were used to evaluated reduction quality.Results
In all 30 cases the acceptable reduction was achieved. The mean duration of the surgical procedure was 73.7?±?3?min. The mean duration of fluoroscopy 85.9?±?4.8?s. In 7 cases we faced with technical difficulties, which were successfully addressed.Conclusion
The described technique of FAN is an effective method for the treatment of “difficult for nailing” tibial fractures. Future multi-centered studies with a larger number of patients are needed to validate our results. 相似文献9.
Renkai Wang Hao Zhang Haocheng Cui Zhenyu Fan Kaihang Xu Peizhao Liu Fang Ji Hao Tang 《Injury》2019,50(2):432-437
Introduction
This study aims to analyze clinical effects between far cortical locking (FCL) system and standard plating techniques in the treatment of lower limb fractures and identify potential preoperative risk factors for complications in patients treated with FCL system.Method
We retrospectively analyzed 76 patients treated with FCL system (the study group) and 68 patients treated with standard plating techniques (the control group) between January 2014 and January 2017. Patients were followed up for a minimum of one year. Surgery-related complications, fixation features, fracture healing rates, the radiographic union scores, and knee functions (Kolment scores) were analyzed between the two groups in the study. Besides, we analyzed eight preoperative characteristics for surgery-related complications, including age, gender, presence of risk factors affecting bone healing, cause of injury, AO/OTA fracture classifications, facture sites, presence of open fractures, and presence of bone losses.Results
The distributions of baseline date were similar between the two groups (P＞0.05). The average number of FCL screws was 4.5 (range: 3–9) in the study group. The average time to union was 2.8?±?0.9 months in the study group and 3.6?±?1.0 months in the control group (P＜0.001), and average time to whole weight bearing was 2.3?±?0.8 months and 2.8?±?1.2 months, respectively (P?=?0.004). Regarding radiographic union score, the study group scores were significantly higher than the control group scores at 1 and 3 months after surgery (P＜0.001), while it becomes insignificant between the two groups at 6 and 12 months after surgery (P?=?0.19 and P?=?0.15).The working lengths, fracture healing rates, complication rates, and Kolment scores were similar between the two groups (P＞0.05). In the multivariate analysis, fracture sites (OR?=?5.34; 95% CI, 1.11–25.75; P?=?0.03) and presence of open fractures (OR?=?6.19; 95% CI, 1.05–36.38; P?=?0.04) were significant associated with complications, whereas other variables were not included.Discussion
FCL system can truly accelerating bone healing and allow earlier whole weight bearing. Fracture healing rates and complication rates were similar between patients treated with FCL implants or conventional plating techniques. Patients with shaft fractures and open fractures trended to have higher complication rates.Conclusions
FCL system is superior to standard plating technique in terms of early callus formation, but standard plating technique is not inferior to FCL system in terms of final fracture healing, surgery-related complication, and function outcome. Fracture site and presence of open fracture are the independent factors for complications in patients treated with FCL system. 相似文献10.
Christina Marie Joseph Chandrasekaran Gunasekaran Abel Livingston Hepsy Chelliah Thilak Samuel Jepegnanam P.R.J.V.C. Boopalan 《Injury》2019,50(3):784-789
Background
Contrary to acute posterior cruciate ligament (PCL) bony tibial avulsions, surgical management of chronic injuries is technically challenging and appears to be controversial. We sought to assess the outcome of a novel screw post augmentation technique in neglected cases.Methods
16 patients were followed up in a tertiary single-center retrospective study. The bony fragment was fixed using a lag screw with a spiked washer and an additional screw post through an open posterior approach. The pre- and postoperative knee range of movement (ROM), laxity, and modified Tegner–Lysholm (TL) scores were compared.Results
The median time from injury to surgery was 10 weeks (range, 3–260). The mean clinical follow-up time was 24.25?±?9.21 months. At the final follow-up, the mean knee ROM flexion was 130°?±?11.55° with no extension lag. 3 patients had grade 1 laxity. The TL grade was predominantly excellent, and the overall median score improved from 76 preoperatively to 95 postoperatively (p?<?0.0004). Bony union was achieved in all cases.Conclusion
The described screw post fixation technique results in an excellent outcome for these rare injuries.Level of evidence
Level IV, case series. 相似文献11.
Giacomo Strigini Michele Rendina Matteo Ghiara Fabrizio Quattrini Laura Ghidoni Valeria Burgio Pietro Maniscalco Francesco Benazzo 《Injury》2019,50(2):382-385
Introduction
In this retrospective study we have analyzed a consecutive series of patients affected by isolated radial head Mason III fractures and treated with bone resection or prosthesis.Patients and methods
This study includes 24 patients affected by fractures mentioned above and treated between July 2009 and November 2015.15 patients (average age 48 y.o.) have been treated with prosthesis. The remaining 9 (average age 573) have been treated with a capitellectomy instead.From a clinical point of view, we have evaluated the patients according to main performance indicators such as range of motion, pain, instability and Mayo Elbow Performance Score as parameters.Results
We have found similar results in both group, with an average MEPS value of 95 in the prosthesis group and 966 in the radial head resection group.The range of motion was similar too: between 1,3° and 1203° in the first group and between 4,4° and 120° in the second one. No significant complication has detected in any patient.Discussion
According to most recent literature, it is not precisely defined how to treat isolated Mason III fractures, contrary to what is defined in more complex pattern, in which prosthesis are now evaluated as the best indication.Due to radial head limited contribution to elbow stability, in absence of other bony or ligamentous lesions both capitellectomy and prosthesis can be good treatment in this kind of fracture.Conclusion
According to our experience and to the most recent literature, we recommend prosthesis in patient younger than 50 y.o., high demanding or manual worker, while in other cases we think that radial head resection can be the treatment of choice. 相似文献12.
Thomas Ruffing Tilmann Rückauer Frederic Bludau Alexander Hofmann Markus Muhm Arnold J Suda 《Injury》2019,50(2):607-612
Introduction
Compression fractures of the cuboid bone in children and adolescents are rare. Fracture morphology, associated lesions, treatment options and long-term outcomes of this very rare injury are published in a few case reports. This study with review of the literature aims to support the understanding of fracture pattern and optimize pathways of decision making.Material and Methods
A retrospective two-center study was performed in a patient cohort treated between 2001 and 2016. All patients aged less than 18 years who sustained a cuboid fracture were included. Age, gender, mechanism of injury, fracture morphology, amount of displacement, associated injuries, and therapy were analyzed. In the follow-up (FU), the AOFAS Midfoot Scale was investigated.Results
Fractures of the cuboid bone were diagnosed in 7 boys and 9 girls. The mean age of the patients was 10 years (range: 2.2–16.1 years). According to the classification of Fenton we detected 11 (69%) type 2, 2 (12%) type 3 and 3 (19%) type 5b fractures. Other fracture types according to Fenton were not observed. All children under 10 years sustained a type 2 fracture. Open reduction and internal fixation was performed in 5 (31%) patients. Bone grafting was not necessary. FU was performed in 14/16 patients on average after 9 years (mean; range: 1.4–16.2 years). The mean AOFAS Midfoot Scale at FU for extra-articular type 2 fractures was 100 points, whereas in intra-articular fractures (Type 3) and fractures associated with mid-tarsal disruption (type 5b) worse results were found (95 and 66 points, accordingly).Conclusion
This rare injury shows inhomogenous morphologies and offers different treatment approaches. Extra-articular Fenton type 2 lesions are the most common type of cuboid fracture in children (69%). A potential loss of length of the lateral column must be considered. In contrast to adults, type 1, 4, and 5a fractures were not found in our cohort of children and adolescents. Lower scores of the AOFAS Midfoot Scale were found with either intra-articular involvement or associated midfoot lesions. 相似文献13.
Background
Few methods have been described for measuring hindfoot alignment from an anteroposterior view. The objective of this study was to compare two methods of angular measurement based on the views of Meary and Saltzman.Methods
Thirty asymptomatic volunteers were included. Four radiographs were performed: the views of Meary and Saltzman with parallel feet and with the Fick correction. The reproducibility was determined by the inter- and intraobserver variability (ICC).Results
Meary’s method revealed a mean valgus angulation of 3.9° (SD 3.47°). The reliability was extremely variable with a mean ICC of 0.59. The best reproducibility was obtained with Meary’s method with and without Fick correction.Conclusion
The results of this study show that the reliability of the angular measurements depends on the radiographic view and measurement method chosen. The lateral Fick correction did not counteract the influence of tibial rotation. The same method should be used consistently. 相似文献14.
Jan Herzog Robert Wendlandt Sebastian Hillbricht Rainer Burgkart Arndt-Peter Schulz 《Injury》2019,50(3):744-751
Introduction
The annual incidence of proximal femoral fractures is 100–150/100,000 and continues to increase with an aging population. Cut-out of hip screws after fracture fixation has been quoted as 8% in the literature. The tip-apex distance (TAD) is the strongest predictor for cut-out after operative fracture stabilisation.The aim of this study was to evaluate the novel ADAPT system (Adaptive Positioning Technology, Stryker, USA), a navigation device for intramedullary nailing of trochanteric fractures and its effect on optimising the TAD. This is the first clinical study to evaluate this new technology.Methods
The study group of 36 consecutive patients with a pertrochanteric fracture underwent intramedullary nailing for fracture fixation using ADAPT technology, while the matched control group underwent conventional Gamma-3-nailing. Matching criteria included fracture classification, gender and age. We measured the operative time and the postoperative TAD in anteroposterior (AP) and lateral radiographs of the 72 patients.Results
The mean TAD using ADAPT was 16.9?mm (range 8.4–33.7?mm) compared with 24.9?mm (range 14.6–40.2?mm) in the reference group treated without ADAPT. Using the ADAPT system significantly improved (p?<?0.0005) the accuracy of lag screw placement but had no effect on operating time in fixation of femoral pertrochanteric fractures.Conclusion
Working with the novel ADAPT system for positioning the lag screw using the Gamma-3-nail led to a statistically highly significant reduction of the TAD compared to the reference group (p?<?0.001). The ADAPT system proved to be a very useful device in achieving higher surgical standards for the treatment of trochanteric fractures with intramedullary nailing. It enables higher accuracy in screw positioning and therefore better placement of the implant. 相似文献15.
Purpose
To explore the hidden blood loss (HBL) in treatment of extra-articular tibial fractures with plate and intramedullary nail fixation.Methods
We conducted a retrospective study including 209 consecutive patients treated by plate (Group LCP) or intramedullary nail fixation (Group IMN) for extra-articular tibial fractures between January 2015 to December 2017. Demographics, intraoperative data, perioperative laboratory values, transfusion rate, and early complications were collected and analyzed.Results
Of 209 patients, 96 patients fixed with IMN and 113 fixed with LCP. The average HBL was 272.71?±?57.88?ml in Group LCP and 507.66?±?109.81?ml in Group IMN, and there was statistical difference in the HBL between two groups (p?<?0.001). The Hb and Hct loss, surgical duration, and postoperative number of anemic patients in Group IMN were significantly higher than in Group LCP (p?<?0.001), and IMN fixation has a significantly higher rate of transfusion (p?=?0.027), whereas patients in group IMN has significantly less VBL (p?<?0.001), shorter postoperative hospital stay (p?<?0.001), and less superficial infection (p?=?0.014).Conclusions
There was a significant amount of hidden blood loss after reamed intramedullary nail fixation for extra-articular tibial fractures, which was much higher than expected. In view of the morbidity of acute anaemia and transfusion, we suggest that for patients who suffer from extra-articular tibial fractures with multiple injuries, or those with low haemoglobin preoperatively, plates might be more suitable than nail fixation. 相似文献16.
Introduction
The reported rate of nonunion of distal femoral fractures varies in the literature. Several risk factors for nonunion following lateral locked plating (LLP) have been described. We aimed to study the rate of nonunion, and risk factors thereof, in a Swedish population where fragility fractures are common. A secondary aim was to study risk factors for reoperation for any cause.Patients and Methods
We retrospectively reviewed the hospital files and radiographs of all adult patients admitted to our institution with a distal femoral fracture, from 2004 through 2013. In cases treated with LLP, medical comorbidities, fracture characteristics and implant characteristics were analysed as potential risk factors for nonunion, defined as any surgical intervention to improve healing.Results
There were 8 cases (4%, 95%CI: 1.8–8.1%) of nonunion in 191 fractures treated with LLP. Patients with nonunion were younger: 62 vs. 81 years (p?=?0.009) and more commonly had open fractures: 38% vs. 9% (p?=?0.034). No patient 80 years or older had a surgical intervention for nonunion. Lower age was independently associated with reoperation for any cause, but not for nonunion.Discussion
The low rate of nonunion in this study is probably due to the fact that we present data from a complete cohort from a geographic catchment area. Referral centres with a high proportion of young patients with high-energy injuries, may be better suited for studies on risk factors for nonunion, due to higher statistical power. However, results from such institutions may not be generalizable to the more common low-energy fractures. 相似文献17.
Matthew R. Walker Ashraf N. El Naga Omar H. Atassi Christopher H. Perkins Scott A. Mitchell 《Injury》2019,50(3):686-689
Objectives
Hip dislocations are highly morbid injuries necessitating prompt reduction and post-reduction assessment for fracture and incarcerated fragments. Recent literature has questioned the need for initial pelvic radiographs for acute trauma patients, resulting in computed tomography (CT) scans as the initial evaluation. This study investigates the relationship between choice of pre-reduction imaging and treatment of acute hip dislocations.Design
Retrospective Case-Control.Setting
Single Academic Level I Trauma Center.Methods
All acute hip dislocations from 2011 to 2016 were reviewed. Exclusion criteria were diagnosis of dislocation at another facility, death prior to reduction, emergent surgical or ICU intervention, and periprosthetic dislocation. Patients were grouped by those with only a radiograph prior to reduction, Group I, versus those with a pre-reduction CT scan, Group II. The primary outcomes were time to reduction and the acquisition of a second CT scan.Results
Of the 123 hip dislocations identified, 35 patients were excluded, mostly for transfer with a known dislocation. Group I included 29 patients and Group II included 59 patients. The mean time to reduction was 74?min in Group I and 129?min in Group II for a difference of 55?min (p?<?0.001). The rate of repeat CT scan was 0 in Group I versus 48 (81%) in Group II (p?<?0.001).Conclusion
Initial trauma pelvic radiography prior to CT is still important in the setting of suspected hip pathology to decrease time to hip reduction and unnecessary radiation exposure.Level of evidence
Prognostic Level III. 相似文献18.
Objective
To analyse whether early post-operative full weight bearing following syndesmotic ankle fixation affected radiographic outcomes suggestive of diastasis.Design
Retrospective comparative cohort study over a two year period.Setting
Level 1 trauma centrePatients/Participants
152 consecutive patients sustaining an unstable ankle fracture requiring syndesmotic stabilisation were included. Exclusions were 49 patients who had trimalleolar fixation without syndesmosis screws, one patient who had concomitant ankle and talar fracture. Five patients were lost to follow up and eleven patients were followed up in other centres. A total of 86 patients were analysedIntervention
Protected or full weight bearing.Main Outcome Measurement
The primary outcome measure was early diastasis. The secondary outcomes were late diastasis, wound complications and re-operation. Analysis of variance was used for the predictor variable of weight bearing status. We assumed a priori that p values of less than 0.05 were significant.Results
Median age was 36 (IQR 30), with 54 males and 32 females. Median follow up was 12 weeks (IQR 6). There was no significant difference when comparing weight bearing status and change in radiographic measurements intra-operatively compared to 6 and 12 week follow up radiographs (tibiofibular clear space p?=?0.799, tibiofibular overlap p?=?0.733 and medial clear space p?=?0.261).Conclusion
After surgical stabilization of an unstable syndesmotic injury, full weight bearing did not lead to syndesmotic diastasis in the early post-operative period. Full weight bearing is recommended following ankle fixation which includes syndesmotic fixation. 相似文献19.
Nam Hoon Moon Won Chul Shin Jung Shin Kim Seung Hun Woo Seung Min Son Kuen Tak Suh 《Injury》2019,50(3):713-719
Background
The aim of this study was to investigate the postoperative outcomes of cementless Total hip arthroplasty (THA) following failed internal fixation for femoral neck and intertrochanteric fractures.Method
Ninety-six cementless THAs for failed internal fixation after femoral neck fracture (59, group I) and intertrochanteric fracture (37, group II) with a minimum follow-up of 3 years were analyzed. Clinical and radiologic evaluations were performed on all patients.Results
The intraoperative blood loss and operating time were significantly increased in group II (p?=?0.001, p?=?0.001, respectively). Harris hip score at last follow-up was significantly improved in group I (p?=?0.007) but, there were no differences in hospital stay, Koval score at last follow-up, and perioperative complications between both groups. Long femoral stems for diaphyseal fitting were frequently used in group II (32/37, 86%) (p?=?0.001). Radiographically, none of the acetabular cups showed evidence of migration, loosening. All cases showed stable fixation of the femoral stem at last follow-up.Conclusions
Outcomes of cementless THA following failed internal fixation for femoral neck and intertrochanteric fractures were satisfactory; increased intraoperative blood loss, operating time, and requirement of long femoral stem should be considered in the latter type of fracture. 相似文献20.