Injury
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Review Meta Analysis
A systematic review of early versus delayed treatment for type III supracondylar humeral fractures in children.
We performed a systematic review of early versus delayed treatment for type III Gartland supracondylar humeral fractures in children. We identified five non-randomised retrospective studies that fulfilled our criteria. ⋯ We found that failure of closed reduction and conversion to open reduction was significantly higher in the delayed treatment group (22.9%) as compared with the early treatment group (11.1%). Our study provides evidence that type III supracondylar humeral fractures in children should be treated early within 12h of injury.
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Distal clavicular fractures are associated with an increased risk of delayed union and non-union, and therefore operative treatment is favoured. Fragment dislocation and instability result from detachment of the coracoclavicular ligaments. Various methods for operative treatment can be found in the literature, but no gold standard has been established. ⋯ All but one patient regained excellent shoulder function, the mean Constant and DASH scores were 93.3 and 15.3, respectively. Coracoclavicular distance was successfully restored with a mean 1mm (range 0-2mm) side-to-side difference. Early clinical and radiographic results of this new method are promising, with good to excellent outcome in all cases.
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Undisplaced and minimally displaced scaphoid waist fractures can be managed either operatively (percutaneous or ORIF) or non-operatively with both methods obtaining high rates of fracture union and subsequent return of function. The aim of this systematic review is to identify and evaluate the best available evidence to determine whether they should be managed operatively or non-operatively. ⋯ The majority of these injuries can be treated in a cast with good results. Operative treatment should be reserved for patients unable to work in a cast and considered for most manual workers and high-level athletes.
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We evaluated the results of acute application of the Ilizarov external fixator for segmental tibial fractures and also examined the experience with these special type fractures. ⋯ Ilizarov external fixator is a successful method in the acute management of segmental tibial fractures. This method is particularly effective in the treatment of distal segmental fractures of the tibia when the distal segment is short. This method allows for control of complications by decreasing the need for new operations even in the presence of infection.
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We evaluated the efficacy of the expandable nailing system for treating femur and tibia shaft nonunions. ⋯ Our results demonstrated satisfactory healing for the treatment of diaphyseal nonunions of the femur and tibia. The expandable nail offers the theoretical advantages of improved load sharing and rotational control without the need for interlocking screws. We recommend expandable nail systems for femur and tibia shaft nonunions and the use of reamed debris in order to decrease the use of autogenous bone graft.