Injury
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Comparative Study
Factors associated with the decision for operative versus non-operative treatment of displaced proximal humerus fractures in the elderly.
In the management of displaced proximal humerus fractures in the elderly, wide variation has been documented. However, no prior study has investigated the factors that currently lead surgeons to treat patients with surgical fixation, arthroplasty or non-operative management. The purpose of this study was to identify the factors associated with treatment selection in the management of displaced proximal humerus fractures in individuals over the age of 60 years. To this end, we conducted a retrospective review of all such injuries that presented to our two level-I trauma centres between 2006 and 2009. ⋯ In this study of displaced proximal humerus fractures in the elderly, the decision for surgery was influenced by the patient's age, the presence of associated orthopaedic injuries, the severity of the fracture and the presence of an associated glenohumeral dislocation. In addition, treatment by a shoulder or upper extremity specialist (as opposed to an orthopaedic trauma specialist) was associated with a higher likelihood of operative intervention. Further investigation into the resultant clinical outcomes is required to determine whether the use of these characteristics to select operative candidates is appropriate and beneficial for patients.
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Wrist fractures are common in older adults and are expected to increase because of ageing populations worldwide. The introduction of plate and screw fixation has changed the management of this trauma in many patients. For policymaking it is essential to gain insight into trends in epidemiology and healthcare utilisation. The purpose of this study was to determine trends in incidence, hospitalisation and operative treatment of wrist fractures. ⋯ Incidence rates of wrist fractures decreased in women and remained stable in men, but hospitalisation rates strongly increased due to a steep rise in operative treatments. The use of plate and screw fixation techniques for distal radius fractures increased in all age groups.
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Four-part fracture dislocations of the proximal humerus occurring in young age are extremely difficult fractures with a high incidence of complications. The risk of avascular necrosis is high; hence, prosthetic replacement is the treatment of choice in older patients with these complex fractures; on the other hand, the longevity of the prosthesis is the main concern in young age. Thus, every effort should be made to fix these fractures in the young. The purpose of this study is to evaluate the results of fixation in a series of young patients with four-part fracture dislocations; to support the trend to fix these fractures; and reserve prosthetic replacement to older patients. ⋯ Anatomical reduction and rigid fixation with meticulous surgical technique can lead to satisfactory results. The results in surgical neck fractures are superior to anatomic neck fractures with significantly less complications.
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Distal biceps tendon rupture is not a very common injury and the literature remains scarce, mainly limited to case series. While surgical repair has become popular, it is not universally accepted and there are insufficient data regarding patient satisfaction following repair. The purpose of this study was to assess the results of anatomical reinsertion according to objective muscle strength testing and patient-reported outcome measures. ⋯ Surgical repair of distal biceps ruptures provides consistently good results in terms of patient-scored outcomes. Objective muscle strength testing does not reveal statistical difference between the injured and the opposite side.
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The tension band principle as applied to transverse olecranon fractures fixed by tension band wiring is based on the premise that distraction forces on the outer cortex of the ulna during elbow flexion are converted to compression forces on the articular surface of the olecranon at the fracture site. In view of some clinical outcomes, where hardware failure and secondary dislocations occur, the question arises if the dynamic compression theory is correct. Compressive forces during active flexion and extension after tension band wiring of a transverse osteotomy of the olecranon were measured in 6 fresh frozen human cadaveric models using a pressure-sensor in the osteotomy gap. ⋯ Posterior, there was no significant pressure difference observed (0.41-0.45 versus 0.36-0.32 MPa) between active flexion and extension. The tension band wiring principle only exists during active extension in a range of 30-120° of flexion of the elbow. Postoperative exercise programs should be modified in order to prevent loss of compression at the fracture site of transverse olecranon fractures, treated with tension band wiring when the elbow is mobilised.