Injury
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The Humerusblock (HB) represents a minimally invasive implant allowing for the stabilisation of proximal humeral fractures after closed or percutaneous reduction. The aim of the study was to perform a general clinical and radiological midterm follow-up focusing on the quality and complications in a large series of patients of younger age (<70 years). ⋯ Retrospective case series (evidence-based medicine (EBM) level IV).
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Extent and orientation of interfragmentary movement (IFM) are crucially affecting course and quality of fracture healing. The effect of different configurations for implant fixation on successful fracture healing remain unclear. We hypothesize that screw type and configuration of locking plate fixation profoundly influences stiffness and IFM for a given load in a distal femur fracture model. ⋯ Mechanical frame conditions can be significantly influenced by type and placement of the screws in locking plate osteosynthesis of the distal femur. By varying plate working length stiffness and IFM are modulated. Moderate axial and concomitantly low shear IFM could not be achieved through changes in screw placement alone. In the present transverse osteotomy model, ratio of shear/axial IFM with simultaneous moderate axial IFM is optimized by the use of appropriate plate working length of about 42-62 mm. Fixation with sLS demonstrated significantly more axial IFM underneath the plate and may further contribute to compensation of asymmetric straining.
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Tranexamic acid (TXA) has been shown to reduce perioperative blood loss in elective lower limb arthroplasty surgery. There are potentially even greater physiological benefits in minimising blood loss in hip fracture surgery, however limited evidence exists for TXA use in hemiarthroplasty surgery. This study investigates the effect of TXA use on postoperative transfusion rates and haemoglobin (Hb) levels specifically following hemiarthroplasty surgery for hip fractures. ⋯ One transfusion was prevented with every 8 patients given prophylactic TXA. There were no differences in the 30 and 90-day mortality rates with TXA use. Tranexamic acid is safe, cost-effective and reduces the need for blood transfusion and should be considered in all patients undergoing hip hemiarthroplasty for fractures.
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Established fracture nonunions rarely heal without secondary intervention. Revision surgery is the most common intervention, though non-surgical options for nonunion would be useful if they could overcome nonunion risk factors. Our hypothesis is that low-intensity pulsed ultrasound (LIPUS) can enhance heal rate (HR) in fractures that remain nonunion after one year, relative to the expected HR in the absence of treatment, which is expected to be negligible. ⋯ Low-intensity pulsed ultrasound enhanced HR among fractures that had been nonunion for at least 1 year, and even healed fractures that had been nonunion >10 years. LIPUS resulted in successful healing in the majority of nonunions without further surgical intervention.
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Analyzing the different age groups in a population who suffered a pelvic ring fracture it becomes obvious that there are important differences between the pelvic ring lesions of an elderly patient compared to a young adult concerning trauma mechanism, fracture pattern and therapeutic options. In the elderly patient it is very important to achieve maximum of stability if surgery is necessary in order to avoid early failure of the ostheosynthesis under mobilization with full weight bearing. ⋯ The focus of this study was to describe the modified surgical technique of the caTIFI with placing the Schanz screws from the posterior superior iliac spine to the anterior inferior iliac spine into the supraacetabular bone canal. Usage of cannulated and perforated Schanz screws gives the opportunity to control the correct position of the screws before implanting them. Another advantage is that additional stability can be obtained by cement augmentation. We believe that the new technique of the caTIFI provides a greater intraoperative versatility and a greater mechanical stability for fragility fractures of the pelvis.