Injury
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We investigated functional and radiological outcome in 57 cases of midshaft clavicle nonunion treated with open reduction and internal fixation with plate and screws over a 13 year-period. Intercalary bone graft was used in 42 patients; opposite autologous strut graft was used in 31 cases to provide mechanical support to the host bone. Patients were analysed using chart and radiological review and assessed with DASH questionnaire obtained at the latest follow-up. 37 patients were male while 20 were females, with a mean age of 35 years (63-17). ⋯ DASH score was 16.7 at an average of 42 months. Open surgery and internal fixation, using plate and screws in a compression construct is the treatment of choice for symptomatic clavicular non-unions. Intercalary autologous or allograft bone graft should be used especially in patient with significant bone loss; autologous cortical strut graft provides optimum mechanical stability, thus assuring optimal screw purchase and allowing immediate limb movement.
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Two-stage limb reconstruction is an option for patients with critical size segmental bone defects following acute trauma or non-union. Reconstruction is technically demanding and associated with a high complication rate. Current protocols for limb reconstruction have well-documented challenges, and no study has reported on patient outcomes using a validated questionnaire. In this study, we aimed to examine the clinical and patient-centered outcomes following our surgical protocol for two-stage limb reconstruction following critical size segmental defects. ⋯ Outcomes in this small patient cohort were good despite risks of complication. There is an association between infection and non-union. Further studies addressing clinical and functional outcomes will help to guide expectations for future surgeons and patients.
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Minimally invasive surgical operation of intramedullary (IM) nailing is a standard technique for treating diaphyseal fractures. However, in addition to its advantages, there are some drawbacks such as the frequent occurrence of malalignment, physical fatigue and high radiation exposure to medical staff. The use of robotic and navigation techniques is promising treatments for femoral fractures. ⋯ An experimental model for simulating human femoral characteristics was proposed. Experiments conducted on the artificial lower limb model demonstrated high reduction accuracy, safety, sufficient working space, and low radiation exposure of the proposed robot-assisted system. Thus, the minimally invasive teleoperated manipulator would have greater development prospect.
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To evaluate the effectiveness of a step-by-step oral recount by residents before the final execution of a practical exercise simulating a surgical fixation of a radial diaphyseal fracture. ⋯ An oral step-by-step recount by the residents before the final execution of a practical simulation exercise of surgical fixation of a diaphyseal radial fracture improved the technique and reduced the execution time of the exercise.
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To determine the variability in the ideal entry point of cephalomedullary (CM) nail around the greater trochanter (GT) and the consequent conformity with the proximal femur by analyzing three-dimensional (3D) modeling and virtual implantation MATERIALS AND METHODS: A total of 105 cadaveric femurs (50 males and 55 females) underwent continuous 1.0mm slice computed tomography (CT) scans. CT images imported into Mimics® software to reconstruct the 3D model of the proximal femur and medullary canal. PFNA-II® was processed into a 3D model using a 3D-sensor at the actual size and optimally implanted in the proximal femur model using Mimics® software. The ideal entry point, nail conformity with the proximal femur, and the relationship between the entry point and adjacent structures were assessed. ⋯ The ideal entry point was located a mean of 2.38mm (SD, 3.53mm) medial to the tip of GT. No lateral cortex impingement of the proximal femur occurred in the coronal plane based on the recommended point. However, a disparity in the sagittal plane between the proximal shaft and nail curvature was found in 47 models (44.8%). Rotation and magnification of the 3D model exposed all nails above the surface of the medial side of the GT. The proximal nail end was contained entirely within bone and circumferential endosteal cortical contact was present at the nail-bone interface.