Injury
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Review Comparative Study
Comparison of adverse events and postoperative mobilization following knee extensor mechanism rupture repair: A systematic review and network meta-analysis.
Extensor mechanism rupture (EMR) of the knee is a rare but potentially debilitating injury that often occurs due to trauma. While a wide variety of surgical treatments have been reported, there is currently no consensus on the most successful treatment method. The timing of post-operative joint mobilization is also critical for successful recovery after EMR repair. Despite the traditional method of complete immobilization for 6 weeks, there is an increasing trend towards early post-operative knee mobilization. The purpose of this network meta-analysis was to compare adverse event rates and function outcomes between repair methods and between post-operative mobilization protocols. ⋯ We performed the first network meta-analysis to date comparing treatment of EMRs. Our results support the current body of knowledge that there is no single superior repair method. Although there is an increasing trend towards early or immediate post-operative knee mobilization, we found that early mobilization is associated with significantly higher adverse event and total event rates compared to fixed immobilization for a minimum of 6 weeks, implicating an increased financial burden and decreased quality of life associated with early post-operative mobilization.
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To identify and describe the characteristics of existing practices for postoperative weight bearing and management of tibial plateau fractures (TPFs), identify gaps in the literature, and inform the design of future research. ⋯ Postoperative rehabilitation for TPFs most commonly involves significant non-weight bearing time before full weight bearing is recommended at 9-12 weeks. Partial weight bearing protocols and brace use were varied. Type of rehabilitation may be an important factor influencing recovery, with future high quality prospective studies required to determine the impact of different protocols on clinical and radiological outcomes.
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In the present retrospective study, we aimed to analyze the results of treatment for recalcitrant distal tibial nonunion using Masquelet technique with locking plate as a definitive external fixator. ⋯ Although the current study involved only a small number of patients and the intervention comprised two stages, we consider that the used protocol is a simple and valuable alternative for the treatment of recalcitrant distal tibial nonunion.
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The purpose of this study was to investigate whether surgical delay or the educational level of surgeon is associated with early mortality in patients with distal femoral fractures. ⋯ No association between surgical delay or educational level of surgeon and mortality was found. These findings do not support the development of guidelines for decreasing surgical delay in this population.
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Review
How can we influence the incidence of secondary fragility fractures? A review on current approaches.
With the increasing number of elderly patients presenting with fragility fractures, their care has become a focus among trauma and orthopaedic surgeons. Protocols are ever evolving to improve the clinical pathways and treatment modalities targeting a more efficient and patient centred service. In this article, current approaches and their potential to reduce mortality and re-fracture in these patients are discussed.