Injury
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Randomized Controlled Trial Multicenter Study
Minimal impact of a care pathway for geriatric hip fracture patients.
Adherence to guidelines for patients with proximal femur fracture is suboptimal. ⋯ Implementation of a care pathway improved compliance to evidence, but no significant effect on patient outcomes was found. The impact of the collaboration between surgeons and geriatricians on adherence to guidelines and patient outcomes should be studied.
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Randomized Controlled Trial Multicenter Study
Cement augmentation of the Proximal Femoral Nail Antirotation (PFNA) - A multicentre randomized controlled trial.
New implant designs like the Proximal Femoral Nail Antirotation (PFNA) were developed to reduce failure rates in unstable pertrochanteric fractures in the elderly. Standardized implant augmentation with up to 6 mL of polymethylmethacrylate (PMMA) cement has been introduced to enhance implant anchorage by increasing the implant-bone interface in osteoporotic bone conditions. Biomechanically, loads to failure were significantly higher with augmentation. The primary objective of this study was to compare the mobility of patients with closed unstable trochanteric fractures treated by PFNA either with or without cement augmentation. ⋯ Augmentation of the PFNA blade did not improve patients' walking ability compared to the use of a non-augmented PFNA but might have the potential to prevent reoperations by strengthening the osteosynthesis construct.
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A femoral shaft fracture is usually a high-energy injury and, thus, is likely to be accompanied by an injury of adjacent joints such as a knee ligament injury. However, these associated injuries are often neglected because of severe pain and deformity. The purpose of the current study is to evaluate the incidence, type and risk factors of ipsilateral knee injuries associated with femoral shaft fractures. ⋯ Knee injuries were identified in approximately 30% of femoral shaft fractures. About 30% of ligament injuries were not detected before internal fixation of femoral shaft fractures. Care should be taken since knee injuries can be accompanied by ipsilateral femoral shaft fractures.