Injury
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Prophylactic femoral neck fixation may be performed in the setting of geriatric diaphyseal femur fracture, pathologic or impending atypical femur fractures. Fixation constructs often utilize cephalomedullary implants with one or two proximal interlocking screws into the femoral head/neck. Variations in proximal femoral anatomy and implant design can interfere with the placement of two screws in the femoral head and neck. Our objective was to assess the strength of piriformis entry reconstruction implants with one versus two proximal interlock screws for prophylactic femoral neck fixation. ⋯ Our results demonstrate that piriformis entry reconstruction implants have a significantly lower load to failure compared to an intact femur irrespective of screw construct. Further studies are needed to investigate this potential iatrogenic weakening.
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The purpose of this article was to introduce calcaneal lengthening for partial traumatic loss of the calcaneus. Effectiveness with the use of the technique was also assessed. ⋯ For the treatment of partial traumatic loss of the calcaneus, calcaneal lengthening using an Ilizarov frame is a preferable technique to restore the length of calcaneus and foot function.
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The annual incidence of proximal femoral fractures is 100-150/100,000 and continues to increase with an aging population. Cut-out of hip screws after fracture fixation has been quoted as 8% in the literature. The tip-apex distance (TAD) is the strongest predictor for cut-out after operative fracture stabilisation. The aim of this study was to evaluate the novel ADAPT system (Adaptive Positioning Technology, Stryker, USA), a navigation device for intramedullary nailing of trochanteric fractures and its effect on optimising the TAD. This is the first clinical study to evaluate this new technology. ⋯ Working with the novel ADAPT system for positioning the lag screw using the Gamma-3-nail led to a statistically highly significant reduction of the TAD compared to the reference group (p < 0.001). The ADAPT system proved to be a very useful device in achieving higher surgical standards for the treatment of trochanteric fractures with intramedullary nailing. It enables higher accuracy in screw positioning and therefore better placement of the implant.
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Randomized Controlled Trial
A prospective randomized trial of 100 patients using trochanteric support plates; worth their mettle?
To compare the radiological and clinical results of sliding hip screw (SHS) fixation with or without a Trochanteric Support Plate (TSP) on unstable three-or-more-part trochanteric fractures. ⋯ This study cannot confirm that TSP has any beneficial effects on unstable three-or-more-part trochanteric fractures. If any effect at all, the difference is most likely slight and clinically irrelevant.
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The aim of this study was to investigate the postoperative outcomes of cementless Total hip arthroplasty (THA) following failed internal fixation for femoral neck and intertrochanteric fractures. ⋯ Outcomes of cementless THA following failed internal fixation for femoral neck and intertrochanteric fractures were satisfactory; increased intraoperative blood loss, operating time, and requirement of long femoral stem should be considered in the latter type of fracture.