Injury
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Despite the generally successful outcome of intertrochanteric fracture fixation, the treatment is challenging when fixation failure occurs. Some studies have reported a systemic treatment strategy for salvaging failed intertrochanteric fracture fixation. This prospective study with a retrospective review of data aimed to evaluate and validate the efficacy of an evidence-based protocol developed for the treatment of failed intertrochanteric fractures. ⋯ The new treatment strategy for failed intertrochanteric fracture fixation based on the condition of the femoral head, deformation of the fracture site and bone defect is successful based on clinical and radiographic results. Restoration of NSA of failed intertrochanteric fractures is a key factor for obtaining successful results.
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Periprosthetic femoral fractures (PFFs) following total hip arthroplasty are becoming more prevalent and management of these fractures is often demanding. The surgeon has to assess in detail implant loosening, bone loss and type of fracture. The aim of the study is to identify the suitability of a treatment algorithm, based on the Vancouver classification that takes into account the activity and comorbidity of each patient. ⋯ PFF remains a serious complication of hip arthroplasty that is accompanied by high morbidity and mortality rates. This study shows how patients' comorbidities and functional demand can direct the proper treatment. This is a suitable algorithm for the treatment of PFF, which can provide satisfactory results in terms of pain and function.
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Randomized Controlled Trial
Posterior malleolar fracture morphology determines outcome in rotational type ankle fractures.
Rotational type ankle fractures with a concomitant fracture of the posterior malleolus are associated with a poorer clinical outcome as compared to ankle fractures without. However, clinical implications of posterior malleolar (PM) fracture morphology and pattern have yet to be established. Many studies on this subject report on fragment size, rather than fracture morphology based on computed tomography (CT). The overall purpose of the current study was to elucidate the correlation of PM fracture morphology and functional outcome, assessed with CT imaging and not with -unreliable- plain radiographs. ⋯ Posterior malleolar ankle fractures with medial extension of the fracture line (i.e. Haraguchi Type II) are associated with significantly poorer functional outcomes. The current dogma to fix PM fractures that involve at least 25-33% of the tibial plafond may be challenged, as posterior malleolar fracture pattern and morphology - rather than fragment size - seem to determine outcome.
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Randomized Controlled Trial
Hip precautions not meaningful after hemiarthroplasty due to hip fracture. Cluster-randomized study of 394 patients operated with direct anterolateral approach.
We aimed to compare two treatment regimes, one with and one without postoperative precautions in hemiarthroplasty patients, in terms of dislocation rate and patient-reported outcome. Direct lateral approach was used. ⋯ Rehabilitation precautions are not needed for preventing dislocation when direct lateral approach is used. Without precautions, rehabilitation personnel implement significantly shorter work effort during hospital. We found no statistically significant differences regarding PROM and complications except for somewhat more reoperations in total in the precaution group.