Injury
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Syndesmotic injury with supination-external rotation (SER)-type ankle fractures are well known for the serious damages to the osseous and soft tissue envelope. However, the Lauge-Hansen classification system does not provide sufficient information related to syndesmotic injury. In this study, we aimed to investigate factors for preoperative detection of syndesmotic injury according to fracture patterns in SER III and IV ankle fractures by using radiography and computed tomography (CT). ⋯ CT was superior to simple radiography in predicting syndesmotic injury at the preoperative period in SER-type III and IV. Medial space widening and fragment angle of the fibular posterior cortex, as predictive factors, showed significant correlations. In particular, sharper fragment angle of the posterior cortex indicated higher probability of instability that remained after fracture fixation.
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Comparative Study
Outcome of non-surgical treatment of proximal femur fractures in the fragile elderly population.
With the aging of the population the rate of fragility hip fractures increases. While medical recommendations are for hasten surgical treatment, for some older patients burdened with severe comorbidities, this might be risky. ⋯ Operative treatment for fragility hip fracture reduces long-term mortality rates even in the more fragile patients, compared to non-surgical treatment.
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The "missed" scaphoid fracture is a common cause of litigation. This study investigates why a series of scaphoid fractures involved in medical negligence litigation were missed. It also assesses how many might have been detected if MRI had been used to assess all suspected scaphoid fractures with normal X-rays, as suggested by National Institute for Health and Care Excellence (NICE). ⋯ Most of these scaphoid fractures were missed due to failure to consider the possibility of a scaphoid fracture and search for clinical signs of this injury. Some were missed due to failure to detect (or absence of) tenderness over the scaphoid bone. As a scaphoid fracture was never considered, or excluded by clinical examination, in 49 of the 52 cases, a policy of obtaining MRI for all suspected scaphoid fractures would only have detected three of 52 (6%) fractures. Improved awareness through better education is required to reduce the number of missed scaphoid fractures.
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Early mobilization following hip fracture surgery is of superior importance especially in elderly hip fracture patients. Reduced mobilization can result in complications and increased mortality. In this study a gait analysis was performed using force-measuring insoles. ⋯ The focus of further studies should concentrate on alternative analgesia and verify the cause of the observed difference in order to facilitate early full weight bearing especially in hip fracture patients following fracture fixation. The results indicate that in elderly patients, the fracture pattern and thus the surgical approach lead to a different weight bearing pattern. The primary therapeutic goal for elderly patients must be early mobilization at full weight bearing.
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Periprosthetic femoral fracture represent a severe complication, at present the third cause of revision surgery, with an estimated incidence from 0,1 to 2,1%. The number of these fracture can be expect to increase in line with the aging of population and amount of THA implants also in younger high demanding patients. ⋯ In this surgery the objectives are provide an adequate bone healing and return to previous functional status as soon as possible. Many reasons make these goals challenging, in particular advanced age, osteoporosis, co-morbidity and weakness that lead to low energy trauma, the most frequent cause of these injuries. In our opinion a crucial aspect is the evaluation of stem stability, considering an implant mobilized until the opposite is clearly evident. Reduction of surgical time and early mobilization are goals of this surgery, often associated with several complications and high mortality rate.