Injury
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Stephan Perren's contributions to the understanding and application of the principles of bone pathobiology, healing, and fracture fixation to clinical care remain as a lasting legacy of a great creative mind. Less well appreciated perhaps were his important contributions to the dissemination and practical application of those principles through the use of technology as applied to the learning environment. This paper describes and pays tribute to a series of initiatives in which Perren was a leading mentor and collaborator in the development of methods and instruments through which the principles of bone mechano-pathobiology could be translated through active learning environments into the practical world of clinical musculoskeletal traumatology.
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Randomized Controlled Trial Multicenter Study Retracted Publication
A Multicentre Randomized Controlled Trial Comparing Plating with Intramedullary Nailing for Extra-articular Distal Tibial Fractures.
This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). Injury was alerted to concerns regarding similarities of the data of this study to those published in the FixDIT UK trial.1 The investigators were invited to reply to the issues raised and were also asked to provide their original dataset available to the Editor-in-Chief. ⋯ Costa ML, Achten J, Griffin J, Petrou S, Pallister I, Lamb SE, Parsons NR; FixDT Trial Investigators Effect of Locking Plate Fixation vs Intramedullary Nail Fixation on 6-Month Disability Among Adults With Displaced Fracture of the Distal Tibia: The UK FixDT Randomized Clinical Trial.. JAMA. 2017 Nov 14;318(18):1767-1776.
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A new AO classification for intertrochanteric fractures was recently published; no studies have evaluated its inter- and intra-observer agreement. ⋯ The inter-observer agreement using the new AO classification was significantly better than using its original version. Also, the new AO classification system allowed better agreement when distinguishing stable from unstable patterns.
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Bone healing is a complicated process of tissue regeneration that is influenced by multiple biological and biomechanical processes. In a minority of cases, these physiological processes are complicated by issues such as nonunion and/or fracture-related infection (FRI). Based on a select few in vivo experimental animal studies, construct stability is considered an important factor influencing both prevention and treatment of FRI. ⋯ In this review we describe the role of biomechanical stability on fracture healing, and provide a detailed analysis of the preclinical studies addressing this in the context of FRI. Furthermore, we demonstrate how Perren's concepts of stability are still applied to current surgical techniques to aid in the prevention and treatment of FRI. Finally, we highlight the key knowledge gaps in the underlying basic research literature that need to be addressed as we continue to optimize patient care.
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Since its conception in 1989, minimally invasive plate osteosynthesis (MIPO) has gained widespread popularity. It has been studied in over forty countries with most of the publications originating from Asia, Europe and North America. ⋯ Finally, the up to date evidence is discussed with regard to several anatomical regions in which MIPO is mostly used. In the meantime, MIPO treads steadily towards accomplishing the same or better outcomes for more and more indications with the goal to leave a smaller surgical footprint to allow for undisturbed bone healing.