Injury
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Instability of the distal radioulnar joint (DRUJ) commonly results from traumatic disruption of the distal radioulnar ligaments of the triangular fibrocartilage complex (TFCC). Treatment of this rupture typically requires immobilization of the wrist and elbow for a period of 6 to 8 weeks. This study evaluated the hypothesis that treatment of DRUJ instability with dynamic stabilization would allow early mobilization of both the radiocarpal and distal radioulnar joints by the first postoperative week without compromising restoration of TFCC integrity. ⋯ Acute DRUJ instability treated with dynamic stabilization led to satisfactory clinical outcomes in terms of range of motion, pain relief and joint stability, allowing DRUJ movement from the first postoperative week. This technique represents a simple, reproducible and minimally invasive procedure with a low rate of implant related complications.
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Distal radius fractures (DRF) are among the most frequent in the body. About one third of these fractures can result in malunion with restriction of movement and pain in the wrist, the treatment in these cases consists of corrective osteotomy of the deformity. Due to its three-dimensional (3D) complexity, careful preoperative planning is a fundamental step in correction. The prototyping from the 3D reconstruction of the computed tomography of the affected wrist, allows the real understanding of the deformity. ⋯ Corrective osteotomy through planning with prototyping in 3D printing is an effective method of treating symptomatic distal radius malunions. The possibility of performing the osteotomy in a 3D model, simulating the surgery, making the procedure more predictable.
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Observational Study
Factors of presenting an acute confusional syndrome after a hip fracture.
Acute confusional syndrome (ACS) is a geriatric syndrome that manifests itself with changes in cognition, attention, underactive or hyperactive motor response, and fluctuation in the level of consciousness after trauma, hospitalisation or surgery. The objective is to know the risk factors and prevention of acute confusional syndrome in the elderly with hip fractures (HF) . ⋯ Identifying patients with HF and cognitive impairment using RCMS or the Pfeiffer test and performing HF surgery within 36 h administering perioperative PNB could reduce the incidence of ACS.
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An entry point medial to the tip of the greater trochanter is considered optimal for antegrade femur nailing. The deforming forces in a subtrochanteric fracture often make it difficult to establish a perfect entry point during antegrade cephalomedullary nailing. To overcome this problem, we report a simple technique of making a retrograde entry portal for select difficult subtrochanteric fractures. ⋯ Additional reaming of the thick endosteal lateral cortex through the fracture was performed in atypical fractures. Satisfactory fracture reduction was achieved in all patients and 11 out of the 12 fractures united in the series. 1 patient developed an infected nonunion and was considered failure of treatment. The retrograde entry portal is a valuable alternative method that can be considered in nailing of difficult subtrochanteric fractures to establish an ideal entry point and nail trajectory.
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There is no well-established gold standard for treating trochanteric femur fractures in the elderly. The two common treatment options are cephalomedullary nails (CMN) and sliding hip screws (SHS). In this study, treatment using CMN and SHS were compared for a cohort of patients older than 70 years of age: The main outcomes were quality of life and main residence after surgery. ⋯ There might be a benefit for geriatric patients with trochanteric femur fractures to be treated with a proximal femur nail in regard to a higher QoL and a reduced institutionalization rate. Mortality or revision rate was not affected by the chosen implant.