Injury
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To evaluate the cost-effectiveness of antibiotic cement-coated intramedullary nails (IMN) in the initial management of Gustilo-Anderson type Ⅲ (GAIII) open tibia fractures. ⋯ This break-even analysis model suggests the initial use of an antibiotic coated IMN in the setting of GAⅢ open tibia fractures is cost-effective.
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The best internal fixation method for the treatment of Pauwels type III femoral neck fractures (FNFs) remains to be demonstrated. Through finite element analysis, this study explored whether dynamic hip screw (DHS) combined with anti rotation screw or medial buttress plate can improve the stability of internal fixation, and the femoral neck system (FNS) with similar structure to DHS and the traditional cannulated screw (CSs) were added for comparison. To evaluate their respective biomechanical advantages and disadvantages in the treatment of Pauwels type III FNFs. ⋯ Both the anti rotation screw and medial buttress plate can effectively reduce the movement of fracture section and share the shear force of DHS, FNS has the similar fixation stability to DHS + SS, DHS + BS has the biomechanical advantages of significantly reducing the risk of internal fixation failure and femoral yield. Therefore, the use of DHS + BS may be a more favorable choice in the case of Pauwels type III FNFs with higher fixation requirements.
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To assess the accuracy and reliability of the AO Spine Upper Cervical Injury Classification System based on a surgeons' work setting and trauma center affiliation. ⋯ Type B injuries are the most difficult injury type to correctly classify. They are classified with greater reliability and classification accuracy when evaluated by academic surgeons, hospital-employed surgeons, and surgeons associated with higher-level trauma centers (I or II/III).
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Proximal humerus fractures with metaphysodiaphyseal extension represent a challenge for the orthopedic surgeon due to their reduced incidence and the difficulty in the treatment decision. These can be treated with an intramedullary nail or using the MIPO technique, associating different advantages and complications depending on the procedure. The objective of this study was to compare metaphyseal-diaphyseal fractures of the humerus treated with antegrade intramedullary nailing and those operated using the MIPO technique to see if there were significant differences in terms of functional, clinical, and radiological results. ⋯ Proximal fractures with metaphyseal-diaphyseal extension are a challenge for the orthopedic surgeon due to the infrequency, the complexity of these fractures and the fact that there is no established consensus on the ideal treatment for this type of injury. Both the MIPO technique with the Philos plate and the intramedullary nail are valid options for the treatment of these fractures, with no differences observed in terms of fracture consolidation time or in terms of functional results.
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U- and H-shaped fragility fractures of the sacrum (FFP IVb) are unstable fractures. Non-operative treatment may be associated with impaired walking abilities, chronic pain and the potential loss of independency. However, different treatment options are still controversially debated. The aim of surgical treatment includes sufficient fracture stability for immediate full weight bearing and good pain control postoperatively. A new surgical treatment algorithm was developed. This algorithm was evaluated in a cohort of geriatric patients with FFP type IVb regarding surgical complications and patient-related outcome. ⋯ IV.