Injury
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
PC-Fix and local infection resistance--influence of implant design on postoperative infection development, clinical and experimental results.
Bacterial infection is still one of the main complications after internal fixation of fractures. The design of implants influences local infection resistance. To reduce the development of infections around implants after internal fixation, the vitality of the bone should be preserved to optimize cellular and humoral host defence mechanisms. ⋯ Infection rates in the DCP group were significantly higher than in the PC-Fix group: Of the 38 evaluated animals, 12 with a DCP and 5 with a PC-Fix developed local infection (p=0.022). The new PC-Fix design shows low postoperative infection rates in the clinical setting and lower infection rates than the DCP in the experimental setting. The design is an important step in the process of reducing postoperative infection rates.
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Randomized Controlled Trial Comparative Study Clinical Trial
Internal fixation versus hemiarthroplasty versus total hip arthroplasty for displaced subcapital fractures of femur--13 year results of a prospective randomised study.
In this prospective randomised trial we compare the mortality, morbidity and functional results of patients following each of the three principal methods of treatment for displaced subcapital fractures of the femur. Two hundred and ninety patients over the age of 65 years were included and randomly allocated to undergo closed reduction and internal fixation with a sliding compression screw plate or uncemented Austin Moore hemiarthroplasty or cemented Howse II total hip arthroplasty (THA). Nineteen patients were subsequently excluded. ⋯ In the long term, both internal fixation and hemiarthroplasty resulted in a poor outcome with respect to pain and mobility. Despite high early complications, THA resulted in least pain and most mobility both in the short and long-term and was encouraging with a revision rate of only 6.25%. THA should be seriously considered in physiologically active patients with a displaced subcapital fracture of the femur.
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Randomized Controlled Trial Clinical Trial
Intra-articular lignocaine versus Entonox for reduction of acute anterior shoulder dislocation.
We assessed, in a prospective randomised trial, the relative analgesic effects of Entonox and intra-articular lignocaine (IAL) in patients with acute anterior dislocation of the shoulder. A statistically significant reduction in pain scores was achieved with IAL (7.9 vs 5.2, P < 0.05), but the effect with Entonox was greater (7.8 vs 2.9, P < 0.001). We conclude that Entonox provides better analgesia than IAL in patients with acute anterior shoulder dislocation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Kocher's painless reduction of anterior dislocation of the shoulder: a prospective randomised trial.
Forty-five patients with an anterior dislocation of the shoulder were randomised into one of two treatment groups and manipulation performed using Kocher's original method (without traction). A successful reduction was achieved in 80.9% of patients administered Entonox only and in 100% of patients sedated intravenously. No statistical significance was found in the pain scores between the two groups. The study shows that Kocher's original method is a reliable technique for reducing anterior dislocation of the shoulder and a successful outcome can be expected using nitrous oxide only, obviating the need for intravenous sedation and analgesia in the majority of patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of dynamic hip screw and gamma nail: a prospective, randomized, controlled trial.
We report a prospective, randomized, controlled trial, comparing the results of treatment with a dynamic hip screw (DHS) and a gamma nail in 95 consecutive patients with peri-trochanteric fractures of the femur. The DHS was used in 48 patients, the gamma nail in 47. Clinical and radiological outcomes were similar, but the gamma nail was associated with a higher incidence of complications, in particular fracture of the femur below the implant in eight cases. This is consistent with previous reports, and we do not recommend the gamma nail for the treatment of peri-trochanteric femoral fractures.