International orthopaedics
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Comparative Study
Comparison of intramedullary nail, plate, and external fixation in the treatment of distal tibia nonunions.
The purpose of this study was to examine time to union of extra-articular distal tibia nonunions based on fracture type and fixation methods: intramedullary nail (IMN), plate osteosynthesis (PO), and external fixation (EF). ⋯ In this nonunion population, comminuted fracture types needed more time and revisions to reach union. Time to union was only clinically shorter when revision fixation was not performed, but IMN and PO were both successful fixation options with significantly shorter times to union than EF. Mean time to union increased even more when revision of fixation method was performed vs. exchange revision, as did nonunions with deep infections.
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Managing hip fracture surgery in patients taking clopidogrel is challenging. The optimal timing for surgery remains unclear. Early surgery in such patients potentially increases peri-operative bleeding, whereas delayed surgery has been shown to be associated with worse postoperative outcomes. The aim of this study was to investigate whether a delay to surgery affects total blood loss, bleeding kinetics, blood transfusion requirements, or post-operative outcomes. ⋯ Early surgical treatment of hip fracture in patients receiving clopidogrel does not increase the overall red blood cell loss or the transfusion requirement, but may affect the timing of blood transfusion. Hip fracture surgery should preferably be performed without delay in patients taking clopidogrel.
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Carbon-fibre reinforced polyetheretherketone (CFR-PEEK) plates have recently been introduced for proximal humerus fracture treatment. The purpose of this study was to compare the locking screw-plate interface stability in CFR-PEEK versus stainless steel (SS) proximal humerus plates. ⋯ The mechanical stability of locking screws in CFR-PEEK plates is comparable or superior to locking screws in SS plates.
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The purpose of this study is to compare INFIX to plating in the treatment of unstable pelvic ring injuries with disruption of the symphysis. ⋯ Plating provides better reduction of the pubic symphysis and requires only one surgery. Outcomes scores were similar. INFIX may be preferable in obese patients, young women of childbearing age or those with urological injury.
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Displaced unstable distal third fractures of the humeral diaphysis are treated surgically through open reduction and internal fixation. Conventionally, surgeons prefer using long plates for secure fixation; however, we performed short plate dual plating for robust fixation that required a smaller incision and less dissection through an anterior approach. In this study, we report the results of dual plating of fractures of the humeral shaft, with radiographic evidence and clinical analysis. ⋯ Satisfactory radiographic evidence and clinical results suggest that dual plating for distal diaphyseal humeral fractures may be considered a surgical option, with the advantages of strong fixation, less invasion of soft tissue, and early rehabilitation.