Orthopedics
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Clinical Trial
The use of calcium sulfate impregnated with vancomycin in the treatment of open fractures of long bones: a preliminary study.
The purpose of this study was to investigate the effect of calcium sulfate impregnated with vancomycin combined with internal fixation in the treatment of open fractures of long bones. Between October 2007 and January 2008, twenty-eight patients (24 men, 4 women) who sustained open fractures of long bones were enrolled. Mean patient age was 34.5 years (range, 19-57 years). ⋯ Bone union was observed in 23 patients, with a mean bone union time of 5.8 months (range, 4-9 months). All the calcium sulfate pellets had completely resorbed in an average of 1.4 months (range, 1-2 months). Our study showed that the combination of internal fixation and calcium sulfate impregnated with vancomycin could decrease the incidence of deep infection without impairment to the bone healing process in the treatment of open fractures of long bones.
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This is the first reported case of the completely endoscopic management of osteitis pubis with pubic symphysectomy. A 31-year-old woman suffered from recalcitrant osteitis pubis that had progressed to an end-stage auto-fused condition. Ossified pubic symphyseal fibrocartilage and adjacent heterotopic bone were endoscopically removed as part of a comprehensive surgery that also involved bilateral arthroscopic surgery for symptomatic femoroacetabular impingement. ⋯ Twelve months following this single-stage surgery, the patient reported high satisfaction with decreased pain, improved function, and resolution of a classic waddling gait. The association of intra-articular hip pathology with osteitis pubis is noted. We believe that this minimally invasive bone-conserving surgery may be useful in the management of recalcitrant osteitis pubis and perhaps find broader application in the outpatient endoscopic treatment of athletes afflicted with this condition.
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External fixation is a temporizing measure that has a long history in the treatment of fractures. Thirty-eight newly designed large-frame external fixators were applied for acute lower-limb fractures and pelvis injuries in a level I trauma center. In 75% of cases, the frames were used for first-stage skeletal stabilization, followed by revision to plates or nails 1 to 2 weeks later. ⋯ Patient acceptance of the device was good. There were no complications or disadvantages associated with the use of this lower-cost device. Specifically, there were no pin tract infections, no loss of fixation, and no loosening or disassembly of the devices.
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The population of Western countries is aging. Previous studies have reported that advancing age does not significantly affect acute inpatient stay in femoral neck fractures. The primary goal of our study was to compare inpatient stay in acute orthopedic wards and time delay to surgery with increasing age in patients with femoral neck fractures. ⋯ As the population ages, the number of femoral neck fractures will increase. Our study demonstrates that age is an independent predictor of increased inpatient stay and surgical delay. It also shows that we need increased resources to tackle femoral neck fractures in the aging population.