Journal of orthopaedic trauma
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Randomized Controlled Trial
A prospective, randomized clinical trial comparing an antibiotic-impregnated bioabsorbable bone substitute with standard antibiotic-impregnated cement beads in the treatment of chronic osteomyelitis and infected nonunion.
We sought to compare the effectiveness of an antibiotic-impregnated bioabsorbable bone substitute (BBS, tobramycin-impregnated medical-grade calcium sulfate) with antibiotic-impregnated polymethylmethacrylate (PMMA) cement beads after surgical débridement in patients with chronic nonhematogenous osteomyelitis and/or infected nonunion. ⋯ The results of this preliminary study suggest that, in the treatment of chronic osteomyelitis and infected nonunion, the use of an antibiotic-impregnated BBS is equivalent to standard surgical therapy in eradicating infection and that it may reduce the number of subsequent surgical procedures. A larger, definitive study on this topic is required.
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The purpose of this study is to assess the initial results of percutaneously reducing and fixing calcaneus fractures compared with a concurrent control group that was openly reduced and internally fixed through an extensile lateral approach. ⋯ The results of this study suggest that in comparison to open reduction, this method of percutaneously reducing and fixing calcaneus fractures minimizes complications and achieves and maintains extra-articular reductions as well as the standard extensile open reduction and internal fixation. Further study of this technique is warranted. This should include assessment of articular reduction and longer follow-up of a larger number of patients.
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To assess the recovery of ankle function and general health status at multiple time points during the first 24 months after an isolated tibial plafond fracture treated with joint-spanning external fixation and to determine factors that affect a rapid versus a slow recovery and factors that influence patient outcome at a minimum of 2 years after injury. ⋯ In patients recovering from a tibial plafond fracture that was treated with joint-spanning external fixation, the MCS improves quickly and completely, whereas the PCS often takes 1 full year or longer to reach maximal improvement and does not completely recover, because it remains on average one standard deviation below normal at 2 years after injury. Changes in the AOS pain and disability scales between 6 and 12 months after injury were not significantly different but at all time points, the patient's ankle pain and function remains dramatically different than the normal population. These results can be used in future studies for comparison with patients treated with alternate treatment techniques and to assess the effect of important treatment variables such as stabilization techniques and quality of reduction.
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The selection of a surgical approach for the treatment of tibia plateau fractures is an important decision. Approximately 7% of all tibia plateau fractures affect the posterolateral corner. Displaced posterolateral tibia plateau fractures require anatomic articular reduction and buttress plate fixation on the posterior aspect. ⋯ No complications and no loss of reduction were observed. Additionally, the new posterolateral approach permits direct visual exposure and facilitates the application of a buttress plate. Our approach does not require fibular osteotomy, and fragments of the posterolateral corner do not have to be detached from the soft tissue network.