Journal of orthopaedic trauma
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This study aimed to analyze the clinical results after treatment of complex elbow injuries with modular anatomic radial head prosthesis (MARHP), along with ligament repair and fracture fixation. ⋯ Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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To compare implant positioning in the distal femur between 2 cohorts of elderly patients treated for a hip fracture with a long 200- or 150-cm radius of curvature (ROC) cephalomedullary nail. We theorized that the 150-cm ROC nails would more closely approximate the femoral bow and result in fewer implant-related complications. ⋯ Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Randomized Controlled Trial
Diagnosis of femoral neck fracture associated with femoral shaft fracture: blinded comparison of computed tomography and plain radiography.
Femoral neck fractures that are associated with femoral shaft fractures have historically been associated with high rates of missed diagnosis. Despite the potentially serious consequences of a missed femoral neck fracture, little work has been conducted to rigorously evaluate the ability of commonly used imaging studies to detect such fractures. Our hypothesis was that axial-view computed tomography is superior to plain radiography at detecting femoral neck fractures. ⋯ Plain radiography and computed tomography have rates of missed femoral neck fractures that are similar and substantial, with a sensitivity of only 56%-64%. Our data emphasize the importance of intraoperative and postoperative imaging in detecting nondisplaced femoral neck fractures in association with femoral shaft fractures.
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The rotationally stable screw-anchor plate system (RoSA) is unique in using a novel screw-blade combination. This investigation tested the hypothesis whether RoSA is advantageous over the sliding hip screw plate system (SHS) with regard to stiffness, failure load, displacement, and migration in stable trochanteric femur fractures (OTA 31A1.1). ⋯ The fixation of stable trochanteric femur fractures with RoSA in cadavers led to greater primary stability under cyclic load, with significant advantages with regard to stiffness, failure load, and rotational stability, compared with the SHS. A detrimental effect was its migration tendency, which began at 1800 N and occurred in the cranial direction. A meticulous insertion technique was a prerequisite to avoid iatrogenic perforation of the femoral head. Our results will have to be substantiated by further biomechanical and clinical trials using an optimized RoSA system.
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: A unique complication of using full-length intramedullary nails for pertrochanteric and subtrochanteric femur fractures is nail penetration of the anterior cortex at the distal end of the femur because of a mismatch of the anatomic femoral bow with that of currently available cephalomedullary nails (CMNs). This study was performed to determine the rate of distal femoral cortical penetration after stabilization of the proximal femur in a consecutive series of patients using a long CMN with a curvature of 180 cm and to examine the final location of the nails within the femoral canal. ⋯ : Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.