Journal of orthopaedic trauma
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Osteoporotic fractures present a number of significant challenges for surgical management, including high degrees of fracture comminution, poor implant fixation secondary to inferior bone quality, and compromised capacity for fracture healing. Osteobiologics are materials/agents that can promote fracture healing and enhance fracture stability. ⋯ Despite this, limited clinical investigation into the use of osteobiologics in the management of osteoporotic fractures has been performed. This article reviews a select number of osteobiologic products and the evidence for their use in osteoporotic fractures.
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Typical posterior pelvic fixation constructs use one or more large screws inserted from the lateral iliac cortex into the safe upper sacral ala or body. As a result of the deforming forces acting perpendicular to the implant axis, routine iliosacral screw fixation may not provide adequate stabilization, especially in certain unstable injuries. ⋯ These screws require careful preoperative planning and more precise technical attention during insertion because they pass through both sacral alar zones. Transiliac-transsacral screws may be particularly useful in the presence of osteoporosis, significant posterior pelvic instability including spinopelvic dissociation, patient obesity, anticipated noncompliant behavior, bilateral posterior pelvic injuries, and nonunion procedures.
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We report three cases of a closed Hawkins III talar neck fracture in which the posteromedially dislocated talar body was irreducible even with combined anteromedial and anterolateral approaches. Our intraoperative solution was to proceed with a medial malleolar osteotomy, which resulted in an easy reduction. The combined incisions provided excellent exposure for anatomic reduction and rigid internal fixation. At a mean follow-up of 4 years, all fractures had healed with no evidence of avascular necrosis or talar dome collapse.
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We conducted a study to evaluate the functional outcomes of elderly patients after open reduction internal fixation of intra-articular distal humerus fractures. ⋯ Intra-articular distal humerus fractures are severely disabling injuries, particularly in the elderly population. Good results can be achieved with stable fixation and fracture union. Despite reasonable range of motion, patient-directed questionnaires revealed persistent pain and functional limitations.
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Results of hemiarthroplasty for complex four-part proximal humerus fractures in the elderly have been unreliable. Although patients often achieve pain relief, return of above-shoulder level function can be challenging, because tuberosity nonunion, malunion, and/or resorption is quite common. The reverse shoulder replacement has been advocated as a reliable alternative for these patients. ⋯ Subjective satisfaction ratings were excellent for four patients, and good for two, and satisfactory for one. No patients were unsatisfied with their outcomes. The horseshoe graft technique provides a reliable means for anatomic restoration of the tuberosities, facilitating the return of shoulder function in elderly patients with complex four-part proximal humerus fractures treated with a reverse total shoulder.