Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 1999
Diagnosis and treatment of scaphoid fractures, can non-union be prevented?
In order to evaluate the diagnostic management of scaphoid fracture, 100 consecutive patients with clinically suspected scaphoid fractures were investigated. If a scaphoid fracture was seen on scaphoid radiographs, patients were immobilized in a plaster cast. If the radiographs were negative or dubious for scaphoid fracture, patients were referred for three phase bone scintigraphy. ⋯ Of these 68 patients, 17 patients (25%) showed a hotspot on the bone scan in the region of the scaphoid. We found that scaphoid radiographs, additional carpal box radiographs and the bone scan (in radiographically negative patients) in combination with conservative therapy did not lead to non-union at long-term follow-up in patients who were treated for scaphoid fracture. We conclude that when a scaphoid fracture is diagnosed within the 1st week followed by plaster immobilization, non-union of the scaphoid could be prevented.
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Intraoperative femoral fracture is a well recognized technical complication of cementless total hip arthroplasty (THA). The aim of this study was to establish an in vitro model for initiation of fractures of the femur in cementless THA and to assess the effect of fracture fixation by cerclage wiring. An in vitro comparison of two methods of cerclage fixation was performed using steel wire (Protasul) versus multifilament Vitallium alloy cable. ⋯ After monofile cerclage wire application, a force of 1.8-8.1 times body weight was necessary to press the prosthesis 30 mm deeper into the medullary canal. After polyfile Vitallium alloy cable application in other specimens, the force was 7.7-12 times body weight. The difference was statistically significant (U-test, alpha < 0.025).
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Arch Orthop Trauma Surg · Jan 1999
Clinical Trial Controlled Clinical TrialThe classic nail in the therapy of trochanteric fractures.A prospective, controlled study.
In a prospective controlled study we analysed the classic nail, a new intramedullary implant for the fixation of peritrochanteric fractures. By means of lateral bending of 4 degrees, unreamed implantation is generally possible. Our collective of 85 patients was characterized by elderly mean age (82.3 years), a predominance of female patients (4.3 : 1), a minor trauma aetiology without relevant additional injuries, and a high rate of concomitant disease (92%). ⋯ The mortality (30 days: 18%, 6 months: 25%) as well as the high rate of unspecific complications (20%) were caused by the patients' multiple morbidity. Deficits in the Merle d'Aubigne score at follow-up after 6 months can be interpreted within the same context. Nevertheless, 85% could return to their former social environment and only 15% became dependent on a nursing institution in connection with the fracture treatment.
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Arch Orthop Trauma Surg · Jan 1999
Clinical Trial Controlled Clinical TrialImmunohistochemical localization of collagen VI in arthrofibrosis.
Arthrofibrosis is a disabling complication after knee trauma and surgery. Clinically, it is characterized by pain and joint stiffness due to massive connective tissue proliferation. In similar pathological conditions with fibrotic transformation such as lung fibrosis or superficial fibromatoses, an increased expression of collagen type VI has been reported. ⋯ Histologic analysis showed a synovial hyperplasia with inflammatory cell infiltration and vascular proliferation. Compared with normal synovial tissue, type VI collagen was widely distributed as a network subsynovially and around the capillary walls. The results of the present study suggest that dysregulation of collagen VI synthesis could be an important contributing factor in the complex mechanisms of disordered matrix protein deposition leading to arthrofibrosis.
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Arch Orthop Trauma Surg · Jan 1999
Combined sciatic and femoral nerve block for knee arthroscopy: 4 years' experience.
Selective block of the femoral and sciatic nerves was performed on 601 patients undergoing knee arthroscopy. The results were good in 87%, adequate in 12%, and poor in 1%. ⋯ No correlation was observed between the effectiveness of the anesthesia and type of surgery performed. The technique described thus proved adequate for knee arthroscopic surgery, reproducibility was excellent, costs and hospital stays were reduced with respect to general anesthesia, and surgeon and patient satisfaction was high.