Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Feb 2002
Randomized Controlled Trial Comparative Study Clinical TrialResults of a prospective randomised study comparing a non-invasive surgical zipper versus intracutaneous sutures for wound closure.
A prospective randomised study was undertaken to investigate the advantages and disadvantages of a non-invasive surgical zipper (Medizip) vs intracutaneous sutures skin closure in orthopaedic surgery. The study group consisted of 120 consecutive patients, 45 men and 75 women with a mean age of 47 years. The Medizip was used in 20 surgical knee wounds, 20 hip wounds and 20 orthopaedic spine wounds. ⋯ Patients were positive in their assessment of the wound healing progress and results; they found the skin closure device agreeable to wear. The scar result was rated very good in 82% (n = 4 9) of the zipper group, and 85% (n = 5 1) in the intracutaneous group (p = 0 .67). Based on the results obtained, the non-invasive skin closure system Medizip represents a safe option in the spectrum of surgical wound treatment.
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Arch Orthop Trauma Surg · Feb 2002
Comparative StudyHumeral shaft fractures as predictors of intra-abdominal injury in motor vehicle collision victims.
To assess the utility of humeral shaft fractures as predictors of organ injuries and skeletal injuries in multiply injured patients involved in motor vehicle collisions (MVCs). A prospectively collected database of multiply injured motor vehicle occupants with an Injury Severity Score (ISS) greater than 12 admitted to a level I regional trauma centre during a 102-month period (January 1992 to June 2000) was reviewed to assess skeletal and organ injuries associated with a humeral shaft fracture. The effect of occupant location within the vehicle, the point of collision, and the use of a seat belt restraint was also examined to identify trends in injury patterns. ⋯ A lateral collision impact showed a trend towards increased splenic and hepatic injuries within the humeral shaft fracture group. The presence of a humeral shaft fracture in a multiply injured patient involved in a MVC is significantly associated with an increased incidence of both upper and lower extremity fractures and liver injury. Moreover, humeral shaft fractures may serve as a predictor of potential intra-abdominal pathology in multiply injured trauma patients involved in MVCs.
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Arch Orthop Trauma Surg · Feb 2002
Comparative StudyRequirements for NF-kappaB activation in hemorrhagic shock.
The activation of nuclear factor (NF)-kappaB contributes to the dysfunctional inflammatory response accompanying resuscitation from hemorrhagic shock (HS), in part through induction of pro-inflammatory cytokines including granulocyte colony-stimulating factor (G-CSF) and interleukin (IL)-6. In previous studies, we demonstrated that G-CSF and IL-6 up-regulation required both the ischemic and resuscitation phases of HS. In this study, we examined whether or not both phases of HS were required for NF-kappaB activation and the kinetics of its activation. ⋯ NF-kappaB activity did not increase in any of the unresuscitated groups compared with sham controls. In contrast, resuscitation as early as 1 h following HS resulted in increased NF-kappaB activity compared with both the unresuscitated shock group and sham controls; NF-kappaB activation persisted for 8 h. Thus, NF-kappaB activation requires both phases of HS, occurs rapidly following resuscitation, and persists throughout the early stages of dysfunctional inflammation following resuscitation.
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Arch Orthop Trauma Surg · Feb 2002
Comparative StudyComparison of two different posterior approachs for hemiarthroplasty of the hip.
A prospective study was undertaken on 183 patients who had suffered a femoral neck fracture between 1998 and 1999. The aim was to compare the complication rates for the classical posterior approach and the modified posterior approach. The modified posterior approach used was the one described by Williams et al., which preserved the pyriformis, the labrum and the capsule. ⋯ This difference was statistically significant (p < 0.05). There were no significant differences in the incidences of other intraoperative and postoperative complications. We concluded that the modified posterior approach significantly increases the stability of a hemiarthroplasty in relation to the classical posterior approach.
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Arch Orthop Trauma Surg · Feb 2002
Comparative StudySurgical treatment of basal joint disease of the thumb: comparison between resection-interposition arthroplasty and trapezio-metacarpal arthrodesis.
Thirty-six thumbs with symptomatic osteoarthritis of the first carpometacarpal joint were treated either by trapezio-metacarpal arthrodesis (n = 18) or resection-tendon-interposition arthroplasty (n = 18). The mean follow-up of the 29 patients was 42 months. ⋯ No difference in grip strength between the operated and the normal contralateral hand could be established. Nevertheless, the arthrodesis seems to be the procedure causing fewer problems (only one patient not completely satisfied) and is therefore preferred over the resection-tendon-interposition arthroplasty.