Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Apr 2010
The management of humeral shaft fractures with associated radial nerve palsy: a review of 117 cases.
This single center retrospective study reviews the management and outcomes of 117 consecutive patients with humeral shaft fractures and associated radial nerve palsy (RNP) treated over a 20-year period (1986-2006). A total of 101 fractures were managed conservatively and 16 fractures underwent external fixation for poor bony alignment. Sixteen grade 1 and 2 open fractures underwent wound toileting alone. No patients underwent initial radial nerve exploration or opening of the fracture sites. ⋯ Humeral fractures with associated RNP may be treated expectantly. With low rates of humeral nonunion, 95% spontaneous nerve recovery in closed fractures and 94% in grade 1 and 2 open fractures, one has the opportunity of waiting. If at 10-12 weeks there are no clinical/EMG signs of recovery, then nerve exploration/secondary reconstruction is indicated. Late tendon transfers may also give good/excellent functional results.
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Arch Orthop Trauma Surg · Apr 2010
Randomized Controlled Trial Comparative StudyInterscalene brachial plexus block for open-shoulder surgery: a randomized, double-blind, placebo-controlled trial between single-shot anesthesia and patient-controlled catheter system.
Interscalene brachial plexus block (ISB) is widely used as an adjuvant regional pain therapy in patients undergoing major shoulder surgery and has proved its effectiveness on postoperative pain reduction and opioid-sparing effect. ⋯ Based on our results, we recommend the use of interscalene plexus block in combination with a patient-controlled catheter system under ultrasound guidance only for the first 24 h after major open-shoulder surgery.
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Arch Orthop Trauma Surg · Apr 2010
Randomized Controlled TrialIntracorporeal pneumatic shock application for the treatment of chronic plantar fasciitis: a randomized, double blind prospective clinical trial.
Plantar fasciitis (PF) is a common clinical condition that usually resolves with non-operative treatments. Extracorporeal shock wave therapy (ESWT) has been used in the treatment of chronic PF not responding to other conservative measures; however, ESWT devices are expensive and available for daily practice in only few centers (In developing countries). A pneumatic lithotripter is a cheap and readily available device which uses pneumatic shock application for the intracorporeal lithotripsy. The aim of this study was to investigate the clinical efficacy of intracorporeal pneumatic shock therapy (IPST) application for the treatment of chronic PF using a cheap and readily available pneumatic lithotripter. ⋯ This pilot study showed that IPST is an effective and safe method of treatment of patients with chronic PF not responding to conservative measures. IPST application should be considered before surgical intervention when the extracorporeal shock devices are not available for daily practice. However, further evaluation of this novel treatment is necessary to understand the exact mechanism of action.
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Arch Orthop Trauma Surg · Apr 2010
Comparative StudyBiomechanical evaluation of fixation of comminuted olecranon fractures: one-third tubular versus locking compression plating.
New concepts in plate fixation have led to an evolution in plate design for olecranon fractures. The purpose of this study was to compare the stiffness and strength of locking compression plate (LCP) fixation to one-third tubular plate fixation in a cadaveric comminuted olecranon fracture model with a standardised osteotomy. ⋯ Contoured LCP and intramedullary screw fixation can be used as an alternative treatment method for comminuted olecranon fractures as its stiffness and strength were not significantly different from a conventional plating technique.
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Arch Orthop Trauma Surg · Apr 2010
Comparative StudyThree-dimensional measurement of femoral antetorsion: comparison to a conventional radiological method.
The aim of our study was to produce a 3-D reconstruction of a CT dataset and compare it to the conventional method, with that same dataset, in terms of precision and the influence of femoral positioning. ⋯ 3-D reconstruction enables precise determination of the femoral AT angle, and is independent of femoral positioning as conventional methods seem to be. In clinical practice, 3-D reconstruction may allow a greater understanding of the femoral AT angle post fracture reduction and internal fixation. However, we believe the 3-D method of measuring the AT-angle can potentially optimize the patient's treatment outcome by allowing the orthopaedic surgeon to measure the femoral AT-angle more precisely after femoral fracture reduction.