Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Dec 2019
Computed tomography versus plain radiography assessment of acetabular fracture reduction is more predictive for native hip survivorship.
Computed tomography (CT) is more accurate than plain pelvic radiography (PXR) for evaluating acetabular fracture reduction. As yet unknown is whether CT-based assessment is more predictive for clinical outcome. We determined the independent association between reduction quality according to both methods and native hip survivorship following acetabular fracture fixation. ⋯ Native hip survivorship is better predicted based on postoperative CT imaging as compared to PXR assessment. Predicting need for THA in patients with inadequate reductions based on both assessment methods remains challenging. While both PXR and CT-based methods are associated with hip survivorship, only an inadequate reduction according to CT assessment was an independent risk factor for conversion to THA.
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Arch Orthop Trauma Surg · Dec 2019
Biomechanical evaluation of suture buttons versus cortical screws in the Latarjet-Bristow procedure: a fresh-frozen cadavers study.
A commonly used method of fixation of the transferred coracoid in the traditional Latarjet-Bristow procedure (open or arthroscopic) is by two bicortical screws. Although mechanically effective, screw fixation is also a major source of hardware and neurologic complications. This study aimed to compare the biomechanical performances of traditional metal screws and endobuttons as fixators of the Latarjet-Bristow procedure. ⋯ A single endobutton fixation appears to be biomechanically comparable to screw fixation in the Latarjet-Bristow procedure and provides a lower risk for graft fracture. Further studies with more numerous specimens are warranted to conclusively validate these findings.
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Arch Orthop Trauma Surg · Dec 2019
ReviewRegional anaesthesia for surgical repair of proximal humerus fractures: a systematic review and critical appraisal.
Regional anaesthesia (RA) is often used in shoulder surgery because it provides adequate postoperative analgesia and may enhance the patient outcome. RA reduces overall opioid consumption and is frequently used in enhanced recovery programs to decrease hospital stay. However, there is very limited literature confirming these advantages in the surgical repair of proximal humerus fractures. This paper reviews the current literature on the use of RA in pain management after surgical repair of these fractures and evaluates the effect of RA on the functional outcome, length of stay in hospital, and health care expenditure. ⋯ This systematic review suggests that RA is a good option for postoperative analgesia in patients undergoing surgical repair of a proximal humerus fracture and is associated with fewer adverse events, a shorter recovery time, and a better functional outcome than those achieved by general anaesthesia alone. However, given the limited amount of data available, conclusions need to be made with caution and prospective studies are needed in the future.
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Arch Orthop Trauma Surg · Dec 2019
Trends in surgical management of proximal humeral fractures in adults: a nationwide study of records in Germany from 2007 to 2016.
Proximal humeral fractures (PHF) are among the most common adult fractures. However, valid epidemiologic population-based data, including differentiation of treatment modalities, are lacking. ⋯ Descriptive epidemiology study, large database analysis.
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Arch Orthop Trauma Surg · Dec 2019
Ex situ reconstruction of comminuted radial head fractures: is it truly worth a try?
Complex radial head fractures are difficult to treat. In cases where stable fixation cannot be achieved, radial head resection or primary arthroplasty are frequently performed. Ex situ reconstruction of comminuted fractures may also be an option. This technique has widely been neglected in the literature, and only two small case series report satisfactory results. The aim of the present case series was to determine the functional and radiological outcomes of ex situ reconstructed Mason III and Mason IV fractures. We expect that the on-table reconstruction of comminuted radial head fractures will lead to bony union with no avascular necrosis in the postoperative course, which will demonstrate that this operative procedure is a reasonable option. ⋯ Level IV-retrospective cohort study.