Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 2008
Case ReportsA primarily overlooked and incorrectly treated Essex-Lopresti injury: what can this lead to?
What result can one expect in treating an Essex-Lopresti lesion--a rare complex combination injury of the forearm consisting of a radial head fracture and a rupture of the interosseous membrane--which failed to be identified at first? ⋯ Years of illness and multiple corrective operations which only serve to limit the collateral damage caused by the wrong therapy strategy and ultimately only lead to restoration of moderate function. The crucial factor is an early diagnosis. Then a radial head prosthesis should first be implanted in an operation in order to prevent an additional proximal migration of the radius and to move the distal radioulnar joint into the proper anatomical position.
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Arch Orthop Trauma Surg · Dec 2007
Randomized Controlled TrialSimplified wound care and earlier wound recovery without closed suction drainage in elective total hip arthroplasty. A prospective randomized trial in 100 operations.
Evidence to support or refute closed suction drainage (CSD) in primary total hip replacement (THR) is not conclusive. Our anecdotical experience was that persistent ooze from the drainage hole often delayed wound recovery. We hypothesized that, without CSD, wound care would be simplified without short or long term disadvantage. ⋯ To omit CSD in primary THR results in simplified and more rapid wound management without any disadvantage at short and long term.
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Arch Orthop Trauma Surg · Dec 2007
Comparative StudyTrochanteric fractures in the elderly: the influence of primary hip arthroplasty on 1-year mortality.
The aim of the study was to compare the mortality risk and complication rate after operative treatment of pertrochanteric fractures with primary arthroplasty, dynamic hip screw (DHS) or proximal femoral nail (PFN). ⋯ For stable fractures a dynamic hip screw (DHS) and for unstable fractures a short proximal femoral nail (PFN) can be recommended. The mortality risk of primary cemented arthroplasty did not differ significantly from the other treatment groups and because of its low complication rate it is a viable treatment option for trochanteric fractures if osteoporosis prevents from full weight bearing or if osteoarthritis makes further operations likely. Primary total hip replacement should be handled with care due to its significantly higher dislocation rate compared with hemiarthroplasty especially in unstable fractures.
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Arch Orthop Trauma Surg · Dec 2007
Case ReportsInferior dislocation of the proximal tibiofibular joint: a new type of dislocation with poor prognosis.
Dislocation of the proximal tibiofibular joint is an unusual injury. We report a patient, who developed inferior proximal tibiofibular dislocation after a severe motorcycle accident. ⋯ Classifications of proximal tibiofibular dislocations did not include inferior dislocation. This type is always associated with avulsion mechanism and has the poorest prognosis.
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Arch Orthop Trauma Surg · Dec 2007
Angular and sliding stable antegrade nailing (Targon PH) for the treatment of proximal humeral fractures.
The optimal surgical treatment for displaced proximal humeral fractures continues to be controversial. Different treatment modalities are available. Mechanical implant-related problems, however, and the preservation of the biological integrity of the humeral head remain unsolved. New implants providing angular stability are expected to maintain the intraoperative result of reduction until definitive healing. The purpose of this study was to evaluate the functional outcome and the complication rate of an angular and sliding stable antegrade interlocking nail for the treatment of displaced proximal humeral fractures. ⋯ The treatment of displaced proximal humeral fractures with an angular and sliding stable antegrade nail (Targon-PH) led to good functional results, especially in 2- and 3-part fractures. There exists a substantial risk for postoperative complications and bad motor function in Neer IV/4 fractures. Lateral backing out of screws was abolished by implant modifications (PEEK-inlay) from 2003 onwards. Additional tension wire banding of the major tubercle may further reduce the risk of secondary displacement.