Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Nov 2007
The use of hamstrings in anterior cruciate ligament reconstruction in patients over 40 years.
Anterior cruciate ligament reconstruction is an increasingly established method even in patients over 40 years old. Recent studies with regard to this procedure used BTB transplants. We did a retrospective follow-up examination on over-40-year-old patients with anterior cruciate ligament reconstruction using hamstring transplants and compared them to a younger control group. Our hypothesis is that functional outcome after ACL-reconstruction is comparable in patients under and over 40 years of age. ⋯ The predominantly good results and a high level of patient satisfaction show that anterior cruciate ligament reconstruction is justified even in over-40-year-old patients with persistend subjective symptomatic anterior knee instability. The indication for reconstruction should be based on individual factors such as level of activity or subjective feeling of instability rather than on a dogmatic age limit. Advanced arthrotic changes compared to the healthy side, might be due to a too long period of preoperative decision making.
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Arch Orthop Trauma Surg · Oct 2007
Review Case ReportsOpen grade III "floating ankle" injuries: a report of eight cases with review of literature.
"Floating ankle" injuries result from high-energy trauma and are usually associated with extensive soft tissue damage. Such rare and complex injuries in the acute phase pose therapeutic dilemma to the treating surgeon. When salvage instead of amputation is preferred, a variety of treatment options are available ranging from open reduction along with minimal internal fixation to external fixation. In this retrospective case series study we report eight patients with open "floating ankle" injuries who had been treated with external fixation with or without internal fixation. ⋯ External fixation with or without internal fixation is an option when salvaging rare injuries like open grade III "floating ankle" injuries. Salvaged patients do suffer a cocktail of crippling disease characterized by psycho-socio-economic and physical disability and result in increased hospital costs. We recommend more prospective studies with long-term follow-up of such complex injuries to identify the indications for salvage and also the criteria for a successful salvage.
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Arch Orthop Trauma Surg · Oct 2007
Treatment of the humeral shaft nonunion after surgical failure using the Selfdynamisable internal fixator.
A nonunion of the humeral shaft is not a rare condition and is a complication of both nonoperative and operative treatment of the fracture. Several fixation options were used in the nonunion treatment, including various plate techniques, intramedullary nails and external fixator. We applied our Selfdynamisable internal fixator for the treatment of humeral shaft nonunion after surgical failure and evaluated its clinical outcome. ⋯ Selfdynamisable internal fixator with bone graft for the treatment of recalcitrant humeral shaft nonunion provided successful clinical outcome with minimal complications.
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Arch Orthop Trauma Surg · Oct 2007
Randomized Controlled TrialTreatment of type IIIA open fractures of tibial shaft with Ilizarov external fixator versus unreamed tibial nailing.
The aim of this study was to compare the radiographic results and clinical outcome of unreamed tibial nailing (UTN) and Ilizarov external fixation (IEF) for the treatment of type IIIA open fractures of the tibia. ⋯ The results of the current study showed that IEF technique had a notable incidence of pin-tract infection, joint contracture, and shorthening related to treatment of the delayed union. The UTN technique had the disadvantage of a posttraumatic osteomyelitis and delayed union requiring additional surgery. We believe that the decision to use IEF or UTN should be made on a case-by-case basis.
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Arch Orthop Trauma Surg · Oct 2007
Case ReportsComplete osseous avulsion of the adductor longus muscle: acute repair with three fiberwire suture anchors.
An acute tear of the adductor longus tendon is a seldom injury. A proximal osseous avulsion of this tendon has never been reported in literature. ⋯ Case report.