J Bone Joint Surg Br
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J Bone Joint Surg Br · Nov 1997
Randomized Controlled Trial Comparative Study Clinical TrialExternal fixation or flexible intramedullary nailing for femoral shaft fractures in children. A prospective, randomised study.
We report the outcome of 19 children aged 5.2 to 13.2 years with 20 fractures of the femoral shaft requiring surgery, who were randomly assigned to have external fixation (EF) or flexible intramedullary nailing (FIN) (10 fractures each). The duration of the operation averaged 56 minutes for the EF group with 1.4 minutes of fluoroscopy, compared with 74 minutes and 2.6 minutes, respectively, for the FIN group. The early postoperative course was similar, but the FIN [corrected] group showed much more callus formation. ⋯ In the FIN group, one patient had mild pain and one had quadriceps wasting; there were no length discrepancies, malalignment or limitation of movement. Parents of the FIN group were more satisfied. We recommend the use of flexible intramedullary nailing for fractures of the femoral shaft which require surgery, and reserve external fixation for open or severely comminuted fractures.
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J Bone Joint Surg Br · May 1997
Randomized Controlled Trial Comparative Study Clinical TrialExternal fixation and secondary intramedullary nailing of open tibial fractures. A randomised, prospective trial.
We performed a prospective, randomised trial in 39 patients with open tibial fractures treated initially by external fixation to compare cast immobilisation (group A) and intramedullary nailing (group B) as a sequential protocol planned from the onset of treatment. The results showed that group B achieved faster union (p < 0.05) than group A with less malunion or shortening and a greater range of movement. Patients treated by intramedullary nailing required fewer radiographs and outpatient visits (p = 0.0015) and had a more predictable and rapid return to full function. We feel that these severe fractures are better treated by delayed intramedullary nailing and that this has an acceptable rate of complications.
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J Bone Joint Surg Br · Jul 1996
Randomized Controlled Trial Comparative Study Clinical TrialReamed or unreamed nailing for closed tibial fractures. A prospective study in Tscherne C1 fractures.
We performed a prospective, randomised study on 50 patients with Tscherne C1 tibial diaphyseal fractures comparing treatment with reamed and unreamed intramedullary nails. Our results show that reamed nailing is associated with a significantly lower time to union and a reduced requirement for a further operation. Unreamed nailing should not be used in the treatment of the common Tscherne C1 tibial fracture.
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J Bone Joint Surg Br · May 1996
Randomized Controlled Trial Clinical TrialFibrinolytic inhibition with tranexamic acid reduces blood loss and blood transfusion after knee arthroplasty: a prospective, randomised, double-blind study of 86 patients.
We investigated the effect of a fibrinolytic inhibitor, tranexamic acid, on blood loss and blood transfusion in knee arthroplasty by a randomised, double-blind study of 86 patients. A dose of 10 mg/kg body-weight of either tranexamic acid or placebo was given intravenously shortly before the release of the tourniquet, and repeated three hours later. ⋯ The number of thromboembolic complications was the same in both groups. Tranexamic acid should be given prophylactically in order to be effective.
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J Bone Joint Surg Br · May 1996
Randomized Controlled Trial Comparative Study Clinical TrialPostoperative treatment of internally fixed ankle fractures: a prospective randomised study.
In a prospective, randomised trial of 81 patients with fractures of the ankle of AO types A, B and C we compared two regimes of postoperative management after internal fixation. The patients were mobilised either non-weight-bearing with crutches or weight-bearing in a below-knee walking plaster. ⋯ There were no significant differences between the groups in the loaded dorsal range of movement (25 degrees v 23 degrees, Mann-Whitney test, cft, p = 0.16) or in the overall clinical result. Both treatments were considered to be satisfactory and their choice depends on the ability to mobilise non-weight-bearing, wound healing, the type of work and personal preference.