Annales chirurgiae et gynaecologiae
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Randomized Controlled Trial Comparative Study Clinical Trial
Thompson hemiarthroplasty is superior to Ullevaal screws in treating displaced femoral neck fractures in patients over 75 years. A prospective randomized study with two-year follow-up.
The Finnish orthopaedic tradition has preferred hemiarthroplasty to internal fixation in femoral neck fracture treatment, while in Sweden internal fixation has been the method of choice. We decided to study whether internal fixation would prove superior to hemiarthroplasty even in displaced femoral neck fractures in patients over 75 years old. ⋯ We conclude that displaced femoral neck fractures in patients over 75 years should be treated by arthroplasty.
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Randomized Controlled Trial Clinical Trial
Intra-articular ropivacaine injection does not alleviate pain after day-case knee arthroscopy performed under spinal anaesthesia.
To evaluate the effect of intra-articular ropivacaine injection on postoperative knee pain after day case arthroscopy. ⋯ This study failed to demonstrate a decrease in postoperative VAS scores at eight hours and later postoperatively when 20 ml of ropivacaine 0.5% were injected intra-articularly after day-case knee arthroscopy performed under spinal anaesthesia. Furthermore, there was no significant difference in the need for postoperative pain medication between the study groups.
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Randomized Controlled Trial Comparative Study Clinical Trial
Cannulated screws versus hemiarthroplasty for displaced intracapsular femoral neck fractures in demented patients.
There are no randomised trials comparing internal fixation and hemiarthroplasty for a displaced intracapsular femoral neck fracture in relation to mental state. ⋯ Postoperative mortality is high and the chance of successful rehabilitation very small for both types of treatment in this group of patients. In our opinion, demented patients should not be treated with a major surgical procedure like hemiarthroplasty. Internal fixation should be considered the treatment of choice, because it is a smaller operation than prosthetic replacement, with less morbidity. If adequate reduction can not be achieved, a primary hemiarthroplasty should be performed.
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Randomized Controlled Trial Clinical Trial
Fixation of displaced femoral neck fractures with a sliding screw plate and a cancellous screw or two Olmed screws. A prospective, randomized study of 225 elderly patients with a 3-year follow-up.
To analyse the importance of fixation method in displaced femoral neck fractures and to identify factors predictive of failure of the fixation. ⋯ Operation and anaesthesia time was considerably longer for the SSP system. The risk of failure was significantly increased (odds ratio 6.6) for patients operated with SSP outside ordinary working time. Poor reduction was recognized as a risk factor of failure for both types of fixation (odds ratio 3.1). The rate of reoperation within 3 months was 18.5% in the SSP group and 9.4% in the Olmed screw group. The rates of nonunion were 6.2% and 8.5%, respectively. The rates of late segmental collapse, 18.0% and 19.5% of all united fractures, respectively, decreased with increasing age (odds ratio 0.88). Salvage operations (replacement with bipolar or total hip prosthesis) were made in 30.6% and 26.5% of the cases, and the total rates of reoperation were 37.0% and 29.1%, respectively. We conclude that both treatment methods result in an unacceptably high rate of failures and reoperations, and that alternative treatment, prosthesis replacement, should be considered in selected cases.
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Randomized Controlled Trial Comparative Study Clinical Trial
Perioperative volume effect of HES 120/0.7 compared with dextran 70 and Ringer acetate.
Hydroxyethyl starch 120 (HES 120/0.7, Plasmafusin) is the smallest medium molecular weight HES preparation used as a plasma substitute for all clinical purposes. We compared the volume and colloid osmotic effect of 6% HES 120 with 6% dextran 70 and Ringer's solution during and after surgery with minimal blood loss. Patients (n = 48) having general anaesthesia were randomly divided into six groups. ⋯ With both infusions rates the COPs of dextran and HES groups were higher compared with Ringer groups. There were no differences in COP between the dextran and HES groups. It is concluded, that in this clinical setting the volume effect of 6% dextran 70 exceeds that of the HES 120/0.7, and that both colloids are superior to Ringer's solution.