Articles: fracture-fixation.
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Multicenter Study
Incidence of deep venous thrombosis after temporary joint spanning external fixation for complex lower extremity injuries.
The purpose of this study was to determine the incidence of deep venous thrombosis (DVT) in a prospective protocol of early spanning external fixation with the concurrent use of low-molecular weight heparin (LMWH) in patients with high-energy lower extremity trauma. ⋯ The incidence of DVT in patients treated with a protocol of early joint spanning external fixation and LMWH administration does not exceed historical controls. The early restoration of limb length, alignment, and stability allows early mobilization, which may contribute to the prevention of DVT.
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J Bone Joint Surg Am · Mar 2009
Randomized Controlled Trial Multicenter Study Comparative StudyOpen reduction and internal fixation compared with circular fixator application for bicondylar tibial plateau fractures. Surgical technique.
Standard open reduction and internal fixation techniques have been successful in restoring osseous alignment for bicondylar tibial plateau fractures; however, surgical morbidity, especially soft-tissue infection and wound necrosis, has been reported frequently. For this reason, several investigators have proposed minimally invasive methods of fracture reduction followed by circular external fixation as an alternative approach. To our knowledge, there has been no direct comparison of the two operative approaches. ⋯ Both techniques provide a satisfactory quality of fracture reduction. Because percutaneous reduction and application of a circular fixator results in a shorter hospital stay, a marginally faster return of function, and similar clinical outcomes and because the number and severity of complications is much higher with open reduction and internal fixation, we believe that circular external fixation is an attractive option for these difficult-to-treat fractures. Regardless of treatment method, patients with this injury have substantial residual limb-specific and general health deficits at two years of follow-up.
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Multicenter Study Clinical Trial
Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate: a prospective multicenter analysis.
The goal of this study is to evaluate the incidence of complications and the functional outcome after open reduction and internal fixation with the proximal humeral locking plate (Philos). ⋯ Fixation with Philos plates preserves achieved reduction, and a good functional outcome can be expected. However, complication incidence proportions are high, particularly due to primary and secondary screw perforations into the glenohumeral joint, with an overall complication rate of 35%. More accurate length measurement and shorter screw selection should prevent primary screw perforation. Awareness of obtaining anatomic reduction of the tubercles and restoring the medial support should reduce the incidence of secondary screw perforations, even in osteopenic bone.
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Orthop Traumatol Sur · Feb 2009
Multicenter StudyProximal humerus fractures treated by percutaneous locking plate internal fixation.
There is no consensually accepted recommendation for optimum surgical treatment of unstable fractures of the proximal humerus. ⋯ Our study suggests that percutaneous plating with angular screw fixation of proximal humeral fractures is a safe and effective method, which produces good functional and radiologic outcomes. These minimally-invasive techniques allowing a better preservation of soft-tissues help promote early functional recovery. This more friendly approach combined to upgraded implants and instruments will also improve early and long-term outcomes of these fractures.
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J Shoulder Elbow Surg · Jan 2009
Randomized Controlled Trial Multicenter StudyA multicenter, prospective, randomized, controlled trial of open reduction--internal fixation versus total elbow arthroplasty for displaced intra-articular distal humeral fractures in elderly patients.
We conducted a prospective, randomized, controlled trial to compare functional outcomes, complications, and reoperation rates in elderly patients with displaced intra-articular, distal humeral fractures treated with open reduction-internal fixation (ORIF) or primary semiconstrained total elbow arthroplasty (TEA). Forty-two patients were randomized by sealed envelope. Inclusion criteria were age greater than 65 years; displaced, comminuted, intra-articular fractures of the distal humerus (Orthopaedic Trauma Association type 13C); and closed or Gustilo grade I open fractures treated within 12 hours of injury. ⋯ TEA may result in decreased reoperation rates, considering that 25% of fractures randomized to ORIF were not amenable to internal fixation. TEA is a preferred alternative for ORIF in elderly patients with complex distal humeral fractures that are not amenable to stable fixation. Elderly patients have an increased baseline DASH score and appear to accommodate to objective limitations in function with time.