MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Orthopedic Trauma Directions' source. Fri, 19 Mar 2010 16:06:46 +0100 http://www.medworm.com/index.php?rid=3296652&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0028-1100881 Orthopedic Trauma Directions 2010; 8: 27-32DOI: 10.1055/s-0028-1100881Author summaryFifty-five patients with 57 vertical fractures of the neck of the talus were included in this series, 43 of whom were followed for a minimum of 1 year. Fractures were classified into three groups based on the presence and location of dislocation. The treatment method employed varied according to fracture classification. Nonunion was reported in three cases, all occurring in patients with fracture dislocations affecting both the subtalar and ankle joints. The overall incidence of avascular necrosis (AVN) was 58%, with the majority occurring in severely displaced fractures. Union was frequently delayed following treatment for AVN and in those patients requiring fusion following AVN, a fusion rate of only 50% ... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=3296652 Tue, 23 Feb 2010 15:14:50 +0100 3296652 http://www.medworm.com/index.php?rid=3296651&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0028-1100880 Orthopedic Trauma Directions 2010; 8: 19-26DOI: 10.1055/s-0028-1100880SummaryEvidence from three small randomized controlled trials indicates that medial-lateral crossed pinning and lateral pinning for fixation of supracondylar fractures in children may be comparable. Overall, no differences were found between the treatment groups regarding mean Baumann-angle loss, carrying angle loss, range of motion, risk of poor outcome, iatrogenic nerve injury, and infection. Infection (two studies) and ulnar nerve injury (one study) were more common in the medial-lateral treatment group, but the difference was not significant. Additional randomized trials with larger sample sizes and longer follow-up are necessary to establish the long-term safety and efficacy of these two operative treatments.[...]©... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=3296651 Tue, 23 Feb 2010 15:14:50 +0100 3296651 http://www.medworm.com/index.php?rid=3296650&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0028-1100879 Orthopedic Trauma Directions 2010; 8: 11-18DOI: 10.1055/s-0028-1100879SummaryLimited evidence from two small randomized controlled trials and one retrospective cohort study suggest negative pressure wound therapy (NPWT) might reduce infection rate, drainage time, and time to wound closure when compared with standard-pressure dressing methods for high-energy orthopedic trauma. All three studies found NPWT to be more effective than standard treatment for the primary outcomes studied; however, each study evaluated a different type of wound and reported a different primary outcome. Evidence-based conclusions are difficult given the relatively small sample sizes and selection of treatment based on patient presentation in the cohort study. A methodologically rigorous multicenter randomized contr... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=3296650 Tue, 23 Feb 2010 15:14:50 +0100 3296650 http://www.medworm.com/index.php?rid=3296649&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0028-1100878 Orthopedic Trauma Directions 2010; 8: 1-10DOI: 10.1055/s-0028-1100878SummaryEvidence from one small randomized controlled trial and one small retrospective cohort study suggests that treatment with total elbow arthroplasty (TEA) for distal humeral fractures may lead to improved outcomes compared with open reduction and internal fixation (ORIF). Patients receiving TEA had significantly better Mayo elbow performance scores compared with those treated with ORIF. While those who had TEA tended to have better patient-reported outcomes (DASH), greater range of motion, and lower reoperation rates, the results did not consistently reach statistical significance. The treatment groups were similar regarding postoperative complications; however, there were somewhat conflicting results regarding heter... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=3296649 Tue, 23 Feb 2010 15:14:50 +0100 3296649 http://www.medworm.com/index.php?rid=3081353&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0028-1100871 Orthopedic Trauma Directions 2009; 7: 29-33DOI: 10.1055/s-0028-1100871Author summaryOf 459 patients treated in the intensive care unit (ICU) from 1975 – 1978, 211 patients with multiple injuries and fractures of the long bones and pelvis / spine were treated emergently using internal fixation in a primary stage. The main outcome of interest was clinical fat embolism syndrome (grade III), a severe and potentially life-threatening condition that is common following long-bone and pelvic fractures. Early operative fixation resulted in a low rate of grade III fat embolism and, therefore, may effectively prevent subsequent morbidity and mortality in this patient population.[...]© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents  |  Ab... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=3081353 Sat, 12 Dec 2009 14:44:15 +0100 3081353 http://www.medworm.com/index.php?rid=3081352&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0028-1100870 Orthopedic Trauma Directions 2009; 7: 19-27DOI: 10.1055/s-0028-1100870SummaryIt is not clear whether plating or intermedullary nailing is better for treating extraarticular distal-tibial fractures based on evidence from one moderate sized randomized controlled trial and three retrospective cohort studies. Time to union and functional scores appear to be similar in patients treated with plating and nailing, but infection may be more frequent for the plating based on the results from one randomized controlled trial. Statistical significance was not consistent across studies, which may be a function of sample size and / or bias in some studies. Results did not clearly favor one treatment over the other. To better understand the differences in outcomes between plating and nailing f... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=3081352 Sat, 12 Dec 2009 14:44:15 +0100 3081352 http://www.medworm.com/index.php?rid=3081351&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0028-1100869 Orthopedic Trauma Directions 2009; 7: 11-18DOI: 10.1055/s-0028-1100869SummaryLimited, poor evidence is available for comparing the treatment of extraarticular proximal tibial fractures by intramedullary nail or plate fixation. There was no difference in the rates of nonunion for either treatment. Significantly less patients treated by intramedullary nailing experience infection than patients treated by plating, whereas more patients treated by intramedullary nailing experienced malunion or compartment syndrome than those treated by intramedullary nailing. Implant failure occurred only in patients treated by intramedullary nailing. However, definitive conclusions cannot be drawn from this collection of case-series and a well-conducted prospective or randomized controlled trial would be a si... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=3081351 Sat, 12 Dec 2009 14:44:15 +0100 3081351 http://www.medworm.com/index.php?rid=3081350&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0028-1100868 Orthopedic Trauma Directions 2009; 7: 1-9DOI: 10.1055/s-0028-1100868SummaryIn a review of five case series and two retrospective cohort studies, nearly 50% of patients had their hardware removed without a clear indication. Approximately half of patients who underwent hardware removal for pain experienced pain relief, although some patients did experience increased pain after removal. It is unclear whether the indication for hardware removal affects resultant pain relief. Improved function was also observed in a few select studies. While generally safe, the available evidence does not support a general recommendation for hardware removal after fracture healing. Well-designed comparative studies are needed to determine whether there is any benefit of hardware removal for patients, particular... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=3081350 Sat, 12 Dec 2009 02:59:23 +0100 3081350 http://www.medworm.com/index.php?rid=2870548&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0028-1100867 Orthopedic Trauma Directions 2009; 7: 25-29DOI: 10.1055/s-0028-1100867Author summaryOutcomes of 84 comminuted distal tibia fractures in 82 patients treated by open reduction and internal fixation were reported. The operative procedure sought to restore bone length and correct axis, reconstruct the articular surface of the distal end of the tibia, fill defects, and prevent late varus deformity. Pain-free status with good functional results was achieved in 74% of the patients, and those with better anatomical restoration had better functional results.[...]© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents  |  Abstract  |  Full text (Source: Orthopedic Trauma Directions) Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=2870548 Thu, 08 Oct 2009 10:02:20 +0100 2870548 http://www.medworm.com/index.php?rid=2870547&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0028-1100866 Orthopedic Trauma Directions 2009; 7: 19-24DOI: 10.1055/s-0028-1100866SummaryLimited evidence from three randomized controlled trials provide mixed results for LIPUS treatment of acute tibial fractures compared with a placebo treatment in both operatively and nonoperatively managed injuries. One operatively managed study indicated a reduced time to healing may occur with LIPUS compared with placebo, but another operatively managed study suggested no difference between the two treatments. Both studies had relatively small sample sizes. One older study that utilized nonoperative management of the tibial fractures reported better results with LIPUS compared with the control treatment, and had larger sample sizes. The inconsistency of the evidence might be due to type II error in the smaller s... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=2870547 Thu, 08 Oct 2009 10:02:20 +0100 2870547 http://www.medworm.com/index.php?rid=2870546&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0028-1100865 Orthopedic Trauma Directions 2009; 7: 13-18DOI: 10.1055/s-0028-1100865SummaryLimited evidence from four small randomized controlled trials suggests a possible benefit for ES treatment of tibial nonunions compared with a placebo treatment. Although time to healing was not reported, three studies indicated a higher proportion of healed tibias with ES compared with placebo as treatment, but one older study in 1984 reported no such benefit. All studies had small sample sizes. There were no differences in pain or postoperative infection between groups. Additional methodologically rigorous randomized controlled trials with larger populations are necessary to establish the superiority of ES treatment for treatment of acute tibial fractures.[...]© Georg Thieme Verlag KG Stuttgart · New YorkGet c... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=2870546 Thu, 08 Oct 2009 10:02:20 +0100 2870546 http://www.medworm.com/index.php?rid=2870544&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0028-1100864 Orthopedic Trauma Directions 2009; 7: 1-11DOI: 10.1055/s-0028-1100864SummaryEvidence from four randomized or quasi-randomized controlled trials suggests that treatment of acute distal radius fractures with wrist bridging external fixation compared with nonbridging external fixation leads to comparable results with respect to DASH functional scores, grip strength, extension, and VAS pain scores. There was conflicting evidence in regard to which method may provide the best final degree of flexion and length of ulnar variance. The total number of reported complications was greater for nonbridging fixation in three of the four trials; similarly, the percentage of patients with pin track infection was consistently higher in the nonbridging fixation groups. However, these differences were not st... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=2870544 Thu, 08 Oct 2009 10:02:20 +0100 2870544 http://www.medworm.com/index.php?rid=2680394&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0028-1100863 Orthopedic Trauma Directions 2009; 7: 25-29DOI: 10.1055/s-0028-1100863Author summaryThe outcomes of 97 open tibial fractures in 95 patients treated with immediate plate fixation are reported, focusing on wound healing, time to full weight-bearing (union), function, and complications, including malunion and infection. Overall, 62 wounds healed in 3 weeks or less and 26 between 3 and 6 weeks. By 30 weeks, 77 legs were fully weight-bearing and significant stiffness in one or more of the knee, ankle, or subtalar joints developed in 11.4 % patients. Delayed union occurred in 32 cases (33 %). Angular malunion of greater than 5° in any plane was seen in only 3.1 % of patients. The deep infection rate was 10.3 % overall, including 5.4 % of Grade I wounds, 7.8 %... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=2680394 Sat, 08 Aug 2009 11:23:30 +0100 2680394 http://www.medworm.com/index.php?rid=2680393&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0028-1100862 Orthopedic Trauma Directions 2009; 7: 15-24DOI: 10.1055/s-0028-1100862SummaryEvidence from one large and three smaller randomized controlled trials suggests that time to union may be faster and the proportion of patients with nonunion lower with the use of reamed compared with unreamed nails. The rate of complications appears to be similar between groups. Rates of reoperation were not statistically different between groups. Additional studies that measure patient function and quality of life could help substantiate these findings and provide more definitive evidence regarding advantages of reamed versus unreamed nailing of tibial fractures.[...]© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents  |  Abstract  |  Full text (Source: Orthopedic Trauma Direct... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=2680393 Sat, 08 Aug 2009 11:23:30 +0100 2680393 http://www.medworm.com/index.php?rid=2680392&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0028-1100861 Orthopedic Trauma Directions 2009; 7: 7-14DOI: 10.1055/s-0028-1100861SummaryLimited evidence from three small retrospective cohort studies provide mixed results for operative treatment by excision of Mason type II, III, and IV radial head fractures compared with open reduction and internal fixation (ORIF) with plates, wires, screws, or silastic replacement. Two recent studies suggest that slightly better functional results may occur with ORIF compared with excision as treatment, but neither study reached statistical significance. One older study that utilized excision of the radial head as an operative treatment reported a better functional outcome compared with silastic replacement but again, results were not statistically significant. Evidence-based conclusions are difficult given the sm... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=2680392 Sat, 08 Aug 2009 11:23:30 +0100 2680392 http://www.medworm.com/index.php?rid=2680391&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0028-1100860 Orthopedic Trauma Directions 2009; 7: 1-6DOI: 10.1055/s-0028-1100860SummaryTwo predictive scoring systems for mortality in hip fracture patients, the Nottingham hip fracture score (NHFS) and the Charlson comorbidity index, are examined in three studies. The NHFS was shown in one study to be a fair predictor of 30 day mortality after hip fracture surgery. Results with the Charlson comorbidity index demonstrated that it was a poor predictor of mortality in the 90 day period after hip fracture treatment in one prospective study, but the odds ratios of a mortal outcome were found to be significantly higher with higher comorbidity scores in a retrospective study. Further well designed studies would be desirable to develop or refine a valid scoring system useful for prediction of mortality in hi... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=2680391 Sat, 08 Aug 2009 11:23:30 +0100 2680391 http://www.medworm.com/index.php?rid=2466320&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0028-1100856 This study sought to test both its criterion and construct validity, an important aspect of creating a health status instrument. The criterion validity was tested against physicians’ ratings of patient function and against various clinical measures. Construct validity was evaluated using medical records, demographic data, other standard health instruments, and by comparing patients based on their various health issues. Both types of validity were affirmed by significant correlations between the MFA scores and the criteria evaluated.[...]© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents  |  Abstract  |  Full text (Source: Orthopedic Trauma Directions) Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=2466320 Tue, 09 Jun 2009 20:44:46 +0100 2466320 http://www.medworm.com/index.php?rid=2466319&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0028-1100855 Orthopedic Trauma Directions 2009; 7: 17-24DOI: 10.1055/s-0028-1100855SummaryStudies suggest that outcomes comparing percutaneous compression plating (PCCP) and hip screw (HS) for treatment of pertrochanteric hip fractures are varied. Outcomes favoring PCCP include lower mean blood transfusion requirements and slightly lower postoperative pain. Both PCCP and HS are associated with low rates of implant failure, however, in the PCCP group implant failure and unplanned reoperations may be more common. Mortality rates were consistently but not statistically lower in the PCCP group than in the DHS group in all studies. Additional randomized controlled trials are recommended to verify these results.[...]© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents  |  Abstra... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=2466319 Tue, 09 Jun 2009 20:44:46 +0100 2466319 http://www.medworm.com/index.php?rid=2466318&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0028-1100854 Orthopedic Trauma Directions 2009; 7: 9-16DOI: 10.1055/s-0028-1100854SummaryData from five case series suggest that talar neck fractures are a significant injury. Complications that include pain, osteonecrosis, and osteoarthritis are not infrequent following open reduction and internal fixation of this fracture. Additionally, one study reported that a significant proportion of patients required secondary reconstructive surgery. Unfortunately, very few studies reported on objective functional outcome measures.[...]© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents  |  Abstract  |  Full text (Source: Orthopedic Trauma Directions) Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=2466318 Tue, 09 Jun 2009 20:44:46 +0100 2466318 http://www.medworm.com/index.php?rid=2466317&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0028-1100853 Orthopedic Trauma Directions 2009; 7: 1-8DOI: 10.1055/s-0028-1100853SummaryLimited evidence from six case series provides mixed results for outcomes following open calcaneal fractures. In two studies that reported functional results, the outcome was considered to be fair to poor after 2 – 10 years of follow-up, and depended in part on severity as measured by the Gustilo classification system. In these two studies, complications following difficult soft-tissue management hindered fracture treatment. Infection was a common outcome in all studies. Even though most patients eventually resolved a chronic infection, amputation resulted in a proportion of these patients. Evidence-based conclusions concerning which treatment options are the most effective in treating these diffic... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=2466317 Tue, 09 Jun 2009 00:55:41 +0100 2466317 http://www.medworm.com/index.php?rid=2384756&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0028-1100852 This article provided the first description of this type of injury, which was later named after the author (Colles' fracture) and its treatment.[...]© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents  |  Abstract  |  Full text (Source: Orthopedic Trauma Directions) Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=2384756 Mon, 04 May 2009 00:59:57 +0100 2384756 http://www.medworm.com/index.php?rid=2384755&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0028-1100851 Orthopedic Trauma Directions 2009; 7: 17-26DOI: 10.1055/s-0028-1100851SummaryEvidence from five small case series, Class of evidence (CoE) IV, regarding the safety and efficacy of calcium phosphate bone cement in the treatment of calcaneal fractures, is weak. Outcomes were analyzed using different measures, and were highly variable. Functional outcomes results were mixed depending on the type of cement and the outcomes measure used. Wound infections occurred in 0 – 21% of fractures across all series. Acceptable reduction and joint reconstruction were experienced in all three series of patients treated with a skeletal repair system (Norian SRS). Well-designed comparative studies are needed to clarify whether augmentation with calcium phosphate bone cement for the treatment... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=2384755 Mon, 04 May 2009 00:59:57 +0100 2384755 http://www.medworm.com/index.php?rid=2384754&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0028-1100850 Orthopedic Trauma Directions 2009; 7: 9-16DOI: 10.1055/s-0028-1100850SummaryEvidence is poor from four small retrospective cohort studies comparing operative treatment of Mason type II radial head fractures with nonoperative methods. More recent studies that utilized open reduction and internal fixation (ORIF) as an operative treatment demonstrated better functional results compared with nonoperative treatment. In contrast, older studies that utilized excision of the radial head as an operative treatment reported poorer results compared with nonoperative treatment. Better outcomes following ORIF are suggested based on indirect comparison with excision results, however, this needs to be formally evaluated via studies directly comparing these two methods. Evidence-based conclusions are diffi... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=2384754 Mon, 04 May 2009 00:59:57 +0100 2384754 http://www.medworm.com/index.php?rid=2384753&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0028-1100849 Orthopedic Trauma Directions 2009; 7: 1-8DOI: 10.1055/s-0028-1100849SummaryLimited evidence from one small randomized controlled trial (RCT) suggests that a higher fracture union rate is achieved when intramedullary screw fixation is used compared with nonoperative cast treatment in athletes. Faster recovery times and quicker return to sports were also reported for patients who had operative treatment compared with nonoperative treatment in the RCT. While a higher union rate was reported in a retrospective cohort as well, results were not statistically significant and because of the methodological limitations of this study, greater weight should be placed on the RCT findings. A multicenter randomized controlled trial may provide sufficient sample size for more effective comparison of the t... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=2384753 Fri, 01 May 2009 01:03:38 +0100 2384753 http://www.medworm.com/index.php?rid=2164176&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0028-1100845 Orthopedic Trauma Directions 2009; 7: 31-33DOI: 10.1055/s-0028-1100845Author summaryThe author reviews aspects of anatomy and physiology, especially vascularization and pathophysiology, as well as mechanisms of injury that influence the treatment decision for intracapsular fractures of the hip. A number of other factors that may influence surgeons’ choice between treatments are discussed, such as age, displacement, limited life expectancy, chronic disease, and poor bone quality. Avascular necrosis and other complications are also reviewed. Consensus at the time of this article’s publication was that the best treatment for intracapsular hip fractures results in fracture healing, the patient retaining their own femoral head, and the absence of avascular necrosis.[...]© Georg Thi... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=2164176 Fri, 06 Feb 2009 12:26:38 +0100 2164176 http://www.medworm.com/index.php?rid=2164175&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0028-1100844 Orthopedic Trauma Directions 2009; 7: 21-30DOI: 10.1055/s-0028-1100844SummaryLimited evidence from one small quasi-randomized controlled trial and one retrospective cohort study suggests that tuberosity fixation with cable wire and autogenous bone grafting may result in better functional outcomes compared with nonabsorbable suture fixation of the tuberosity when hemiarthroplasty is used for treatment of proximal humerus fractures (three- or four-part). Both radiographic and functional outcomes were consistent across the two different quality studies, with fewer prosthesis migrations, tuberosity dislocations and resorptions, and better Constant-Murley shoulder scores with the cable-wire fixation technique. A multicenter trial or larger, methodologically rigorous randomized controlled trials... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=2164175 Fri, 06 Feb 2009 12:26:38 +0100 2164175 http://www.medworm.com/index.php?rid=2164174&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0028-1100843 Orthopedic Trauma Directions 2009; 7: 11-20DOI: 10.1055/s-0028-1100843SummaryData from six small case series suggest that complications are minimal following treatment with the less invasive stabilization system (LISS) for complex tibial plateau fractures. All studies reported low nonunion rates (4%, based on pooled estimates). The overall pooled deep infection rate was 5% (range 0 – 22%). There are no data available to directly compare complications of LISS with other treatment options for tibial plateau fractures. High-quality studies that compare LISS with other fixation methods are needed in order to more fully evaluate the value of LISS in these complex fractures.[...]© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents  |  Abstract  |... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=2164174 Fri, 06 Feb 2009 12:26:38 +0100 2164174 http://www.medworm.com/index.php?rid=2164173&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0028-1100842 Orthopedic Trauma Directions 2009; 7: 1-10DOI: 10.1055/s-0028-1100842SummaryEvidence from seven randomized (or quasi-randomized) controlled trials suggests that patients receiving internal screw fixation may heal more quickly and return to work sooner than patients receiving cast immobilization for treating nondisplaced scaphoid fractures. Similar rates of union in both operative and nonoperative groups were seen, and grip strength and range of motion outcomes were not significantly different between the two groups in studies reporting follow-up of 1 year or longer. Long-term studies showed a slight reduction in range of motion for operatively treated patients, but statistical significance was not uniformly reported. Two of three long-term studies reported a significant increase in inciden... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=2164173 Fri, 06 Feb 2009 12:26:38 +0100 2164173 http://www.medworm.com/index.php?rid=2164172&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0028-1100841 Orthopedic Trauma Directions 2008; 6: 29-32DOI: 10.1055/s-0028-1100841Author summaryProper treatment of pelvic injuries requires careful assessment of the type of displacement (based on the mechanism of force) and the degree of stability of the hemipelvis. Open-book type AP compression fractures of the pelvis can be treated by simple reduction followed by immobilization in a pelvic sling, plaster spica, or with external fixators. The lateral compression fractures all produce some degree of inward rotation of the hemipelvis and often reduce spontaneously while in the supine position but may require external rotation forces to reduce the fracture. Complete bed rest with traction through a supracondylar femoral pin or with external fixators are the recommended means of immobilization. Vertica... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=2164172 Fri, 06 Feb 2009 12:26:38 +0100 2164172 http://www.medworm.com/index.php?rid=2164171&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0028-1100840 Orthopedic Trauma Directions 2008; 6: 19-28DOI: 10.1055/s-0028-1100840SummaryEvidence from one randomized controlled trial suggests that for hip fracture patients, short-term heparin-type prophylaxis with an extended duration of 4 – 6 weeks for prevention of venous thromboembolitic events leads to significantly lower venous thromboembolism (VTE) than in those given a placebo following a short-term prophylaxis. In patients with ankle fractures, VTE was less frequent for short-term plus extended prophylaxis versus the short-term plus placebo, but differences were not statistically significant. Overall mortality rates were not significantly affected by prophylaxis status in either study, but extended treatment with fondaparinux following the short-term course after hip fract... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=2164171 Fri, 06 Feb 2009 12:26:38 +0100 2164171 http://www.medworm.com/index.php?rid=2164170&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0028-1100839 Orthopedic Trauma Directions 2008; 6: 11-18DOI: 10.1055/s-0028-1100839SummaryLimited data from three retrospective cohort studies suggests that there may be no significant association between time to debridement and rate of infection in open long-bone fractures. However, the studies included did not control for possible confounding factors that may bias study results, such as antibiotic use and fracture type. Methodologically rigorous studies which control for such factors should be conducted to confirm that adherence to the 6-hour debridement window does not appear to affect infection rates.[...]© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents  |  Abstract  |  Full text (Source: Orthopedic Trauma Directions) Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=2164170 Fri, 06 Feb 2009 12:26:38 +0100 2164170 http://www.medworm.com/index.php?rid=2164169&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-0028-1100838 Orthopedic Trauma Directions 2008; 6: 1-10DOI: 10.1055/s-0028-1100838SummaryThere is some evidence from five recent retrospective studies to suggest that surgical delays of 6 (or 8) hours or more do not appear to have detrimental effects on rates of infection, complications, nonunion/delayed union, multiple debridements, secondary procedures to promote union, or length of hospital stay in treating open tibial fractures, when compared with surgical treatment within 6 (or 8) hours. Methodologically rigorous studies that adjust for confounding factors (eg, fracture classification, antibiotic use) and account for all patients at follow-up are needed to confirm these results.[...]© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents  |  Abstract  |  Full text (S... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=2164169 Fri, 06 Feb 2009 02:57:44 +0100 2164169 http://www.medworm.com/index.php?rid=1806779&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-2008-1038277 Orthopedic Trauma Directions 2008; 6: 29-33DOI: 10.1055/s-2008-1038277Author summaryThe authors describe use of specific x-ray views to include anteroposterior, inlet, and outlet views, as well as tomograms for evaluation of pelvic disruption. Classification based on the three major forces (anteroposterior compression, lateral compression and vertical shear) producing pelvic disruption is proposed. The assessment, in addition to a thorough history and physical, can help identify the precise fracture pattern and mechanism of injury, and thus guide the proper management of pelvic disruption. The degree of instability associated with a given fracture pattern is an extremely important prognostic factor for the survival and overall recovery of the patient.[...]© Georg Thieme Verlag KG Stuttgar... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=1806779 Fri, 19 Sep 2008 13:45:39 +0100 1806779 http://www.medworm.com/index.php?rid=1806778&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-2008-1038276 Orthopedic Trauma Directions 2008; 6: 21-28DOI: 10.1055/s-2008-1038276SummaryThe evidence describing early versus delayed motion for minimally displaced fractures of the proximal humerus suggests that for the first 3 – 4 months of follow-up, early motion of the shoulder tended to confer greater overall shoulder function, less pain and greater range of motion than delayed motion. However, at later follow-up, there was no statistical difference in outcomes between early and delayed motion. In one study with 2 year follow-up, one third of the patients in either group reported significant shoulder disability as measured by the Croft shoulder disability questionnaire.[...]© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents  |  Abstract  |  Fu... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=1806778 Fri, 19 Sep 2008 13:45:39 +0100 1806778 http://www.medworm.com/index.php?rid=1806777&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-2008-1038275 Orthopedic Trauma Directions 2008; 6: 11-20DOI: 10.1055/s-2008-1038275SummaryEvidence from two randomized controlled trials suggests that tricortical screw fixation may be sufficient compared with quadricortical screw fixation for ankle fractures. It is unclear whether loss of reduction is greater for tricortical or quadricortical screws. Data from one small study suggests slightly improved functional scores after 3 months among patients treated with tricotical screw fixation, but not after 1 year. No differences between the two treatments were found for dorsiflexion or complications (revision surgery, infection, other complications).Verification of these findings in additional trials is recommended.[...]© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents  | Â... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=1806777 Fri, 19 Sep 2008 13:45:39 +0100 1806777 http://www.medworm.com/index.php?rid=1806776&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-2008-1038274 Orthopedic Trauma Directions 2008; 6: 1-10DOI: 10.1055/s-2008-1038274SummaryEvidence from four small randomized or quasi-randomized controlled trials suggests that:[...]© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents  |  Abstract  |  Full text (Source: Orthopedic Trauma Directions) Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=1806776 Fri, 19 Sep 2008 13:45:39 +0100 1806776 http://www.medworm.com/index.php?rid=1655934&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-2008-1038241 Orthopedic Trauma Directions 2008; 6: 31-33DOI: 10.1055/s-2008-1038241Author summaryResults from 53 patients with 56 complex pilon fractures treated with open reduction and internal fixation in a staged manner were reported. Universal wound healing with only minimal wound complications were demonstrated.[...]© Georg Thieme Verlag Stuttgart · New YorkGet connected:Table of contents  |  Abstract  |  Full text (Source: Orthopedic Trauma Directions) Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=1655934 Sat, 26 Jul 2008 11:56:05 +0100 1655934 http://www.medworm.com/index.php?rid=1655933&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-2008-1038240 Orthopedic Trauma Directions 2008; 6: 21-30DOI: 10.1055/s-2008-1038240SummaryThere is insufficient evidence from four retrospective cohort studies to infer the advantage of either the volar or dorsal plating approach for treatment of distal radius fractures. Results suggest that dorsal plating may be more effective for restoration of palmar tilt. Overall, no differences in other radiographic measures or functional mobility were seen. There was tendency for patients with dorsal plates to have less motion for flexion and extension, but statistical comparison with volar plating was not reported. In all studies, plating choice was made based on surgeon discretion, which may tend to bias comparison of outcomes. Some studies were limited by small sample sizes and some may not have had inadequate... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=1655933 Sat, 26 Jul 2008 11:56:05 +0100 1655933 http://www.medworm.com/index.php?rid=1655932&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-2008-1038239 Orthopedic Trauma Directions 2008; 6: 11-20DOI: 10.1055/s-2008-1038239SummaryResults of four randomized controlled trials, Class of evidence (CoE) II, comparing external fixation (EF) with open reduction and internal fixation (ORIF) for the treatment of intra-articular distal radius fractures described no consistent benefit of one treatment over another. Grip strength was better among those treated with EF compared with ORIF in two studies, but statistical significance was not consistent. No statistically significant differences in wound infection or reflex sympathetic dystrophy were seen between treatment groups. Larger, methodologically sound randomized controlled trials are needed to evaluate the superiority of one treatment over the other for intra-articular distal radius fractures.[..... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=1655932 Sat, 26 Jul 2008 11:56:05 +0100 1655932 http://www.medworm.com/index.php?rid=1655931&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-2008-1038238 Orthopedic Trauma Directions 2008; 6: 1-10DOI: 10.1055/s-2008-1038238SummaryEvidence from one meta-analysis (12 studies) and five population-based cohort studies, totaling more than 150,000 subjects, suggests that BMI is a significant prognostic factor for hip fracture. Low BMI or body size was associated with increased hip fracture risk, while high BMI was found to be protective for fracture. However, after adjustment for bone mineral density (BMD), low BMI remained a factor for increase risk based on the metaanalysis while higher BMI was no longer a protective factor. There was conflicting evidence for the effect of sex-specific BMI on risk. Two studies, including the meta-analysis, found no difference in risk estimates by sex, suggesting that the effect of BMI on hip fracture is not dif... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=1655931 Sat, 26 Jul 2008 00:41:40 +0100 1655931 http://www.medworm.com/index.php?rid=1509834&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-2008-1038215 Orthopedic Trauma Directions 2008; 6: 29-32DOI: 10.1055/s-2008-1038215Author summaryThe two cases of comminuted fracture of the radial head presented in this paper stress the importance of evaluating the distal radio-ulnar joint for dislocation when the mechanism of injury is a longitudinal compression force. Two treatment approaches are recommended for this particular type of injury. The first is reconstruction of the radial head. If reconstruction is not feasible due to severe comminution, leaving the distal radius undisturbed and accepting some distal radio-ulnar subluxation may be required. Another option, after immediate excision, could be to temporarily use a prosthesis in place of the radial head to hold the radius down until the distal joint and interosseous membrane heal and becom... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=1509834 Thu, 12 Jun 2008 00:20:15 +0100 1509834 http://www.medworm.com/index.php?rid=1509833&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-2008-1038214 Orthopedic Trauma Directions 2008; 6: 21-28DOI: 10.1055/s-2008-1038214SummaryEvidence from five cohort studies suggest that smoking is associated with higher rates of delayed and nonunion, longer time to union, and greater requirement for secondary surgery to stimulate union following tibia fracture. Smokers also tended to have higher rates of complication (eg, flap failure and infection), but none of the reported differences in serious complications achieved statistical significance. Discrepancies in follow-up rates for smokers compared with nonsmokers should be considered when interpreting results, as should differences in criteria for ascertainment of union.[...]© Georg Thieme Verlag Stuttgart · New YorkGet connected:Table of contents  |  Abstract  |  Full text (Source: Orthop... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=1509833 Thu, 12 Jun 2008 00:20:15 +0100 1509833 http://www.medworm.com/index.php?rid=1509832&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-2008-1038213 Orthopedic Trauma Directions 2008; 6: 11-20DOI: 10.1055/s-2008-1038213SummaryThere is moderate evidence from two prospective cohort studies that female patients and patients with fracture displacement are at increased risk for nonunion following clavicular fracture. There is inconsistent support for whether older patients and patients with comminuted fractures are at increased risk for nonunion. Other fracture characteristics (angulation, intraarticular involvement, location, and shortening) and smoking appear not to affect risk of nonunion after clavicular fracture.[...]© Georg Thieme Verlag Stuttgart · New YorkGet connected:Table of contents  |  Abstract  |  Full text (Source: Orthopedic Trauma Directions) Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=1509832 Thu, 12 Jun 2008 00:20:15 +0100 1509832 http://www.medworm.com/index.php?rid=1509831&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-2008-1038212 Orthopedic Trauma Directions 2008; 6: 1-9DOI: 10.1055/s-2008-1038212SummaryA metaanalysis of 22 randomized controlled trials found evidence to support parenteral antibiotic prophylaxis regimens for patients undergoing surgical fixation of closed hip and long bone fractures. Preoperative parenteral antibiotic doses (single or combined with multiple postoperative doses) resulted in decreased risk of deep, superficial, and urinary tract infections compared with no antibiotic. Single doses of short acting agents may be less effective than multiple doses of the same agent in decreasing the risk of any of the infections evaluated. By contrast, there was no significant difference in infection risk between a single dose of a long acting agent and multiple doses of other agents with shorter half li... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=1509831 Thu, 12 Jun 2008 00:20:15 +0100 1509831 http://www.medworm.com/index.php?rid=1346335&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-2008-1038166 Orthopedic Trauma Directions 2008; 6: 33-37DOI: 10.1055/s-2008-1038166Author summaryThree types of fractures of the coronoid process of the ulna were described based on x-ray findings: Type I - avulsion of the tipp of the process; Type II - a fragment involving 50% of the process or less; and Type III - a fragment involving more than 50% of the process. Associated injuries, such as a concurrent dislocation or fracture, were seen in 14%, 56%, and 80% of these patients, respectively. The percentage of patients with excellent or good results (based on an objective elbow-performance index) varied by fracture type: 92% for Type-I-fracture, 73% for Type-II, and 20% for Type III. Reoperation and heterotopic bone formation were most frequent with Type III fractures and least common in patients wit... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=1346335 Wed, 02 Apr 2008 23:34:32 +0100 1346335 http://www.medworm.com/index.php?rid=1346334&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-2008-1038165 Orthopedic Trauma Directions 2008; 6: 23-32DOI: 10.1055/s-2008-1038165SummaryEvidence from two small comparative studies is insufficient to determine whether ORIF results in better outcomes compared with primary arthrodesis for the treatment of Lisfranc joint injury. Among patients with primarily ligamentous Lisfranc injury, functional outcomes and pain scores were worse for those treated by ORIF compared with arthrodesis and additional surgeries were significantly more common, based on a small single randomized controlled trial (RCT). Although no significant difference was found in anatomical reduction, after screw removal 75% of ORIF patients had loss of correction with increased degenerative changes.[...]© Georg Thieme Verlag Stuttgart · New YorkGet connected:Table of contents  | Â... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=1346334 Wed, 02 Apr 2008 23:34:32 +0100 1346334 http://www.medworm.com/index.php?rid=1346333&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-2008-1038164 Orthopedic Trauma Directions 2008; 6: 11-22DOI: 10.1055/s-2008-1038164SummaryEvidence for ORIF versus nonoperative treatment for isolated ulnar shaft fractures is limited, consisting primarily of case series. Union rates were high for both treatments, with pooled estimates of 98% for ORIF and 99% for nonoperative treatments. Methodologically rigorous studies comparing ORIF and nonoperative treatments in the same study are needed.[...]© Georg Thieme Verlag Stuttgart · New YorkGet connected:Table of contents  |  Abstract  |  Full text (Source: Orthopedic Trauma Directions) Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=1346333 Wed, 02 Apr 2008 23:34:32 +0100 1346333 http://www.medworm.com/index.php?rid=1346332&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-2008-1038163 Orthopedic Trauma Directions 2008; 6: 1-10DOI: 10.1055/s-2008-1038163SummaryThe evidence base describing surgical treatment of intraarticular glenoid fractures is poor, consisting only of case series. Surgical treatment of glenoid fractures led to excellent or good results in 85% (71 - 100%) of patients, and 57% (40 - 67%) of patients reported no pain at follow-up, based on pooled estimates from four small case series. Since intraarticular glenoid fractures are uncommon, observational studies are likely the only cost effective way to evaluate the outcomes following surgical treatment of this fracture.[...]© Georg Thieme Verlag Stuttgart · New YorkGet connected:Table of contents  |  Abstract  |  Full text (Source: Orthopedic Trauma Directions) Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=1346332 Wed, 02 Apr 2008 23:10:46 +0100 1346332 http://www.medworm.com/index.php?rid=1187327&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-2008-1038107 Orthopedic Trauma Directions 2008; 6: 33-37DOI: 10.1055/s-2008-1038107Author summaryResults from 49 patients with 59 humeral shaft fractures treated with a functional plastic sleeve demonstrated rapid and uneventful healing. Good alignment of the fractures was maintained, union rate was high, and the majority of patients demonstrated good range of motion. Early functional activity to the entire extremity appears to contribute to timely and uninterrupted osteogenesis.[...]© Georg Thieme Verlag Stuttgart · New YorkGet connected:Table of contents  |  Abstract  |  Full text (Source: Orthopedic Trauma Directions) Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=1187327 Wed, 30 Jan 2008 09:34:33 +0100 1187327 http://www.medworm.com/index.php?rid=1187326&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-2008-1038106 Orthopedic Trauma Directions 2008; 6: 23-32DOI: 10.1055/s-2008-1038106SummaryLimited evidence from one small retrospective cohort study and 13 case series suggest little difference in union rates and healing time between treatment with intramedullary (IM) fixation and nonoperative treatment. Pooled estimates combining all studies may suggest improved shoulder function with IM fixation. Methodologically rigorous comparative studies with adequate power are needed to effectively compare IM fixation and nonoperative treatment.[...]© Georg Thieme Verlag Stuttgart · New YorkGet connected:Table of contents  |  Abstract  |  Full text (Source: Orthopedic Trauma Directions) Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=1187326 Wed, 30 Jan 2008 09:34:33 +0100 1187326 http://www.medworm.com/index.php?rid=1187325&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-2008-1038105 Orthopedic Trauma Directions 2008; 6: 11-22DOI: 10.1055/s-2008-1038105SummaryEvidence from one randomized controlled trial (RCT) suggests that patients that undergo plate fixation for acute, displaced, clavicular midshaft fractures may score better on patient-reported and physician-reported measures of shoulder function, may be less likely to experience nonunion or complications requiring additional treatment and may have shorter time to union than patients receiving nonoperative treatment. Plate fixation patients tend to report higher satisfaction with shoulder appearance than patients who don't have surgical repair. Higher loss to follow-up in the nonoperative group, however, may influence the results. Data from case series of patients with acute clavicular midshaft fractures support som... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=1187325 Wed, 30 Jan 2008 09:34:33 +0100 1187325 http://www.medworm.com/index.php?rid=1187324&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-2008-1038104 Orthopedic Trauma Directions 2008; 6: 1-10DOI: 10.1055/s-2008-1038104SummaryEvidence from four randomized controlled studies comparing the effect of multidisciplinary care with usual care after surgery for hip fracture suggests that multidisciplinary care may facilitate walking recovery and improvement in activities of daily living (ADL). However, results were not statistically significant across studies or time frames. Differences in care protocols and outcome definitions across studies should be considered. In-hospital mortality was significantly lower for multidisciplinary care recipients, a 62% reduction in rate based on pooled estimates from two studies. No effect was seen on mortality at 1 year, however. There was no difference in readmission rates at any follow-up time and results f... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=1187324 Wed, 30 Jan 2008 09:34:33 +0100 1187324 http://www.medworm.com/index.php?rid=1046055&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-2007-996159 Orthopedic Trauma Directions 2007; 5: 29-33DOI: 10.1055/s-2007-996159Author summaryThe possibility and the degree of posterior urethral rupture must be investigated in cases of pelvic fractures, with the aim of minimizing the very serious consequences of stricture, impotence, and incontinence. Because clinical signs may be misleading, diagnosis and treatment needs to be based on accurate visualization of the urethra, which can be accomplished in most medical situations via dynamic retrograde urethrography (DRU). This technique reveals whether there is an intact but perhaps damaged urethra, or a partial or complete rupture. Accurate assessment then allows the medical team to decide on presurgical treatment, catheter placement, and the timing of surgical repair.[...]© Georg Thieme Verlag St... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=1046055 Fri, 23 Nov 2007 03:09:21 +0100 1046055 http://www.medworm.com/index.php?rid=1046054&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-2007-996158 Orthopedic Trauma Directions 2007; 5: 19-28DOI: 10.1055/s-2007-996158SummaryEvidence from two studies (one RCT, one cohort) suggests that dynamization of intramedullary nailing (IMN) and static IMN for femoral shaft fractures appear to be comparable with regard to risk of nonunion, nail breakage, and limb shortening. Conflicting results with regard to mean time to union were noted. Additional methodologically rigorous comparative studies, which include patient-reported outcomes and larger sample sizes, are necessary to establish the long term safety and efficacy of these two operative treatments.[...]© Georg Thieme Verlag Stuttgart · New YorkGet connected:Table of contents  |  Abstract  |  Full text (Source: Orthopedic Trauma Directions) Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=1046054 Fri, 23 Nov 2007 03:09:21 +0100 1046054 http://www.medworm.com/index.php?rid=1046053&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-2007-996157 Orthopedic Trauma Directions 2007; 5: 9-17DOI: 10.1055/s-2007-996157SummaryEvidence from six studies suggests that poorer bone quality, lower canal flare index scores, fracture as the indication for the index operation, and initial prosthesis type may increase the risk implant-related fracture. There is conflicting evidence regarding age as a risk factor and sex was not a significant independent risk factor even though more females tended to have such fractures.[...]© Georg Thieme Verlag Stuttgart · New YorkGet connected:Table of contents  |  Abstract  |  Full text (Source: Orthopedic Trauma Directions) Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=1046053 Fri, 23 Nov 2007 03:09:21 +0100 1046053 http://www.medworm.com/index.php?rid=1046052&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-2007-996156 Orthopedic Trauma Directions 2007; 5: 1-8DOI: 10.1055/s-2007-996156SummarySome evidence from two small randomized controlled trials indicates that medial and lateral (crossed) pinning and lateral pinning for fixation of supracondylar fractures in children may be comparable with regard to mean Baumann angle changes, carrying angle loss, risk of poor outcome, iatrogenic nerve injury, and infection. Additional methodologically rigorous comparative studies with larger sample sizes are necessary to establish the long term safety and efficacy of these two operative treatments.[...]© Georg Thieme Verlag Stuttgart · New YorkGet connected:Table of contents  |  Abstract  |  Full text (Source: Orthopedic Trauma Directions) Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=1046052 Fri, 23 Nov 2007 03:09:21 +0100 1046052 http://www.medworm.com/index.php?rid=967525&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-2007-980100 Orthopedic Trauma Directions 2007; 5: 25-29DOI: 10.1055/s-2007-980100Author summaryAt the publication of this study, a better classification system was needed to describe fractures and fracture dislocations of the proximal humerus. In particular, it was important to identify patients who may not respond satisfactorily to conservative treatment, so careful thought could be given to the course of treatment, based on the actual pattern of the fracture. Such a system also could help establish treatment guidelines in the future for similar cases. Furthermore, an objective grading system for the outcome of treatment was sought, so that long-term outcomes reported by different physicians could be reliably and consistently compared.[...]© Georg Thieme Verlag Stuttgart · New YorkGet connected:Tab... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=967525 Mon, 22 Oct 2007 01:17:47 +0100 967525 http://www.medworm.com/index.php?rid=967524&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-2007-980099 Orthopedic Trauma Directions 2007; 5: 17-24DOI: 10.1055/s-2007-980099SummaryEvidence from four randomized or quasi randomized controlled trials (RCT) suggests that for patients presenting with proximal femoral fractures, relative to total hip arthroplasty (THA), patients with hemiarthroplasty (HA) may be at lower risk for dislocation, although at higher risk for revision. Patients with HA may have less mobility, but statistical significance was not consistent across studies. No significant differences in mortality based on prosthesis type were reported. Results should be interpreted cautiously given lack of homogeneity with respect to methods and prostheses used.[...]© Georg Thieme Verlag Stuttgart · New YorkGet connected:Table of contents  |  Abstract  |  Full text (Source: Orth... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=967524 Mon, 22 Oct 2007 01:17:47 +0100 967524 http://www.medworm.com/index.php?rid=967523&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-2007-980098 Orthopedic Trauma Directions 2007; 5: 11-15DOI: 10.1055/s-2007-980098SummaryAge, gender, fracture type, nail locking technique, and bone grafting did not appear to affect union, mean time to union, or need for additional procedures. Evidence on smoking as a prognostic factor was conflicting. Nonsmokers were more likely to achieve union after one procedure compared with smokers in one study. However, the mean time to union and need for additional procedures were not decreased in nonsmokers in two other studies. Studies may have had insufficient power to detect the effects of various prognostic factors. A methodologically rigorous multi-center prognostic study may provide a larger sample size, and help delineate factors affecting outcome in exchange nailing for the treatment of femoral shaft... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=967523 Mon, 22 Oct 2007 01:17:47 +0100 967523 http://www.medworm.com/index.php?rid=967522&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-2007-980097 Orthopedic Trauma Directions 2007; 5: 1-10DOI: 10.1055/s-2007-980097SummaryEvidence from three randomized or quasi-randomized controlled trials indicates that, in older, predominantly female populations there were no differences in either patient-reported or clinician-based outcomes whether distal radial fractures were treated with external fixation (EF) or with cast immobilization. Evidence from one trial suggests that in a younger and predominantly male population, clinician based outcomes may be better for EF compared with casting. Redisplacement was significantly less for EF in two trials, and EF may result in less radial angular deformity and less radial shortening compared with casting. Results should be interpreted cautiously since attrition over long-term follow-up may induce bias ... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=967522 Mon, 22 Oct 2007 01:17:47 +0100 967522 http://www.medworm.com/index.php?rid=967521&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-2007-980136 Orthopedic Trauma Directions 2007; 5: 27-33DOI: 10.1055/s-2007-980136Author summaryA classification inclusive of all forms of acetabular fracture was sought to aid in determining the best surgical approach. Understanding of the pathologic anatomy may be achieved through four x-ray views, allowing determination of the optimal approach for fixation of the fracture with safety and ease. Perfect anatomical reduction with surgery is the goal but on occasion the conservative approach may give a satisfactory clinical outcome. The combined surgical experience of over 22 years of Emile Letournel and Robert Judet with a series of patients is presented in connection with the development of the classification system and evolution of surgical approaches.[...]© Georg Thieme Verlag Stuttgart · New York... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=967521 Mon, 22 Oct 2007 01:17:47 +0100 967521 http://www.medworm.com/index.php?rid=967520&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-2007-980135 Orthopedic Trauma Directions 2007; 5: 19-26DOI: 10.1055/s-2007-980135SummaryThere is conflicting evidence from six retrospective cohort studies that examined the impact of delayed surgical treatment (via closed reduction and pinning) for pediatric supracondylar distal humeral fractures regarding the effect of surgical timing on the need for an open reduction. Delayed surgery does not appear to affect the postoperative complication rates for pin track infection or compartment syndrome. Based on individual studies, timing of surgery does not affect iatrogenic nerve injury. Additional methodologically rigorous comparative studies which delineate outcomes with early versus delayed surgery are necessary to establish the long term safety and efficacy of a delay in surgery in pediatric supracondy... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=967520 Mon, 22 Oct 2007 01:17:47 +0100 967520 http://www.medworm.com/index.php?rid=967519&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-2007-980134 Orthopedic Trauma Directions 2007; 5: 11-18DOI: 10.1055/s-2007-980134SummaryEvidence from three randomized controlled trials suggests that treatment of acute humeral shaft fractures with intramedullary nailing (IMN) compared with dynamic compression plating leads to comparable results with respect to rates of nounion, infection, and iatrogenic nerve injury. There appeared to be an increase in risk of reoperation with IMN, which was significant when data were pooled across studies. There was conflicting evidence in regard to the mean time to union. Additional methodologically rigorous randomized controlled trials with larger populations are necessary to establish the long term safety and efficacy of these two operative treatments and to evaluate the superiority of one treatment over another... Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=967519 Mon, 22 Oct 2007 01:17:47 +0100 967519 http://www.medworm.com/index.php?rid=967518&cid=s_36615_31_f&fid=36615&url=http%3A%2F%2Fwww.thieme-connect.com%2FDOI%2FDOI10.1055%2Fs-2007-980133 Orthopedic Trauma Directions 2007; 5: 1-9DOI: 10.1055/s-2007-980133SummaryInformation from four case series on the treatment of distal tibial fractures by intramedullary (IM) nailing and five case series where plating was used indicates that fracture union rates are high after either treatment, but malunion may occur less often after IM nailing than after plating. Reoperation rates varied widely among studies. Hardware breakage and infection rates were low. Well-designed comparative studies are needed to more effectively compare these two treatment options.[...]© Georg Thieme Verlag Stuttgart · New YorkGet connected:Table of contents  |  Abstract  |  Full text (Source: Orthopedic Trauma Directions) Orthopedic Trauma Directions journals http://www.medworm.com/rss/comments.php?id=967518 Thu, 27 Sep 2007 23:05:52 +0100 967518