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Fractures of the Lower End of the Tibia into the Ankle-JointEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: Orthopedic Trauma Directions - October 8, 2009 Category: Orthopaedics Tags: Classic article review Source Type: journals

Acute tibial fracturesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 be...
Source: Orthopedic Trauma Directions - October 8, 2009 Category: Orthopaedics Tags: Clinical topic Source Type: journals

Tibial nonunionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 large...
Source: Orthopedic Trauma Directions - October 8, 2009 Category: Orthopaedics Tags: Clinical topic Source Type: journals

Distal radius fracturesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Orthopedic Trauma Directions - October 8, 2009 Category: Orthopaedics Tags: Clinical topic Source Type: journals

Plate Fixation of Open Fractures of the TibiaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 grea...
Source: Orthopedic Trauma Directions - August 8, 2009 Category: Orthopaedics Tags: Classic article review Source Type: journals

Open and closed tibial fracturesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Orthopedic Trauma Directions - August 8, 2009 Category: Orthopaedics Tags: Clinical topic Source Type: journals

Displaced radial head fracturesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Orthopedic Trauma Directions - August 8, 2009 Category: Orthopaedics Tags: Clinical topic Source Type: journals

Hip fracturesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 comorbid...
Source: Orthopedic Trauma Directions - August 8, 2009 Category: Orthopaedics Tags: Clinical topic Source Type: journals

Musculoskeletal Function Assessment Instrument: Criterion and Construct Validity.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 �...
Source: Orthopedic Trauma Directions - June 9, 2009 Category: Orthopaedics Tags: Classic article review Source Type: journals

Pertrochanteric hip fracturesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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. Addition...
Source: Orthopedic Trauma Directions - June 9, 2009 Category: Orthopaedics Tags: Clinical topic Source Type: journals

Talar neck fracturesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 te...
Source: Orthopedic Trauma Directions - June 9, 2009 Category: Orthopaedics Tags: Clinical topic Source Type: journals

Open calcaneal fracturesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 infec...
Source: Orthopedic Trauma Directions - June 9, 2009 Category: Orthopaedics Tags: Clinical topic Source Type: journals

On the Fracture of the Carpal Extremity of the RadiusEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: Orthopedic Trauma Directions - May 4, 2009 Category: Orthopaedics Tags: Classic article review Source Type: journals

Calcaneal fracturesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 wit...
Source: Orthopedic Trauma Directions - May 4, 2009 Category: Orthopaedics Tags: Clinical topic Source Type: journals

Displaced radial head fracturesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 indi...
Source: Orthopedic Trauma Directions - May 4, 2009 Category: Orthopaedics Tags: Clinical topic Source Type: journals

Acute Jones fracturesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Orthopedic Trauma Directions - May 1, 2009 Category: Orthopaedics Tags: Clinical topic Source Type: journals

Intracapsular Fractures of the HipEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 tr...
Source: Orthopedic Trauma Directions - February 6, 2009 Category: Orthopaedics Tags: Classic article review Source Type: journals

Proximal humeral hemiarthroplastyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Orthopedic Trauma Directions - February 6, 2009 Category: Orthopaedics Tags: Clinical topic Source Type: journals

Complex tibial plateau fracturesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: Orthopedic Trauma Directions - February 6, 2009 Category: Orthopaedics Tags: Clinical topic Source Type: journals

Nondisplaced scaphoid fracturesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 m...
Source: Orthopedic Trauma Directions - February 6, 2009 Category: Orthopaedics Tags: Clinical topic Source Type: journals

Pelvic Disruption: Principles of ManagementEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: Orthopedic Trauma Directions - February 6, 2009 Category: Orthopaedics Tags: Classic article review Source Type: journals

Fractures of the lower extremitiesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 morta...
Source: Orthopedic Trauma Directions - February 6, 2009 Category: Orthopaedics Tags: Clinical topic Source Type: journals

Open long-bone fracturesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: Orthopedic Trauma Directions - February 6, 2009 Category: Orthopaedics Tags: Clinical topic Source Type: journals

Open tibial fracturesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: Orthopedic Trauma Directions - February 6, 2009 Category: Orthopaedics Tags: Clinical topic Source Type: journals

Pelvic disruption: assessment and classificationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 associa...
Source: Orthopedic Trauma Directions - September 19, 2008 Category: Orthopaedics Tags: Classic article review Source Type: journals

Proximal humeral fractures. Early versus delayed motion in nonoperative treatment of minimally displaced or impacted fracturesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: Orthopedic Trauma Directions - September 19, 2008 Category: Orthopaedics Tags: Clinical topic Source Type: journals

Ankle fractures. Tricortical versus quadricortical screw fixationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 com...
Source: Orthopedic Trauma Directions - September 19, 2008 Category: Orthopaedics Tags: Clinical topic Source Type: journals

Ankle fractures. Early versus delayed motion following internal fixation (update to July 2006 issue)Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: Orthopedic Trauma Directions - September 19, 2008 Category: Orthopaedics Tags: Clinical topic Source Type: journals

A staged protocol for soft-tissue management in the treatment of complex pilon fracturesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: Orthopedic Trauma Directions - July 26, 2008 Category: Orthopaedics Tags: Classic article review Source Type: journals

Distal radial fracturesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Orthopedic Trauma Directions - July 26, 2008 Category: Orthopaedics Tags: Clinical topic Source Type: journals

Intraarticular distal radial fracturesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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, ...
Source: Orthopedic Trauma Directions - July 26, 2008 Category: Orthopaedics Tags: Clinical topic Source Type: journals

Hip fracturesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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-...
Source: Orthopedic Trauma Directions - July 26, 2008 Category: Orthopaedics Tags: Clinical topic Source Type: journals

Fractures of the radial head with distal radio-ulnar dislocationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 immedi...
Source: Orthopedic Trauma Directions - June 12, 2008 Category: Orthopaedics Tags: Classic article review Source Type: journals

Tibial fracturesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: Orthopedic Trauma Directions - June 12, 2008 Category: Orthopaedics Tags: Clinical topic Source Type: journals

Clavicular fracturesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 conn...
Source: Orthopedic Trauma Directions - June 12, 2008 Category: Orthopaedics Tags: Clinical topic Source Type: journals

Closed hip and long bone fracturesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 evaluate...
Source: Orthopedic Trauma Directions - June 12, 2008 Category: Orthopaedics Tags: Clinical topic Source Type: journals

Fractures of the coronoid process of the ulnaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Orthopedic Trauma Directions - April 2, 2008 Category: Orthopaedics Tags: Classic article review Source Type: journals

Lisfranc joint injuryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 remova...
Source: Orthopedic Trauma Directions - April 2, 2008 Category: Orthopaedics Tags: Clinical topic Source Type: journals

Isolated ulnar shaft fracturesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: Orthopedic Trauma Directions - April 2, 2008 Category: Orthopaedics Tags: Clinical topic Source Type: journals

Intraarticular glenoid fracturesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 V...
Source: Orthopedic Trauma Directions - April 2, 2008 Category: Orthopaedics Tags: Clinical topic Source Type: journals

Functional bracing of fractures of the shaft of the humerusEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: Orthopedic Trauma Directions - January 30, 2008 Category: Orthopaedics Tags: Classic article review Source Type: journals

Acute midshaft clavicular fracturesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 |...
Source: Orthopedic Trauma Directions - January 30, 2008 Category: Orthopaedics Tags: Clinical topic Source Type: journals

Acute clavicular midshaft fracturesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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. High...
Source: Orthopedic Trauma Directions - January 30, 2008 Category: Orthopaedics Tags: Clinical topic Source Type: journals

Hip fracturesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: Orthopedic Trauma Directions - January 30, 2008 Category: Orthopaedics Tags: Clinical topic Source Type: journals

Trauma to the pelvis: urethral injuryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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....
Source: Orthopedic Trauma Directions - November 23, 2007 Category: Orthopaedics Tags: Classic article review Source Type: journals

Femoral shaft fracturesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Orthopedic Trauma Directions - November 23, 2007 Category: Orthopaedics Tags: Clinical topic Source Type: journals

Femoral fracturesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: Orthopedic Trauma Directions - November 23, 2007 Category: Orthopaedics Tags: Clinical topic Source Type: journals

Pediatric supracondylar humeral fracturesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: Orthopedic Trauma Directions - November 23, 2007 Category: Orthopaedics Tags: Clinical topic Source Type: journals

Displaced proximal humeral fracturesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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, ...
Source: Orthopedic Trauma Directions - October 22, 2007 Category: Orthopaedics Tags: Classic article review Source Type: journals

Proximal femoral fracturesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 wit...
Source: Orthopedic Trauma Directions - October 22, 2007 Category: Orthopaedics Tags: Clinical topic Source Type: journals