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Medicina (Kaunas, Lithuania) Sep 2022Hip fractures are a leading cause of hospitalisation in elderly patients, representing an increasing socioeconomic problem arising from demographic changes, considering... (Review)
Review
Hip fractures are a leading cause of hospitalisation in elderly patients, representing an increasing socioeconomic problem arising from demographic changes, considering the increased number of elderly people in our countries. Adequate peri-operative treatment is essential to decrease mortality rates and avoid complications. Modern management should involve a coordinated multidisciplinary approach, early surgery, pain treatment, balanced fluid therapy, and prevention of delirium, to improve patients' functional and clinical outcomes. The operative treatment for intertrochanteric and subtrochanteric fractures is intramedullary nail or sliding/dynamic hip screw (DHS) on the basis of the morphology of the fracture. In the case of neck fractures, total hip replacement (THR) or hemiarthroplasty are recommended. However, several topics remain debated, such as the optimum thromboprophylaxis to reduce venous thromboembolism or the use of bone cement. Postoperatively, patients can benefit from early mobilisation and geriatric multidisciplinary care. However, during the COVID-19 pandemic, a prolonged time to operation with a subsequent increased complication rate have burdened frail and elderly patients with hip fractures. Future studies are needed with the aim to investigate better strategies to improve nutrition, postoperative mobility, to clarify the role of home-based rehabilitation, and to identify the ideal analgesic treatment and adequate tools in case of patients with cognitive impairment.
Topics: Humans; Aged; Bone Nails; Bone Cements; Anticoagulants; Pandemics; Venous Thromboembolism; COVID-19; Femoral Fractures; Hip Fractures; Treatment Outcome
PubMed: 36295475
DOI: 10.3390/medicina58101314 -
Ugeskrift For Laeger Jan 2023Diaphyseal forearm fractures in children are common and knowledge of both ordinary and rare variations of these are important to deliver the best treatment as presented... (Review)
Review
Diaphyseal forearm fractures in children are common and knowledge of both ordinary and rare variations of these are important to deliver the best treatment as presented in this review. Closed reduction and cast immobilisation are effective and well-documented treatments for most fractures. Fractures which cannot be sufficiently treated in a cast are stabilised with elastic stable intramedullary nailing which is an effective treatment with a low complication rate. The focus in reduction is to correct alignment, displacement, and rotation to restore normal function of the forearm.
Topics: Child; Humans; Forearm; Ulna Fractures; Radius Fractures; Bone Nails; Treatment Outcome
PubMed: 36760151
DOI: No ID Found -
Ugeskrift For Laeger Jan 2023Fractures in the lower leg are common in children and are most often due to accidental falls. A significant part of the fractures involves the growth plates. This review... (Review)
Review
Fractures in the lower leg are common in children and are most often due to accidental falls. A significant part of the fractures involves the growth plates. This review describes a broad range of techniques for treatment ranging from immobilization in a cast to open reduction and fixation with K-wires, screws, or flexible intramedullary nails. Premature growth arrest is relatively common following the physeal fractures in proximal or distal tibia. We recommend early consultation with a tertiary care centre for guidance and planning of the best treatment.
Topics: Humans; Child; Leg; Bone Nails; Tibial Fractures; Lower Extremity; Growth Plate
PubMed: 36760152
DOI: No ID Found -
Orthopaedics & Traumatology, Surgery &... Feb 2022Geriatrics continues to evolve as a specialty by adapting itself to increasingly older patients. Musculoskeletal injuries are common in these patients, who can maintain... (Review)
Review
Geriatrics continues to evolve as a specialty by adapting itself to increasingly older patients. Musculoskeletal injuries are common in these patients, who can maintain their physical capacities and autonomy for a long time, but whose bone solidness is frequently reduced by osteoporosis. Falls increase with age and because of certain medical conditions. Trauma in the geriatric population involves specific risks; thus, the treatment must be adapted not only to the fracture, but to the local conditions and the patient. Ankle injuries are particularly frequent in general traumatology but even more in geriatric traumatology. They can lead to complete loss of autonomy if the treatment is delayed and/or not adapted to the local conditions or the patient. The functional prognosis is brought into play, along with the patient's life due to loss of autonomy and general complications occurring in patients who are bed-ridden. The treatment of bimalleolar ankle fractures in older adults requires rigorous analysis at all points, which starts by evaluating the cutaneous status and viability of the soft tissues upon admission. The benefit-risk balance of the various treatment options will be assessed with the main goal being that patients recover their autonomy. This article will review this topic by answering 7 questions: 1) What are the distinctive features of elderly? Dependence on others, comorbidities, bone and soft tissue fragility are the main ones, explaining these high-risk situations and frequent complications. 2) When should a bimalleolar ankle fracture be treated surgically? The surgery must be done early, preferably within 8hours of the injury occurring, once the comorbidities have been controlled. The local conditions (skin and soft tissue damage) must be evaluated carefully as they determine the treatment. Errors are not allowed in these patients, who are often fragile and in precarious health. Definitive fixation is preferred if the skin status allows it, but one must keep temporary external fixation in mind as an option. 3) Is there still a role for conservative treatment of displaced fractures? This will produce good results when it is well done; however, the indications are rare and must be selected carefully. The main risks are secondary displacement and skin lesions inside the cast, which are sources of infection. 4) Is fixation with anatomical locking plates an advance? This is definitely an advance for these fragility fractures, which are often comminuted, as it allows return to weight bearing in certain conditions. However, the implantation rules must be followed exactly, and it is preferable to use thinner plates. 5) Does transplantar Steinmann pin fixation still have a role? It has few indications, limited to salvage situations (catastrophic local conditions, very poor general condition). External tibiocalcaneal fixation, alone or in combination, is a better option. 6) Is immediate transarticular fixation with a retrograde or antegrade locked nail a reasonable option? Fixation can be done by retrograde nailing or antegrade nailing. It is proposed to patients who are not very autonomous with a poor cutaneous status and/or severe osteoporosis. It is preferable to transplantar nailing. 7) Is immediate protected weight bearing, with or without fixation, possible? This can be considered on a case-by-case basis depending on the extent of the trauma, patient compliance and treatment carried out. LEVEL OF EVIDENCE: V, Expert opinion.
Topics: Aged; Ankle Fractures; Bone Nails; Bone Plates; Fracture Fixation, Internal; Fracture Fixation, Intramedullary; Humans; Osteoporosis; Treatment Outcome
PubMed: 34757182
DOI: 10.1016/j.otsr.2021.103137 -
Scientific Reports Oct 2023Dry electroencephalography (EEG) electrodes provide rapid, gel-free, and easy EEG preparation, but with limited wearing comfort. We propose a novel dry electrode...
Dry electroencephalography (EEG) electrodes provide rapid, gel-free, and easy EEG preparation, but with limited wearing comfort. We propose a novel dry electrode comprising multiple tilted pins in a flower-like arrangement. The novel Flower electrode increases wearing comfort and contact area while maintaining ease of use. In a study with 20 volunteers, we compare the performance of a novel 64-channel dry Flower electrode cap to a commercial dry Multipin electrode cap in sitting and supine positions. The wearing comfort of the Flower cap was rated as significantly improved both in sitting and supine positions. The channel reliability and average impedances of both electrode systems were comparable. Averaged VEP components showed no considerable differences in global field power amplitude and latency, as well as in signal-to-noise ratio and topography. No considerable differences were found in the power spectral density of the resting state EEGs between 1 and 40 Hz. Overall, our findings provide evidence for equivalent channel reliability and signal characteristics of the compared cap systems in the sitting and supine positions. The reliability, signal quality, and significantly improved wearing comfort of the Flower electrode allow new fields of applications for dry EEG in long-term monitoring, sensitive populations, and recording in supine position.
Topics: Humans; Reproducibility of Results; Electroencephalography; Electrodes; Electric Impedance; Bone Nails
PubMed: 37789022
DOI: 10.1038/s41598-023-42732-8 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... May 2021To review the research progress of intramedullary lengthening nail technology. (Review)
Review
OBJECTIVE
To review the research progress of intramedullary lengthening nail technology.
METHODS
The foreign literature on the development history, types, advantages and disadvantages, indications and contraindications, complications, and effectiveness of intramedullary lengthening nail were reviewed and analyzed.
RESULTS
The intramedullary lengthening nail system mainly includes mechanical type, electric motor drive type, and magnetic drive type. Compared with traditional external fixation and lengthening technology, the intramedullary lengthening nail technology has certain advantages in incidence of complications, bone healing, postoperative functional rehabilitation, incision aesthetics, convenience, and patient satisfaction. However, there are also shortcomings, such as pain, uncontrollable distraction rate, device failure, etc. In the clinical application of intramedullary lengthening nails for limb lengthening, the indications should be grasped reasonably, and the related complications should be prevented and treated.
CONCLUSION
Intramedullary lengthening nails provide a new option for limb lengthening, and the initial effectiveness is good. It is one of the development direction of limb lengthening technology.
Topics: Bone Lengthening; Bone Nails; Femur; Fracture Fixation, Intramedullary; Humans; Leg Length Inequality; Technology; Treatment Outcome
PubMed: 33998220
DOI: 10.7507/1002-1892.202012084 -
ANZ Journal of Surgery Apr 2021This study focuses on (i) the length of the intraosseous part of the supraacetabular pin using the insertion technique from the spina iliaca anterior inferior to the...
BACKGROUND
This study focuses on (i) the length of the intraosseous part of the supraacetabular pin using the insertion technique from the spina iliaca anterior inferior to the cortical part of the incisura ischiadica major, (ii) the angle of insertion of the supraacetabular pin in the transversal plane and (iii) gender-specific differences of the measured results.
METHODS
Images of uninjured pelves from 49 patients (64-line computed tomography scanner) were evaluated, and virtual external fixator pins were positioned using a three-dimensional reconstructions of computed tomography scans. The length of the pins and the insertion angle were investigated. Descriptive statistics were used, and gender-specific differences were calculated. A P-value of <0.05 was considered statistically significant.
RESULTS
The results showed significant differences between male and female pelves concerning both pin length and insertion angel. For male pelves, the mean screw length was 82.7 mm (SD 5.1; range 72.9-94.3). For females, this was statistically significantly shorter (P ≤ 0.001), with an average of 74.1 mm (SD 5.0; range 63.1-81.9). In the male subgroup, the insertion angle was a mean of 22.6° (SD 3.4; range 12.4-31.8), and the female pelves had an average angle of 19.7° (SD 4.0; range 11.7-24.5). These values differed statistically significantly (P = 0.0032).
CONCLUSION
Based on our measurements, we can confirm that both the length of the Schanz screws and the angle of insertion for the supraacetabular external fixator show a statistically significant difference between males and females.
Topics: Bone Nails; Bone Screws; External Fixators; Female; Fracture Fixation; Humans; Ilium; Male
PubMed: 33734540
DOI: 10.1111/ans.16694 -
JAMA Network Open Jun 2023Fractures of the hip have devastating effects on function and quality of life. Intramedullary nails (IMN) are the dominant implant choice for the treatment of... (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Fractures of the hip have devastating effects on function and quality of life. Intramedullary nails (IMN) are the dominant implant choice for the treatment of trochanteric fractures of the hip. Higher costs of IMNs and inconclusive benefit in comparison with sliding hip screws (SHSs) convey the need for definitive evidence.
OBJECTIVE
To compare 1-year outcomes of patients with trochanteric fractures treated with the IMN vs an SHS.
DESIGN, SETTING, AND PARTICIPANTS
This randomized clinical trial was conducted at 25 international sites across 12 countries. Participants included ambulatory patients aged 18 years and older with low-energy trochanteric (AO Foundation and Orthopaedic Trauma Association [AO/OTA] type 31-A1 or 31-A2) fractures. Patient recruitment occurred between January 2012 and January 2016, and patients were followed up for 52 weeks (primary end point). Follow-up was completed in January 2017. The analysis was performed in July 2018 and confirmed in January 2022.
INTERVENTIONS
Surgical fixation with a Gamma3 IMN or an SHS.
MAIN OUTCOMES AND MEASURES
The primary outcome was health-related quality of life (HRQOL), measured by the EuroQol-5 Dimension (EQ5D) at 1-year postsurgery. Secondary outcomes included revision surgical procedure, fracture healing, adverse events, patient mobility (measured by the Parker mobility score), and hip function (measured by the Harris hip score).
RESULTS
In this randomized clinical trial, 850 patients were randomized (mean [range] age, 78.5 [18-102] years; 549 [64.6% female) with trochanteric fractures to undergo fixation with either the IMN (n = 423) or an SHS (n = 427). A total of 621 patients completed follow-up at 1 year postsurgery (304 treated with the IMN [71.9%], 317 treated with an SHS [74.2%]). There were no significant differences between groups in EQ5D scores (mean difference, 0.02 points; 95% CI, -0.03 to 0.07 points; P = .42). Furthermore, after adjusting for relevant covariables, there were no between-group differences in EQ5D scores (regression coefficient, 0.00; 95% CI, -0.04 to 0.05; P = .81). There were no between-group differences for any secondary outcomes. There were also no significant interactions for fracture stability (β [SE] , 0.01 [0.05]; P = .82) or previous fracture (β [SE], 0.01 [0.10]; P = .88) and treatment group.
CONCLUSIONS AND RELEVANCE
This randomized clinical trial found that IMNs for the treatment of trochanteric fractures had similar 1-year outcomes compared with SHSs. These results suggest that the SHS is an acceptable lower-cost alternative for trochanteric fractures of the hip.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT01380444.
Topics: Humans; Female; Aged; Male; Fracture Fixation, Intramedullary; Bone Nails; Quality of Life; Bone Screws; Hip Fractures
PubMed: 37278998
DOI: 10.1001/jamanetworkopen.2023.17164 -
European Journal of Orthopaedic Surgery... Aug 2022The management of limb-length discrepancy secondary to traumatic femoral bone loss poses a unique challenge for surgeons. The Ilizarov technique is popular, but is...
PURPOSE
The management of limb-length discrepancy secondary to traumatic femoral bone loss poses a unique challenge for surgeons. The Ilizarov technique is popular, but is associated with long external fixator time and many complications. This retrospective study assessed outcomes of post-traumatic femoral defects managed by monorail external fixation over an intramedullary nail.
METHODS
Eight patients were included from October 2015 to May 2019 with post-traumatic femoral defects that underwent treatment with monorail fixator-assisted intramedullary nailing. Primary outcome was time to bone union and bone results according to ASAMI classification. Secondary outcomes were lengthening index, consolidation time and index, external fixator index (EFI), time to partial weight bearing(PWB) and full weight bearing (FWB), and complications. Patient reported outcome measures including EQ-5D-5L, SF-36, Oxford knee scores (OKS), and Oxford hip scores (OHS) were recorded after recovery.
RESULTS
Mean follow-up time was 227 weeks. Average bone defect size was 9.69 cm. Average consolidation time and index were 11.35 months and 1.24 months/cm, respectively. Mean lengthening and external fixator index were 20.2 days/cm and 23.88 days/cm, respectively. On average, patients achieved FWB and bone union 56.25 weeks and 68.83 weeks after bone transport initiation, respectively. Two patients had docking site non-union, five patients had pin site infections, and two patients had osteomyelitis. EQ-5D-5L and EQ-VAS scores were compared to UK population norms (p = 0.104, p = 0.238, respectively). Average OKS was 32.17 and OHS was 34.00.
CONCLUSION
Monorail external fixation over an intramedullary nail is an effective option for post-traumatic femoral defects, reducing external fixator time and returning patients' quality of life to a level comparable with the normal population.
Topics: Bone Nails; External Fixators; Fracture Fixation, Intramedullary; Humans; Leg Length Inequality; Osteogenesis, Distraction; Quality of Life; Retrospective Studies; Treatment Outcome
PubMed: 34363107
DOI: 10.1007/s00590-021-03082-1 -
African Journal of Paediatric Surgery :... 2023Bilateral femoral fractures in children (BFFC) are an uncommon condition. Only a few cases were reported in the literature. The frequency and outcome in low-setting...
INTRODUCTION
Bilateral femoral fractures in children (BFFC) are an uncommon condition. Only a few cases were reported in the literature. The frequency and outcome in low-setting facilities are unknown. This study aims to describe our experience in managing BFFC.
PATIENTS AND METHODS
A 10-year ongoing study spanning from 2010 to 2020 was held in a level-1 paediatric facility. We included all cases of BFFC on a bone-free disease with at least 10 months of follow-up time. Data were collected and analysed with statistical software.
RESULTS
A total of eight patients with ten BFFC were collected. It involved mainly boys (n = 7/8) with median age of 8 years. Mechanism of injury were a road traffic accident (n = 4), a fall from height (n = 3), and been crushed by a falling wall (n = 1). Associated injuries were frequent (n = 6/8). Patients were managed nonoperatively with spica cast (n = 5) and by elastic intramedullary nails (n = 3). After 6.11 years of mean follow-up time, all fractures healed. The outcome was excellent and good in 7 cases. One patient sustained knees stiffness.
CONCLUSION
Non-operative management of BFFC showed satisfactory outcomes. Early surgical care must be developed in our low-income settings to reduce in-hospital stay and encourage early weight-bearing.
Topics: Male; Humans; Child; Female; Bone Nails; Femoral Fractures; Fracture Fixation, Intramedullary; Fracture Fixation, Internal; Length of Stay; Treatment Outcome; Fracture Healing; Retrospective Studies
PubMed: 36960507
DOI: 10.4103/ajps.ajps_91_21