A rare combination of an ulnar fracture with posterior dislocation of the head of the radius and fracture of the radius shaft concomitant with an ipsilateral scaphoid fracture is presented. To the best of our knowledg...A rare combination of an ulnar fracture with posterior dislocation of the head of the radius and fracture of the radius shaft concomitant with an ipsilateral scaphoid fracture is presented. To the best of our knowledge, no such case has been reported. The mechanism of this fracture combination is discussed with respect to its role in producing the Monteggia type II fracture. Treatment consisted of a combination of closed and open reduction with external fixation.展开更多
AIM: To determine whether patients taking aspirin during carpal tunnel release had an increase of complications.METHODS: Between January 2008 and January 2010, 150 patients underwent standard open carpal tunnel releas...AIM: To determine whether patients taking aspirin during carpal tunnel release had an increase of complications.METHODS: Between January 2008 and January 2010, 150 patients underwent standard open carpal tunnel release(CTR) under intravenous regional anaesthesia. They were divided into three groups: groups 1 and 2 were made of 50 patients each, on aspirin 100 mg/d for at least a year. In group 1 the aspirin was never stopped. In group 2 it was stopped at least 5 d before surgery and resumed 3 d after. Group 3 acted as a control, with 50 patients who did not take aspirin. The incidence of clinically significant peror post-operative complications was recorded and divided into local and cardio-cerebro-vascular complications. Local complications were then divided into minor and major according to Page and Stern. Local haematomas were assessed at 2 d(before resuming aspirin in group 2) and 14 d(after resuming aspirin in group 2) postoperatively. Patients were reviewed at 2, 14 and 90 d after surgery.RESULTS: There was no significant difference in the incidence of complications in the three groups. A total of 3 complications(2 major and 1 minor) and 27 visible haematomas were recorded. Two major complications were observed respectively in group 1(non stop aspirin) and in group 3(never antiaggregated). The minor complication, observed in one patient of group 2(stop aspirin), consisted of a wound dehiscence, which only led to delayed healing. All haematomas were observed in the first 48 h, no haematoma lasted for more than 2 wk and all resolved spontaneously. A major haematoma(score > 20 cm2) was observed in 8 patients. A minor haematoma(score < 20 cm2) was recorded in 19 patients. All patients at 90 d after surgery were satisfied with the result in terms of relief of their preoperative symptoms. Major and minor haematomas did not impair hand function or require any specific therapy.CONCLUSION: Our study demonstrates that continuation of aspirin did not increase the risk of complications. It is unnecessary to stop aspirin before CTR with good surgical techniques.展开更多
BACKGROUND Distal radius fractures(DRFs)are a common challenge in orthopaedic trauma care,yet for those fractures that are treated nonoperatively,strong evidence to guide cast treatment is still lacking.AIM To compare...BACKGROUND Distal radius fractures(DRFs)are a common challenge in orthopaedic trauma care,yet for those fractures that are treated nonoperatively,strong evidence to guide cast treatment is still lacking.AIM To compare the efficacy of below elbow cast(BEC)and above elbow cast(AEC)in maintaining reduction of manipulated DRFs.METHODS We conducted a prospective,monocentric,randomized,parallel-group,open label,blinded,noninferiority trial comparing the efficacy of BEC and AEC in the nonoperative treatment of DRFs.Two hundred and eighty patients>18 years of age diagnosed with DRFs were successfully randomized and included for analysis over a 3-year period.Noninferiority thresholds were defined as a 2 mm difference for radial length(RL),a 3°difference for radial inclination(RI),and volar tilt(VT).The trial is registered at Clinicaltrials.gov(NCT03468023).RESULTS One hundred and forty-three patients were treated with BEC,and 137 were treated with AEC.The mean time of immobilization was 33 d.The mean loss of RL,RI,and VT was 1.59 mm,2.83°,and 4.11°for BEC and 1.63 mm,2.54°,and VT loss were respectively 0.04 mm(95%CI:-0.36-0.44),-0.29°(95%CI:-1.03-0.45),and 0.59°(95%CI:-1.39-2.57),and they were all below the prefixed noninferiority thresholds.The rate of loss of reduction was similar.CONCLUSION BEC performs as well as AEC in maintaining the reduction of a manipulated DRF.Being more comfortable to patients,BEC may be preferable for nonoperative treatment of DRFs.展开更多
Purpose:The mortality rate for severely injured patients with the injury severity score(ISS)>16 has decreased in Germany.There is robust evidence that mortality is influenced not only by the acute trauma itself but...Purpose:The mortality rate for severely injured patients with the injury severity score(ISS)>16 has decreased in Germany.There is robust evidence that mortality is influenced not only by the acute trauma itself but also by physical health,age and sex.The aim of this study was to identify other possible influences on the mortality of severely injured patients.Methods:In a matched-pair analysis of data from Trauma Register DGU(R),non-surviving patients from Germany between 2009 and 2014 with an ISS_>16 were compared with surviving matching partners.Matching was performed on the basis of age,sex,physical health,injury pattern,trauma mechanism,conscious state at the scene of the accident based on the Glasgow coma scale,and the presence of shock on arrival at the emergency room.Results:We matched two homogeneous groups,each of which consisted of 657 patients(535 male,average age 37 years).There was no significant difference in the vital parameters at the scene of the accident,the length of the pre-hospital phase,the type of transport(ground or air),pre-hospital fluid management and amounts,ISS,initial care level,the length of the emergency room stay,the care received at night or from on-call personnel during the weekend,the use of abdominal sonographic imaging,the type of X-ray imaging used,and the percentage of patients who developed sepsis.We found a significant difference in the new injury severity score,the frequency of multi-organ failure,hemoglobine at admission,base excess and international normalized ratio in the emergency room,the type of accident(fall or road traffic accident),the pre-hospital intubation rate,reanimation,in-hospital fluid management,the frequency of transfusion,tomography(whole-body computed tomography),and the necessity of emergency intervention.Conclusion:Previously postulated factors such as the level of care and the length of the emergency room stay did not appear to have a significant influence in this study.Further studies should be conducted to analyse the identified factors with a view to optimising the treatment of severely injured patients.Our study shows that there are significant factors that can predict or influence the mortality of severely injured patients.展开更多
The high tibial osteotomy(HTO)is a wellestablished and commonly used treatment for younger and active patients with a medial unicompartmental osteoarthritis of the knee and varus malalignment.The aim of this technique...The high tibial osteotomy(HTO)is a wellestablished and commonly used treatment for younger and active patients with a medial unicompartmental osteoarthritis of the knee and varus malalignment.The aim of this technique is to shift the load to a functional lateral compartment in order to delay total knee arthroplasty.The dome-shaped HTO was introduced by Blaimont et al.(1975)and later popularized by Maquet(1980).Out of 118 cases,96 cases of overcorrection,13 cases of undercorrection,and 9 cases展开更多
文摘A rare combination of an ulnar fracture with posterior dislocation of the head of the radius and fracture of the radius shaft concomitant with an ipsilateral scaphoid fracture is presented. To the best of our knowledge, no such case has been reported. The mechanism of this fracture combination is discussed with respect to its role in producing the Monteggia type II fracture. Treatment consisted of a combination of closed and open reduction with external fixation.
文摘AIM: To determine whether patients taking aspirin during carpal tunnel release had an increase of complications.METHODS: Between January 2008 and January 2010, 150 patients underwent standard open carpal tunnel release(CTR) under intravenous regional anaesthesia. They were divided into three groups: groups 1 and 2 were made of 50 patients each, on aspirin 100 mg/d for at least a year. In group 1 the aspirin was never stopped. In group 2 it was stopped at least 5 d before surgery and resumed 3 d after. Group 3 acted as a control, with 50 patients who did not take aspirin. The incidence of clinically significant peror post-operative complications was recorded and divided into local and cardio-cerebro-vascular complications. Local complications were then divided into minor and major according to Page and Stern. Local haematomas were assessed at 2 d(before resuming aspirin in group 2) and 14 d(after resuming aspirin in group 2) postoperatively. Patients were reviewed at 2, 14 and 90 d after surgery.RESULTS: There was no significant difference in the incidence of complications in the three groups. A total of 3 complications(2 major and 1 minor) and 27 visible haematomas were recorded. Two major complications were observed respectively in group 1(non stop aspirin) and in group 3(never antiaggregated). The minor complication, observed in one patient of group 2(stop aspirin), consisted of a wound dehiscence, which only led to delayed healing. All haematomas were observed in the first 48 h, no haematoma lasted for more than 2 wk and all resolved spontaneously. A major haematoma(score > 20 cm2) was observed in 8 patients. A minor haematoma(score < 20 cm2) was recorded in 19 patients. All patients at 90 d after surgery were satisfied with the result in terms of relief of their preoperative symptoms. Major and minor haematomas did not impair hand function or require any specific therapy.CONCLUSION: Our study demonstrates that continuation of aspirin did not increase the risk of complications. It is unnecessary to stop aspirin before CTR with good surgical techniques.
文摘BACKGROUND Distal radius fractures(DRFs)are a common challenge in orthopaedic trauma care,yet for those fractures that are treated nonoperatively,strong evidence to guide cast treatment is still lacking.AIM To compare the efficacy of below elbow cast(BEC)and above elbow cast(AEC)in maintaining reduction of manipulated DRFs.METHODS We conducted a prospective,monocentric,randomized,parallel-group,open label,blinded,noninferiority trial comparing the efficacy of BEC and AEC in the nonoperative treatment of DRFs.Two hundred and eighty patients>18 years of age diagnosed with DRFs were successfully randomized and included for analysis over a 3-year period.Noninferiority thresholds were defined as a 2 mm difference for radial length(RL),a 3°difference for radial inclination(RI),and volar tilt(VT).The trial is registered at Clinicaltrials.gov(NCT03468023).RESULTS One hundred and forty-three patients were treated with BEC,and 137 were treated with AEC.The mean time of immobilization was 33 d.The mean loss of RL,RI,and VT was 1.59 mm,2.83°,and 4.11°for BEC and 1.63 mm,2.54°,and VT loss were respectively 0.04 mm(95%CI:-0.36-0.44),-0.29°(95%CI:-1.03-0.45),and 0.59°(95%CI:-1.39-2.57),and they were all below the prefixed noninferiority thresholds.The rate of loss of reduction was similar.CONCLUSION BEC performs as well as AEC in maintaining the reduction of a manipulated DRF.Being more comfortable to patients,BEC may be preferable for nonoperative treatment of DRFs.
文摘Purpose:The mortality rate for severely injured patients with the injury severity score(ISS)>16 has decreased in Germany.There is robust evidence that mortality is influenced not only by the acute trauma itself but also by physical health,age and sex.The aim of this study was to identify other possible influences on the mortality of severely injured patients.Methods:In a matched-pair analysis of data from Trauma Register DGU(R),non-surviving patients from Germany between 2009 and 2014 with an ISS_>16 were compared with surviving matching partners.Matching was performed on the basis of age,sex,physical health,injury pattern,trauma mechanism,conscious state at the scene of the accident based on the Glasgow coma scale,and the presence of shock on arrival at the emergency room.Results:We matched two homogeneous groups,each of which consisted of 657 patients(535 male,average age 37 years).There was no significant difference in the vital parameters at the scene of the accident,the length of the pre-hospital phase,the type of transport(ground or air),pre-hospital fluid management and amounts,ISS,initial care level,the length of the emergency room stay,the care received at night or from on-call personnel during the weekend,the use of abdominal sonographic imaging,the type of X-ray imaging used,and the percentage of patients who developed sepsis.We found a significant difference in the new injury severity score,the frequency of multi-organ failure,hemoglobine at admission,base excess and international normalized ratio in the emergency room,the type of accident(fall or road traffic accident),the pre-hospital intubation rate,reanimation,in-hospital fluid management,the frequency of transfusion,tomography(whole-body computed tomography),and the necessity of emergency intervention.Conclusion:Previously postulated factors such as the level of care and the length of the emergency room stay did not appear to have a significant influence in this study.Further studies should be conducted to analyse the identified factors with a view to optimising the treatment of severely injured patients.Our study shows that there are significant factors that can predict or influence the mortality of severely injured patients.
文摘The high tibial osteotomy(HTO)is a wellestablished and commonly used treatment for younger and active patients with a medial unicompartmental osteoarthritis of the knee and varus malalignment.The aim of this technique is to shift the load to a functional lateral compartment in order to delay total knee arthroplasty.The dome-shaped HTO was introduced by Blaimont et al.(1975)and later popularized by Maquet(1980).Out of 118 cases,96 cases of overcorrection,13 cases of undercorrection,and 9 cases
