China
Africa
Explore chapters and articles related to this topic
Biomechanical considerations for fixation of osteoporotic bone
Published in Peter V. Giannoudis, Thomas A. Einhorn, Surgical and Medical Treatment of Osteoporosis, 2020
Peter Augat, Christian von Rüden
Correct alignment and accurate fracture reduction are essential to obtain good functional outcome and an adequate healing response. Only with correct functional alignment can the load transfer through the fracture and through the adjacent joints be reconstituted. The first and most important step in fracture fixation is thus the correct alignment of the load axes. Fractures involving the joint require in addition anatomical reduction to restore the bony anatomy and joint surfaces. As reduced weight-bearing or unloading of the fracture is often impossible for elderly and fragile individuals, maintenance of fracture reduction typically requires osteosynthesis of the fracture.
Orthopaedic Surgery
Published in Gozie Offiah, Arnold Hill, RCSI Handbook of Clinical Surgery for Finals, 2019
Fracture Reduction➣ Open or closed reduction Open - Fracture site exposed surgically. The fracture is then usually immobilised by internal fixation with plates and screws, or other surgical fixation devices. This is generally referred to as open reduction and internal fixation (ORIF)Closed - the fracture is reduced manually without surgically exposing the fracture site. This may be done with the patient awake or under general anaesthetic. Immobilisation may then be done with a cast, brace or a surgical device place percutaneously or through an incision remote to the fracture site (e.g. percutaneous wires, or intra medullary nailing).
Proximal humeral fracture repair (greater tuberosity)
Published in Andreas B. Imhoff, Jonathan B. Ticker, Augustus D. Mazzocca, Andreas Voss, Atlas of Advanced Shoulder Arthroscopy, 2017
J. Christoph Katthagen, Alexander Ellwein, Helmut Lill
First, a standard posterior viewing portal is established in the region of the posterior soft spot of the shoulder, and an anterior working portal is created through the rotator interval. All intra-articular structures are inspected and eventual pathology is addressed at this time after the articular hematoma has been washed out. Next, the fracture of the GT can be inspected and evaluated from the articular side, especially with focus on the integrity of the supraspinatus-footprint. The arthroscope is then placed in the subacromial space through the posterior portal, and an anterolateral working portal is established 2 cm lateral to the anterolateral corner of the acromion. All subacromial space pathology is addressed at this time. After the subacromial space has been cleared from bursal-sided hematoma and bursitis, the fracture must be inspected and evaluated form the bursal side. If callus is present it is removed with an arthroscopic shaver and curettes. Next, the fracture site is debrided to a native anatomical contour. This step also serves to create a bleeding bone surface conducive to healing. The specific steps for fracture reduction and fixation are fracture-type dependent and will be delineated in the following sections. If the fracture includes the bicipital sulcus, with painful irritation of the biceps tendon, an additional open subpectoral biceps tenodesis is subsequently performed.
Gaps in evidence on treatment of male osteoporosis: a Research Agenda
Published in The Aging Male, 2023
Adam J. Rose, Susan L. Greenspan, Guneet K. Jasuja
In contrast to the relatively large body of work on the clinical benefits of therapies to reduce fractures in women [18], there have been relatively few studies that focused on fracture reduction in men. A recent meta-analysis by Nayak and Greenspan regarding treatment efficacy in men was based on 4,868 participants – the total number of men who were found to have participated in any qualifying randomized studies of treatment for osteoporosis [19]. This meta-analysis generally found that bisphosphonate treatment is effective compared to placebo in preventing vertebral fractures (Rate Ratio 0.37) and non-vertebral fractures (Rate Ratio 0.60) [19]. However, similar conclusions in women are based on many times as many trial participants. For example, a meta-analysis by Crandall and colleagues included tens of thousands of women for each of the medications studied, and some of the studies cited included more women than the entire meta-analysis of men combined [18].
Interosseous wiring for fragmented proximal phalangeal fractures
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Hidetoshi Teraura, Hideki Sakanaka, Hiroyuki Gotani
The patient was a 22-year-old man who was injured following a slip and fall while riding a 400-cc motorcycle. The patient visited a nearby clinic and was referred to our department. Swelling and tenderness were observed at the proximal phalangeal area of the right ring finger. Radiography revealed a three-part fracture from the neck to the shaft of the proximal phalanx of the right ring finger (Figure 2), and small bone fragments were partially seen on three-dimensional computed tomography (Figure 3). Surgery was performed 4 days after the injury, and fracture reduction was confirmed based on anterior and lateral views on a postoperative radiograph (Figure 4). Finger ROM exercises were initiated from the first day after surgery, and a TAM of 260° and a %TAM of 100% were achieved at 8 weeks postoperatively (Figure 5). Bone healing was achieved (Figure 6), and no pain or rotation deformity of the ring finger was reported at the final assessment. Ten months after surgery, at the final evaluation, the outcome was assessed as excellent based on the ASSH criteria.
Simple dentate area fractures of the mandible – can we prevent postoperative infections?
Published in Acta Odontologica Scandinavica, 2022
Marko Oksa, Aleksi Haapanen, Emilia Marttila, Johanna Snäll
Improper fixation and excessive torque during screw placement may predispose to postoperative complications [8]. Alternatively, the probability of postoperative complications may be linked to surgical experience [25]. In this study, the experience of the surgeon was not determined; however, a slightly suboptimal fixation was found in two patients. In addition to optimal fracture reduction and handling of the bone fragment, careful soft tissue management and wound closure should be considered. For example, inappropriate use of diathermy may impair tissue healing in the oral mucosal region [26,27]. Excessive compression of the bony fragments in fracture reduction can also cause postoperative complications [28]. Interestingly, SSIs occurred over a wide time span, from five days to more than three months. This suggests several different aetiological causes.