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Injuries of the shoulder and upper arm
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Malunion All displaced fractures heal in a non-anatomical position with some shortening and angulation, although most do not produce symptoms. Some may go on to develop periscapular pain and this is more likely with shortening of more than 1.5 cm. In these circumstances the difficult operation of corrective osteotomy and plating can be considered.
Chest Wall Trauma
Published in Stephen M. Cohn, Matthew O. Dolich, Kenji Inaba, Acute Care Surgery and Trauma, 2016
Nonoperative management has been associated with substantial pain and discomfort [9]. Fractured ribs managed nonoperatively are cyclically displaced during breathing while they are healing. This may lead to malunion or nonunion, which may require future surgery [12,13]. The key to nonoperative management relies fully on various pain control methods (IV and oral narcotics, nonsteroidal anti-inflammatory medications, intercostal and paravertebral blocks, patient-controlled analgesia, pleural catheters, and epidural analgesia), pulmonary toilet, and, if necessary, positive pressure mechanical ventilation. Reported long-term problems are rare, and most broken ribs heal uneventfully.
Complications of fracture healing
Published in Sebastian Dawson-Bowling, Pramod Achan, Timothy Briggs, Manoj Ramachandran, Stephen Key, Daud Chou, Orthopaedic Trauma, 2014
Nirav Patel, Verona Beckles, Peter Calder
Symptomatic malunion requires surgical intervention, most obviously in the case of functional or cosmetic defects, but also with deformities outside acceptable ranges and MAD (see Fig. 4.7). There is a paucity of data, and no consensus on the long-term effects of diaphyseal fracture malunion on joint function. Malalignment greater than 15° may load the joints above and below asymmetrically and cause secondary osteoarthritis. However, more recent long-term studies have shown that malunion following tibial and femoral fractures at 30 and 22 years of follow-up, respectively, are not significantly associated with an increased incidence of knee osteoarthritis, although some patients do report pain and stiffness.
Evidence-based orthopedics and the myth of restoring the anatomy
Published in Acta Orthopaedica, 2021
As orthopedic surgeons we have a strong inclination towards bringing broken bones together. Traditionally, in displaced fractures the anatomy should be restored and the success of surgery should subsequently be documented by postoperative imaging. In some common upper limb fractures, for example in displaced fractures of the proximal humerus, best evidence challenges our intuitions. On the one hand, current evidence has failed to demonstrate any benefits to patients in bringing the displaced fragments together by means of plating or nailing or even by replacing the joint (Aspenberg 2015). The only difference is an increased risk of additional surgery in the surgical group (Handoll and Brorson 2015). On the other hand, by following evidence-based recommendations we shall face a substantial number of displaced fractures healing in malunion. Passed-down knowledge and practice are challenged.
Life has become troublesome – my wrist bothers me around the clock: an interview study relating to daily life with a malunited distal radius fracture
Published in Disability and Rehabilitation, 2020
Ingrid Andreasson, Gunilla Kjellby-Wendt, Monika Fagevik-Olsén, Jón Karlsson, Gunnel Carlsson
The most common treatment is immobilization in a cast, which provides pain relief and allows free motion of the fingers and elbow while the fracture heals [6]. If the fracture is displaced, it is most frequently reduced to an anatomical position under local anesthesia and, if the fracture pattern is deemed as stable, a cast is then applied [7]. The cast is usually removed after four weeks when the fracture has healed sufficiently to begin gentle range-of-motion exercises. In cases with unstable fracture patterns, the fracture is treated surgically, provided that the patient’s general health condition allows this [8]. Dislocation occurs in up to 23% of non-surgically treated distal radius fractures and in about 10% of surgically treated [9]. Left untreated, dislocation may lead to malunion, one of the commonest complications [10]. The malunion may in turn affect the functional outcome in terms of residual pain, restricted range of motion and the ability to perform different activities [11]. Not all malunited distal radial fractures lead to dysfunction but between 15 and 30% of non-surgically treated patients have persisting disabilities of this kind [12–14]. These patients could be considered for a corrective osteotomy which is undertaken in approximately 5% of all patients with distal radius fractures [7].
20-Year outcome of TFCC repairs
Published in Journal of Plastic Surgery and Hand Surgery, 2018
Maria Moloney, Simon Farnebo, Lars Adolfsson
X-rays were performed with two projections, frontal and lateral, on both the operated wrist and the contralateral wrist, for comparison. A radiologist examined all images for signs of osteoarthritis in the radiocarpal joint or DRUJ, given the alternatives yes or no. A second radiologist, blinded to the initial assessment, examined the X-rays in which the first assessor found signs of osteoarthritis. The radiologists also assessed signs of malunion as compared with the uninjured wrist. Disagreement between the assessors was resolved by consensus discussion.