Pelvic packing - status 2024.

Patients with unstable hemodynamics and unstable pelvic ring injuries are still demanding patients regarding initial treatment and survival. Several concepts were reported during the last 30 years. Mechanical stabilization of the pelvis together with hemorrhage control offer the best treatment option in these patients.

Comparison of the AO/OTA 1996/2007 and 2018 pelvic ring fracture classifications.

Pelvic ring fractures may present with relevant mechanical and haemodynamic instability. Classifications of the bony or ligamentous injuries of the pelvic ring are well established. The most common classifications used analyse the injury mechanisms and the resulting instability of the pelvic ring structure.

Reverse Shoulder Arthroplasty Is Superior to Plate Fixation for Displaced Proximal Humeral Fractures in the Elderly: Five-Year Follow-up of the DelPhi Randomized Controlled Trial.

Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.

Emergency treatment of pelvic ring injuries: state of the art.

High energy pelvic injuries sustain significant mortality rates, due to acute exsanguination and severe associated injuries. Managing the hemodynamically unstable trauma patient with a bleeding pelvic fracture still forms a major challenge in acute trauma care. Various approaches have been applied through the last decades.

Impact of Pronator Quadratus Muscle Tear in Distal Radius Fractures on Patient Outcomes: Analyses of 55 Patients in a Volar Locking Plate Arm of a Randomized Clinical Trial.

Background The advantage of pronator quadratus (PQ) repair following internal fixation via the volar approach in distal radius fracture (DRF) surgery remains unconfirmed in the literature. The aim of this study was to compare grip strength, patient-reported outcomes, and functional results between patients with an intact PQ and those with a ruptured PQ before undergoing surgery with a volar locking plate for dorsally displaced unstable extra-articular DRFs. Methods A total of 120 patients aged 55 years and older were included in a randomized controlled trial comparing a volar locking plate with a dorsal nail plate.

Non-operative versus operative treatment of suprasyndesmotic ankle fractures: protocol for a prospective, multicentre, randomised controlled trial.

Introduction: Surgery is widely recognised as the treatment of choice for suprasyndesmotic ankle fractures, because of the assumption that these injuries yield instability of the ankle joint. Stability assessment of ankle fractures using weightbearing radiographs is now used regularly to guide the treatment of transsyndesmotic and infrasyndesmotic ankle fractures. Patients with a congruent ankle joint on weightbearing radiographs can be treated non-operatively with excellent results.

Long-term follow-up and survival of delayed total hip arthroplasty following acetabular fracture: a matched cohort study of 552 cases from the Norwegian Arthroplasty Register.

Background: Operative treatment of acetabular fractures generally yields good results, but several authors report up to 15-20% of patients developing post-traumatic osteoarthritis (OA). Previous studies have shown that total hip arthroplasty (THA) following post-traumatic OA have inferior results compared to THA for primary OA. The aim of this study was to report on long-term outcome of THA following acetabular fracture, compared to primary OA.

Closed reduction of dorsally displaced distal radius fractures in the elderly provided improved final radiographic results.

Background: Recent guidelines recommend non-operative treatment as primary treatment in elderly patients with displaced distal radius fractures. Most of these fractures are closely reduced. We aimed to evaluate the radiological results of closed reduction and casting of dorsally displaced distal radius fractures in patients 65 years or older.

Effect of Posterior Malleolar Fixation on Syndesmotic Stability.

Background: Transsyndesmotic fixation with suture buttons (SBs), posterior malleolar fixation with screws, and anterior inferior tibiofibular ligament (AITFL) augmentation using suture tape (ST) have all been suggested as potential treatments in the setting of a posterior malleolar fracture (PMF). However, there is no consensus on the optimal treatment for PMFs.

Purpose: To determine which combination of (1) transsyndesmotic SBs, (2) posterior malleolar screws, and (3) AITFL augmentation using ST best restored native tibiofibular and ankle joint kinematics after 25% and 50% PMF.

Outcomes and complications after open reduction and internal fixation of distal humeral fractures with precontoured locking plates.

Objectives: The aim of this study was to evaluate functional and radiographic results after open reduction and internal fixation of distal humeral fractures using precontoured locking plates. Our main hypothesis was that patients older than 65 years have inferior outcomes compared with younger patients.

Methods: All patients treated for a distal humeral fracture with precontoured locking plates between 2006 and 2017 at a level 1 trauma center were identified.

Functional outcomes and health-related quality of life after reconstruction of segmental bone loss in femur and tibia using the induced membrane technique.

Introduction: The induced membrane technique (IMT), frequently called Masquelet technique, is an operative, two-staged technique for treatment of segmental bone loss. Previous studies mainly focused on radiological outcome parameters and complication rates, while functional outcomes and health-related quality of life after the IMT were sparsely reported.

Materials And Methods: Retrospective study containing of a chart review as well as a clinical and radiological follow-up examination of all patients treated with the IMT at a single institution.

A cost-effectiveness analysis of reverse total shoulder arthroplasty compared with locking plates in the management of displaced proximal humerus fractures in the elderly: the DelPhi trial.

Aim: To evaluate the cost-effectiveness of surgical treatment with reverse total shoulder arthroplasty (RTSA) compared with open reduction and internal fixation (ORIF) with a locking plate for patients 65-85 years old with a displaced proximal humerus fracture.

Methods: A cost-utility analysis was conducted alongside a multicenter randomized controlled trial, taking a health care perspective. A total of 124 patients with displaced proximal humerus fractures were randomized to treatment with RTSA (n = 64) or ORIF (n = 60) during a 2-year period.

Surgical treatment is not cost-effective compared to nonoperative treatment for displaced distal radius fractures in patients 65 years and over.

Aims: The purpose was to compare operative treatment with a volar plate and nonoperative treatment of displaced distal radius fractures in patients aged 65 years and over in a cost-effectiveness analysis.

Methods: A cost-utility analysis was performed alongside a randomized controlled trial. A total of 50 patients were randomized to each group.

Volar Locking Plate Versus Dorsal Locking Nail-Plate Fixation for Dorsally Displaced Unstable Extra-Articular Distal Radial Fractures: Functional and Radiographic Results from a Randomized Controlled Trial.

Unlabelled: The use of low-profile dorsal and volar locking plates for distal radial fracture surgery has improved results and lowered the complication rate compared with older plate designs. The purpose of the present randomized controlled trial was to compare patient-reported outcomes as well as radiographic and functional results between patients who underwent stabilization with a volar locking plate or a dorsal locking nail-plate for the treatment of dorsally displaced unstable extra-articular distal radial fractures.

Methods: One hundred and twenty patients ≥55 years of age were randomized to surgery with either a volar locking plate or a dorsal locking nail-plate and were assessed at 2 weeks, 6 weeks, 3 months, 6 months, and 1 year.

Predicting secondary surgery after operative fixation of olecranon fractures: a model using data from 800 patients.

Background: High rates of secondary surgery after fixation of olecranon fractures have been reported. Identification of risk factors can aid surgeons to reduce complications leading to additional surgical procedures.

Methods: Olecranon fractures treated at seven hospitals from 2007 to 2017 were identified, and the radiographs were classified.

Prognostic value of the Haraguchi classification in posterior malleolar fractures in A0 44-C type ankle fractures.

Background And Purpose: Incidence of posterior malleolar fractures (PMFs) associated with ankle fractures is historically based on plain radiographs. Several classification systems for PMF are currently in use, but the reliability of the Haraguchi classification is not reported. The aim of this diagnostic cohort study was to assess incidence of PMF in patients with AO 44-C fractures, and test the reliability of the Haraguchi fracture classification based on CT.

Trochanteric stabilizing plate in the treatment of trochanteric fractures: a scoping review.

Background and purpose - The trochanteric stabilizing plate (TSP) may be used as an adjunct to a sliding hip screw (SHS) in the treatment of trochanteric fractures to increase construct stability. We performed a scoping review of the literature to clarify when and how the TSP may be useful.Methods - A systematic search was performed in 5 databases and followed by a backwards-and-forwards citation search of the identified papers.

Stable glenoid component of reverse total shoulder arthroplasty at 2 years as measured with model-based radiostereometric analysis (RSA).

Background and purpose - Reverse total shoulder arthroplasty (TSA) is used for treating cuff arthropathy, displaced proximal humeral fractures (PHF), and in revision shoulder surgery, despite sparse evidence on long-term results. We assessed stability of the glenoid component in reverse TSA, using model-based RSA.Patients and methods - 20 patients (mean age 76 years, 17 female), operated on with reverse TSA at Oslo University Hospital, in 2015-2017 were included.

External validity in a multicenter randomized clinical trial of proximal humeral fractures: the DelPhi trial.

Background: Randomized controlled trials (RCT) are regarded as the gold standard for effect evaluation in clinical interventions. However, RCTs may not produce relevant results to all patient groups. We aimed to assess the external validity of a multicenter RCT (DelPhi trial).

Outcome after nonoperative treatment of stable Lisfranc injuries. A prospective cohort study.

Background: The aim of this study was to evaluate the outcome after nondisplaced and stable Lisfranc injuries.

Methods: 26 patients with injuries to the Lisfranc joint complex detected on CT scans, but without displacement were tested to be stable using a fluoroscopic stress test. The patients were immobilized in a non-weightbearing short leg cast for 6 weeks.

Geographical mapping of road traffic injuries in Lilongwe, Malawi.

Background: Road traffic injuries are a leading cause of death and disability, especially in low- and middle-income countries. Identifying injury hotspots are valuable for introducing preventive measures. This is usually accomplished by using police data, but these are often unreliable in low-income countries.

Cast immobilization is non-inferior to volar locking plates in relation to QuickDASH after one year in patients aged 65 years and older: a randomized controlled trial of displaced distal radius fractures.

Aims: To compare operative and nonoperative treatment for displaced distal radius fractures in patients aged over 65 years.

Methods: A total of 100 patients were randomized in this non-inferiority trial, comparing cast immobilization with operation with a volar locking plate. Patients with displaced AO/OTA A and C fractures were eligible if one of the following were found after initial closed reduction: 1) dorsal angulation > 10°; 2) ulnar variance > 3 mm; or 3) intra-articular step-off > 2 mm.

Implants for trochanteric fractures in Norway: the role of the trochanteric stabilizing plate-a study on 20,902 fractures from the Norwegian hip fracture register 2011-2017.

Background: The trochanteric stabilizing plate (TSP) is used as an adjunct to the sliding hip screw (SHS) in unstable trochanteric and subtrochanteric fractures. We wanted to describe the choice of implant for trochanteric fractures with a focus on the TSP in Norway.

Methods: A total of 20,902 fractures from the Norwegian Hip Fracture Register treated surgically in 43 hospitals from 2011 to 2017 were included.