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This report describes factors influencing length of stay and unplanned readmissions within 30 days of discharge for children presenting with femoral fractures to Starship Hospital.The charts and radiographs of all children admitted with femoral shaft fractures between January 1998 and December 2002 were reviewed, excluding pathological fractures. The type of management, the length of stay and the...
Between April 1996 and May 2002, 22 people (18 men, 4 women) were treated for neglected fractures of the patella at our hospital. The median patient age was 43 (range 22–55) years. The majority of the fractures were caused by a direct fall on the knee. In all they comprised 18 transverse, 2 comminuted and 2 lower pole fractures, most of which had been treated by traditional methods initially. The...
A retrograde femoral nail was designed to slide over the tip of the femoral stem. Eighteen patients (4 ♂, 14 ♀) were treated with this retrograde nail between 1995 and 2003. The mean age was 81.4 years (range 61–96) with a mean follow-up of 21 months (range 4–61 months). Eight patients suffered from severe comorbidity. Mean surgical time was 91min. Fourteen patients regained their preoperative functional...
The treatment of open tibial shaft fractures remains controversial. Important considerations in surgical management include surgical timing, fixation technique and soft tissue coverage. This study was performed to evaluate the results of acute surgical debridement, unreamed nailing and soft tissue reconstruction in the treatment of severe open tibial shaft fractures.During a 10-year period between...
Heelys™, the new craze gripping the nation, were first introduced to Ireland in 2005 having been available in the United States since 2000. Designed as “the only shoe with a removable wheel in the sole” and initially marketed among rollerbladers and skateboarders they have been adopted by children as contemporary footwear.From April to June 2006, all patients presenting to trauma orthopaedic services...
A protocol of early intervention (flexible intramedullary nails, early hip spica, and external fixation) was started in 1999 and during a 3-year period there were 25 children who sustained a femoral shaft fracture (early intervention group). These were prospectively reviewed with a minimum follow up of 24 months (Range 24–35 months). A historical control group of 41 children was used. These children...
A retrospective study of all paediatric fractures presenting to hospital in Edinburgh, Scotland in 2000 was undertaken. It showed that the incidence of fractures was 20.2/1000/year and that 61% of children's fractures occurred in males. Analysis of paediatric fractures shows that there are six basic fracture distribution curves with six fractures showing a bimodal distribution but most having a unimodal...
Periprosthetic femoral fractures associated with well-fixed total hip or total knee prostheses present a challenging management problem as these injuries typically occur in osteoporotic bone. Conventional management entails extensive periosteal stripping to allow for plate fixation. We reviewed a consecutive series of patients who sustained fractures associated with a well fixed total knee prosthesis,...
To determine whether a delay of greater than 6h from injury to initial surgical debridement and the timing of antibiotic administration affect infection rates in open long-bone fractures.We studied 248 consecutive open long-bone fractures in 237 patients over a 9-year period. The patients were followed until clinical or radiological union occurred or until a secondary procedure for non-union or infection...
When performing distal interlocking of an intramedullary humeral nail, there is risk of iatrogenic injuring to the neurovascular structures. Our cadaveric study with frozen sections through the distal humerus presents the anatomic relationship of the different neurovascular bundles and the trajectories used for the implantation of the three distal interlocking screws of the AO-UHN. The middle lateromedial...
Studies have shown that women are at higher risk of sustaining noncontact anterior cruciate ligament (ACL) injuries in specific sports. Recent gait studies of athletic tasks have documented that gender differences in knee movement, muscle activation, and external loading patterns exist. The objective of this study was to determine in a knee cadaver model if application of female-specific loading and...
In the elderly person, comorbidities combined with lower functional demands tend to indicate non-operative treatment; however, fast functional recovery is mandatory to prevent loss of independency and social ability. This retrospective follow-up study included 40 people with a mean age of 75 (range 60–87) years. They had all received treatment with a reamed intramedullary nail for humeral fracture;...
Femoral nail length can be estimated preoperatively by several methods, but this usually requires an intact contralateral femur. The aim of this study was to determine an alternative method using fibula and femoral head as references.Digital radiographic views of the lower limbs of 102 healthy volunteers were used to compare femoral medullary length with the sum of fibular length and transverse head...
Open fracture management represents an orthopaedic emergency. Early aggressive management of these debilitating injuries within the first 6h has been encouraged in order to minimise the risk of infection and long term sequelae. Debridement and wash-out of the wound, followed by stabilisation of the bony elements and closure of the soft-tissue envelope are all considered essential. However, the available...
Despite convincing data from Ljubljana, Yugoslavia 20 years ago, that emergency free tissue transfer for open fractures results in a low infection rate, shorter hospitalisation, decreased time for bone healing, and low incidence of flap failure, there are circumstances that preclude against immediate wound closure. The case for delayed wound closure is made based on several parameters that include:...
During the past 18 months we have managed four paediatric patients who have sustained forearm refractures associated with retained plates that were used to treat their original fracture. Although this complication is not new, most literature regarding paediatric forearm refracture relates to refractures that occur after closed treatment or after removal of metalwork. We treated the patients in this...
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