Internal fixation of femoral neck and intertrochanteric fractures; use of anchor scral rest and Gallagher protractor.
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This article presents the results of von Bahr screw fixation in 103 patients, allowing immediate weight bearing. After a follow-up period of 1 year, a failure rate of 18% was recorded. Analysis of the series shows that the failures are due to inadequate reduction of the displacement during operation, especially when the head is in varus, and to bad positions of the screw. The high failure rate was not related to the initial displacement of the fracture.
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Infection of the hip joint is described in three patients after nail-plate fixation of trochanteric fractures. This led to subluxation of the joint in one case and to dislocation in the other two. None of the patients walked again. Attention is drawn to the difficulty in diagnosis and the poor prognosis of this uncommon complication of operating for hip fracture.
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A simple technique for preventing rotation of the femoral head during fixation of a subcapital fracture with an AO dynamic hip screw system is described.
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Three hundred and seventy-one multiply injured patients with 1063 fractures, who were admitted to our service over an 8-year period (1978-1985), were studied retrospectively. The impact of early osteosynthesis on the overall, and especially of the late, mortality due to sepsis was analysed. The patients were divided into two groups depending on whether they were treated with osteosynthesis (group I) or underwent conservative fracture treatment (group II). The late mortality (more than 7 days after injury) due to sepsis fell to 1.8 per cent in patients treated with osteosynthesis compared with 13.5 per cent (P less than 0.001) in patients treated conservatively. The best results were obtained when the osteosynthesis was performed within 24 hours after injury; less than 1 per cent died from late sepsis. We feel that fractures in multiply injured patients should be treated with early osteosynthesis in order to reduce the late mortality from sepsis.
We reviewed 47 patients following operatively treated ankle fracture-dislocation, at an average of 15 months after injury, to assess the outcome of two different postoperative regimens. Of the 47 patients, 27 received early active and passive ankle exercises, and 20 patients received immediate plaster splintage. Patients were assessed clinically by an independent surgeon and subjective, objective and radiological criteria recorded. No significant difference was apparent between the two groups on any of the criteria, although the early movement group contained more patients who were completely pain free, had a normal gait and no radiological signs of arthrosis (P < 0.05). This was achieved at the expense of a longer stay in hospital (average 10.2 days versus 7.4 days for plaster splintage) and more ankle swelling.
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