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Characteristics of Effective and Safe Methods of Treatment for Fresh Fracture-Dislocations of the Proximal Humerus
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Aim
The study was aimed to assess the results of treatment for fracture-dislocations of the proximal humerus (PH) within different time frames for optimizing treatment tactics.
Patients and Methods
This retrospective cohort study evaluated clinical outcomes of 25 patients with fracture-dislocations of the PH (15 patients were analyzed for short- and medium-term results, and 10 – for long-term results). The follow-up period ranged from 1 to 9-years. All patients underwent: clinical examination, constant score assessment and shoulder X-ray examination. Clinical, radiological and statistical methods were used for analysis.
Results
Assessment of the degree of initial displacement of tubercles and its impact on the results of treatment showed that significantly better results were obtained in case of displacement no more than 10 mm (p=0.041). Patients with displacement no more than 10 mm had an average score of 68.0±16.1 points (Mean=69.5), while those with displacement of the tubercle(s) exceeding 10 mm had an average score of 49.5±19.5 points (Mean=44). Analysis of the results of treatment showed that the delay in restoring normal anatomy of the PH or avoiding surgical interventions at all led to functional disorders of the shoulder joint. It was also demonstrated that neither patients, nor doctors were satisfied with the outcomes of the unipolar shoulder replacement (USR). Based on the results of the study, we proposed an algorithm for determining the tactics of surgical treatment in cases when a fracture-dislocation of the PH with complete dislocation of the fragment involving the articular surface of the humeral head is diagnosed.
Conclusion
The present study demonstrated some factors affecting the outcomes of treatment for fracture-dislocations of the PH. Current approaches for endoprosthesis replacement in these cases remain debatable and require further investigation.
Keywords
Trauma; Fracture; Shoulder joint; Fracture-dislocation of the proximal humerus.
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Pre-Debridement and Post-Debridement Culture in Open Fractures of the Extremities: A Comparative Study
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Background
Due to contamination, open fractures are considered to be dangerous and thereby require proper management. Through a systematic review and meta-analysis, this study compares the literature on pre-debridement and post-debridement cultures derived from such fracture sites.
Methods
Data for this review was collected through various online sources such as dataBASE (EMBASE), medical literature analysis and retrieval system online (MEDLINE) and different citations provided the relevant data.
Results
Twenty articles were included. The desired timing to examine the debridement was six hours post-injury (according to the six-hour rule). Antibiotics including ampicillin, penicillin, cefazolin, cefuroxime, and flucloxacillin were used in some patients. The use of Ancef I as an antibiotic during the starting hours of fracture helps to reduce the chances of infection in 1.4% of the infected patients. The infection rate was 3% in pre-debridement culture, while a 2% infection rate was found in post debridement culture. Gram-negative bacteria were responsible for pre-debridement infection, while gram-positive bacteria were responsible for post-debridement.
Conclusion
The pre-debridement infection rates are reduced as compared to post-debridement when treatment is initiated within a strict time interval and limited to the specific use of antibiotics. Treatment of gram-negative bacteria helps to reduce the bulk of infectious material and thereby reduces the infection rate.
Keywords
Open fractures; Debridement; Pre-debridement; Post-debridement; Meta- analysis; Systematic review.
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Lateral Tibial Plateau with Peroneal Nerve Entrapment is Unique Fracture in Diagnosis and Management
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A majority of tibial plateau fractures involve the lateral plateau. Posterolateral tibial plateau fractures are caused by a valgus force that impacts the posterolateral plateau against the lateral femoral condyle. We describe a unique case of a patient who sustained a lateral plateau fracture with posterior displacement behind a fractured fibular head, with entrapment of the peroneal nerve. This unusual fracture pattern required dual anterolateral and lateral approach for reduction and fixation.
Keywords
Tibial plateau; High energy; Fracture; Peroneal nerve entrapment.
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Magnet Expandable Rods a Promising Technology which can Lead to Catastrophic Failure
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In recent years, there has been a paradigm shift in the treatment of early-onset scoliosis. This change is manifested by a propensity to avoiding or delaying fusion surgeries due to their many potential shortcomings. Many surgeons gravitate towards conservative measures and growth-friendly implants such as magnetic expandable growing rods. Still, such interventions are not impeccable. This case report discusses 8-year-old girl with early-onset scoliosis managed with magnetic expandable rods after failing conservative management. The results were promising at first. However, catastrophic failure was diagnosed after multiple successful elongations necessitating discarding the system and changing the construct to conventional growing rods.
Keywords
Magnet rods; Growing rods; Growth friendly procedures; Catastrophic failure; Early-onset scoliosis; Juvenile scoliosis; Scoliosis complications.
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Muscle Cell Function and the Effects of Hyperbaric Oxygen Therapy
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Bilateral Staged Primary Total Knee Arthroplasty: Are Patients Less Pleased with their Second Side?
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Muscle Cell Function and the Effects of Hyperbaric Oxygen Therapy
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There are different processes via which a muscle cell can utilize oxygen to make energy that will sustain activity. The type of activity and duration of activity will determine what energy system is used to sustain the activity being done. Aerobic metabolism uses oxygen to sustain the energy demand. Oxygen is obtained from the air we breathe, and then transported to the cells though the myoglobin. Although ambient air only contains 21% oxygen, it is enough to sustain life and energy needs. But what if the muscle cell could instead receive 100% oxygen? The delivery method would be via hyperbaric oxygen therapy (HBO) which supplies oxygen at 100% concentration under a minimum of 1 atmospheric pressure. Atmospheric pressure will affect the outcomes of consuming 100% oxygen. Research supports positive findings on oxygen therapy under pressure and muscle cell recovery but much research still needs to be investigated. One research study revealed detrimental effects of 100% oxygen breathed in consistently for days resulting in comorbidities that did not exist prior to experiment. HBO can pose some risks but if it is applied in a controlled manner, HBO can be a safe option to enhance cellular recovery and cell function.
Keywords
Oxygen; Hyperbaric oxygen therapy; Muscle recovery; Muscle cells; Pure oxygen.
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Editor-in-Chief
Assad Taha, MD, FACS
Associate Professor Department of Surgery Division of Orthopaedic Surgery American University of Beirut Medical Centre Beirut, Lebanon
Associate Editors
Vinod Kumar Panchbhavi, MD, FACS
Professor Department of Orthopaedic Surgery and Rehabilitation University of Texas Medical Branch 301 University BLVD Galveston, Texas 77555-0165, USA
Abdulrazzaq A. Alobaid, MD, FRCSC
Cheif of Spine Surgery Cheif of Orthopedic Casualties Alrazi Hospital-Kuwait Chairman of Faculty Orthopedics & Post Graduate training Kuwait Institute for Medical Specialization (KIMS) Orthopedic Spine Surgeon - Canadian Board Certified P.O. BOX 1160 Surra 45712, Kuwait
Monem Jemni, PhD
Chair ISAFA www.isafa.info Qatar Olympics Committee Professorial Chair in Sport Science College of Arts and Sciences Qatar University Al Tarfa, Doha 2713 Qatar
Rakesh Bhargava, MBBS, MS
Professor National Institute of Medical Sciences Apex Hospital, Jaipur, Rajasthan 302017, India