Warwick hip trauma study : a randomised clinical trial comparing interventions to improve outcomes in internally fixed intracapsular fractures of the proximal femur : protocol for The WHiT Study

Background Controversy exists regarding the optimal treatment for patients with displaced intracapsular fractures of the proximal femur. The recognised treatment alternatives are arthroplasty and internal fixation. The principal criticism of internal fixation is the high rate of non-union; up to 30% of patients will have a failure of the fixation leading to revision surgery. We believe that improved fracture healing may lead to a decreased rate of failure of fixation. We therefore propose to investigate strategies to both accelerate fracture healing and improve fixation that may significantly improve outcomes after internal fixation of intracapsular femoral fractures. We aim to test the clinical effectiveness of the osteoinductive agent platelet rich plasma and conduct a pilot study of a novel fixed-angle fixation system. Design We have planned a three arm, single centre, standard-of-care controlled, double blinded, pragmatic, randomised clinical trial. The trial will include a standard two-way comparison between platelet-rich plasma and standard-of-care fixation versus standard-of-care fixation alone. In addition there will be a subsidiary pilot arm testing a fixed-angle screw and plate fixation system

External fixation combined with limited internal fixation in the treatment of pilon tibia fractures

Background/Aim. Intraarticular fractures of the tibial plafond (pilon fractures) belong to the group of most severe fractures. They are usually caused by high-energy trauma and frequently associated with a marked soft-tissue damage. Surgical treatment has replaced the traditional nonoperative treatment. The aim of this study was to present the results of the treatment of distal tibial intraarticular fracture by the use of internal fixation, as well as the combination of minimal internal fixation and external fixation. Methods. The study included 47 patients with pilon tibia fractures who went through at the Clinic for Orthopedics and Traumatology, School of Medicine, Niš (1995-2004). Within the analyzed group there were 33 (70.2%) males and 14 (29.8%) females. The patients mean age was 45.8 years. In the first group, which consisted of 22 patients, open reduction and internal fixation of both the tibia and the fibula was performed in the two separate incisions. The second group consisted of 25 patients managed with external fixation by external fixator "Mitković" with limited internal fixation. Besides external fixation, a minimal internal fixation was performed by the use of Kirschner wires and screws. The patients were followed-up inside a 24-months-period. Results. The obtained was a substantially high number of complications after open reduction and internal fixation in the group of patients. There was no difference in a long-term clinical outcome. Postoperative osteitis, as the most severe complication in the management of closed pilon tibia fractures, was not registered in the second group. Conclusion. Considering the results obtained in this study, it can be concluded that external fixation by the "Mitković" external fixator with the minimal internal fixation is a satisfactory method for the treatment of fractures of the tibial plafond causing less complications than internal fixation.

Internal Fixation of Femoral Neck Fractures

__Abstract__ This thesis consists of three parts. Part 1 described aspects of the organization of trauma related trials. Part 2 analyzed the uniformity of current femoral neck fracture treatment and adherence to the Dutch guideline on hip fracture treatment. The implications of treatment with internal fixation on health care costs were also described. Part 3 focused on aspects on functional outcome after internal fixation of a femoral neck fracture. In summary, this thesis provides evidence that: • A central, financed trial coordinator to manage all trial related tasks in participating sites is a recommended strategy to improve trial progression (Chapter 2) • Adequate knowledge on the International Conference of Harmonization-Good Clinical Practice (ICH-GCP) guideline is important when conducting an implant trial in orthopedic trauma surgery (Chapter 3) • The current treatment of femoral neck fracture patients is in agreement with the Dutch national guideline in at least 74% of patients (Chapter 4) • The current treatment of non-simultaneous bilateral femoral neck fractures is uniform in 73-88% of patients (Chapter 5) • In and out of hospital cost of internal fixation of femoral neck fracture patients is approximately €16,000 at one year follow-up and €19,000 at two years follow-up (Chapter 6) • Internal fixation of femoral neck fracture patients leads to femoral neck shortening and secondary permanent physical limitations in a majority of patients (Chapter 7) • Salvage arthroplasty patients have inferior functional outcome than patients who heal after internal fixation of a femoral neck fracture (Chapter 8) • Implant removal positively influences function-related quality of life in patients after internal fixation with persisting pain or unsatisfactory functional recovery (Chapter 9) • The physical therapy that femoral neck fracture patients receive after internal fixation generally consists of active movement, functional exercise, and independent practice for less than two times a week, during 20 weeks (Chapter 10

The management of segmental tibial shaft fractures: A systematic review.

INTRODUCTION: Segmental tibial fractures are complex injuries associated with significant soft tissue damage that are difficult to treat. This study aimed to identify the most effective method of treating segmental tibial fractures. METHOD: A PRISMA compliant systematic review was conducted. Studies investigating the management of segmental tibial fractures with intramedullary nail fixation (IMN), open reduction and internal fixation (ORIF) or circular external fixation (CEF) were included for review. The primary outcome measure was time to fracture union. Secondary outcomes were complications and functional outcome. A narrative analysis was undertaken as meta-analysis was inappropriate due to heterogeneity of the data. RESULTS: Thirteen studies were eligible and included. No randomised controlled trials were identified. Fixation with an intramedullary nail provided the fastest time to union, followed by open reduction and internal fixation and then CEF. The rate of deep infection was highest after IMN (5/162 [3%]), followed by open reduction and internal fixation (2/78 [2.5%]) and CEF (1/54 [2%]). However, some studies reported particularly high rates of infection following IMN for open segmental tibial fractures. There was limited reporting of postoperative deformities. From the studies that did include such data, there was a higher rate of deformity following ORIF (8/53 [15%]), compared to IMN (13/138 [9%]), and CEF (4/44 [9%]). Three studies, not including IMN, described patient reported outcome measures with results ranging from 'excellent' to 'fair'. DISCUSSION: The available evidence was of poor quality, dominated by retrospective case series. This prevented statistical analysis, and precludes firm conclusions being drawn from the results available. CONCLUSION: IMN has the fastest time to fracture union, however there are concerns regarding an increased deep infection rate in open segmental tibial fractures. In this subgroup, the data suggests CEF provides the most satisfactory results. However, the available literature does not provide sufficient detail to make this statement with certainty. We recommend a randomised controlled study to further investigate this challenging problem

Eye movement patterns during the recognition of three-dimensional objects: Preferential fixation of concave surface curvature minima

This study used eye movement patterns to examine how high-level shape information is used during 3D object recognition. Eye movements were recorded while observers either actively memorized or passively viewed sets of novel objects, and then during a subsequent recognition memory task. Fixation data were contrasted against different algorithmically generated models of shape analysis based on: (1) regions of internal concave or (2) convex surface curvature discontinuity or (3) external bounding contour. The results showed a preference for fixation at regions of internal local features during both active memorization and passive viewing but also for regions of concave surface curvature during the recognition task. These findings provide new evidence supporting the special functional status of local concave discontinuities in recognition and show how studies of eye movement patterns can elucidate shape information processing in human vision

THE EFFECT OF DZIKIR CONCERNING TO PAIN LEVEL AFTER SURGICAL OPERATION REDUCTION INTERNAL FIXATION (ORIF)

ABSTRACT Background: Surgical operation of ORIF affect painful which disturb the patient’s comfortable. Dzikir have psychological benefit psichologis which affect comfortable and spiritual feelings focused to Allah, so could give a relaxation effect to percepts pain. Objective: The objectives of this thesis is to find out the effect of dzikir concerning to pain level felt after surgical operation of ORIF in RS Ortopedi Prof. Dr. R. Soeharso Surakarta. Methods: This thesis was done by true eksperimen by applying randomized control group pre-test post-test design method. The number of sample was 44 respondents were obtained by consecutive sampling based on inclusion and exclusion criteria and classified using a simple random sampling to 22 experimental group and 22 control group. Results: The average pain level of the respondents on experimental group after surgical operation of ORIF before gave dzikir was 5.18 and the pain level after dzikir was 4.05. The average pain level pretest of the respondents on control group was 4,82 and pain level of posttest was 4,77. The result of pain level before and after gave dzikir to the experiment groups shows that the significance points 0.001 and 0.317 in the control group. Conclusion: The decrease of pain level in the experimental group were given analgesic therapy and dhikr greater than the control group who were given analgesic therapy. This thesis could be used as reference and consideration for nurse to apply dzikir as a complementary therapy to diminish the pain level to the post-surgical operation patient’s of ORIF. Keyword: Dzikr, Pain, Pasca ORI

Assesment [sic] of cement augmentation and screw trajectory on pedicle screw fixation in osteoporotic vertebrae

Internal fixation of osteoporotic spines for fracture or deformity is currently difficult, owing to failure at the bone- implant interface. This study aims to ascertain whether pedicle screw trajectory and pedicle cortex retention can independently significantly affect fixation strength in osteoporotic vertebrae."MU Grant #00029187