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Kurinchi Selvan Gurusamy - One of the best experts on this subject based on the ideXlab platform.
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Internal Fixation versus arthroplasty for intracapsular proximal femoral fractures in adults
Cochrane Database of Systematic Reviews, 2006Co-Authors: M.j. Parker, Kurinchi Selvan GurusamyAbstract:Background Displaced intracapsular fractures may be treated by either reduction and Internal Fixation, which preserves the femoral head, or by replacement of the femoral head with an arthroplasty. This is an update of a Cochrane review first published in 2003 and previously updated in 2006. Objectives To compare the relative effects (benefits and harms) of any type of Internal Fixation versus any type of arthroplasty for intracapsular femoral fractures in adults. Search methods We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (August 2010), The Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 3), MEDLINE (1966 to August 2010), EMBASE (1988 to 2010 Week 36), and other sources. Selection criteria All randomised and quasi-randomised controlled trials comparing Internal Fixation with arthroplasty for intracapsular hip fractures in adults. Data collection and analysis Both authors independently assessed trial quality and extracted data. Wherever appropriate, results were pooled. Main results Nineteen trials, of which two were newly included in this update, involving 3044 participants, were included. There was considerable variation in the types of implants and techniques used for both Internal Fixation and arthroplasty in the included trials. The risk of selection bias was low in just three trials, unclear in 13 trials and high in the three quasi-randomised trials. Just three trials reported assessor blinding of functional outcomes. Length of surgery, operative blood loss, need for blood transfusion and risk of deep wound infection were significantly less for Internal Fixation compared with arthroplasty. Fixation had a significantly higher re-operation rate in comparison with arthroplasty (40% versus 11%; risk ratio 3.22, 95% CI 2.31 to 4.47, 19 trials). No definite differences for hospital stay, mortality, or regain of pre-injury residential state were found. Limited information from some studies suggested pain was less and function was better for a cemented arthroplasty in comparison with Fixation. Authors' conclusions Internal Fixation is associated with less initial operative trauma but has an increased risk of re-operation on the hip. Definite conclusions cannot be made for differences in pain and residual disability between the two groups. Future studies should concentrate on better reporting of final outcome measures and function. There is still a need for studies to define which patient groups are better served by the different treatment methods.
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Internal Fixation versus arthroplasty for intracapsular proximal femoral fractures in adults
COCHRANE DB SYST REV, 2006Co-Authors: Kurinchi Selvan GurusamyAbstract:Background Displaced intracapsular fractures may be treated by either reduction and Internal Fixation, which preserves the femoral head, or by replacement of the femoral head with an arthroplasty.Objectives To review all randomised controlled trials that have compared Internal Fixation with arthroplasty for intracapsular femoral fractures in adults.Search strategy We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register ( December 2005), the Cochrane Central Register of Controlled Trials ( The Cochrane Library 2005, Issue 4), MEDLINE, EMBASE, the UK National Research Register, several orthopaedic journals, conference proceedings and reference lists of articles. We contacted trialists where possible.Selection criteria All randomised and quasi-randomised controlled trials comparing Internal Fixation with arthroplasty for intracapsular hip fractures in adults.Data collection and analysis Trial quality was assessed by use of a 10 item scale. At least two review authors independently assessed trial quality and extracted data. Additional information was sought from trialists. After grouping into three broad categories, comparable groups of trials were subgrouped and where appropriate, data were pooled using the fixed-effect model.Main results Seventeen trials involving 2694 participants were included. Length of surgery, operative blood loss, need for blood transfusion and risk of deep wound infection were significantly less for Internal Fixation compared with arthroplasty. Arthroplasty had a significantly lower re-operation rate in comparison with Fixation. No definite differences for hospital stay, mortality, or regain of same residential state were found. Limited information from some studies suggested pain was less and function was better for a cemented arthroplasty in comparison to Fixation.Authors' conclusions Internal Fixation is associated with less initial operative trauma but has an increased risk of re-operation on the hip. Definite conclusions cannot be made for differences in pain and residual disability between the two groups. Future studies should concentrate on better reporting of final outcome measures and there is still a need for studies to define which patient groups are better served by the different treatment methods.
M.j. Parker - One of the best experts on this subject based on the ideXlab platform.
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Internal Fixation versus arthroplasty for intracapsular proximal femoral fractures in adults
Cochrane Database of Systematic Reviews, 2006Co-Authors: M.j. Parker, Kurinchi Selvan GurusamyAbstract:Background Displaced intracapsular fractures may be treated by either reduction and Internal Fixation, which preserves the femoral head, or by replacement of the femoral head with an arthroplasty. This is an update of a Cochrane review first published in 2003 and previously updated in 2006. Objectives To compare the relative effects (benefits and harms) of any type of Internal Fixation versus any type of arthroplasty for intracapsular femoral fractures in adults. Search methods We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (August 2010), The Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 3), MEDLINE (1966 to August 2010), EMBASE (1988 to 2010 Week 36), and other sources. Selection criteria All randomised and quasi-randomised controlled trials comparing Internal Fixation with arthroplasty for intracapsular hip fractures in adults. Data collection and analysis Both authors independently assessed trial quality and extracted data. Wherever appropriate, results were pooled. Main results Nineteen trials, of which two were newly included in this update, involving 3044 participants, were included. There was considerable variation in the types of implants and techniques used for both Internal Fixation and arthroplasty in the included trials. The risk of selection bias was low in just three trials, unclear in 13 trials and high in the three quasi-randomised trials. Just three trials reported assessor blinding of functional outcomes. Length of surgery, operative blood loss, need for blood transfusion and risk of deep wound infection were significantly less for Internal Fixation compared with arthroplasty. Fixation had a significantly higher re-operation rate in comparison with arthroplasty (40% versus 11%; risk ratio 3.22, 95% CI 2.31 to 4.47, 19 trials). No definite differences for hospital stay, mortality, or regain of pre-injury residential state were found. Limited information from some studies suggested pain was less and function was better for a cemented arthroplasty in comparison with Fixation. Authors' conclusions Internal Fixation is associated with less initial operative trauma but has an increased risk of re-operation on the hip. Definite conclusions cannot be made for differences in pain and residual disability between the two groups. Future studies should concentrate on better reporting of final outcome measures and function. There is still a need for studies to define which patient groups are better served by the different treatment methods.
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hemiarthroplasty versus Internal Fixation for displaced intracapsular hip fractures in the elderly a randomised trial of 455 patients
Journal of Bone and Joint Surgery-british Volume, 2002Co-Authors: M.j. Parker, Riaz J K Khan, John R Crawford, G A PryorAbstract:A total of 455 patients aged over 70 years with a displaced intracapsular fracture of the proximal femur was randomised to be treated either by hemiarthroplasty or Internal Fixation. The preoperative characteristics of the patients in both groups were similar. Internal Fixation has a shorter length of anaesthesia (36 minutes versus 57 minutes, p versus 177 ml, p versus 0.39 units, p versus 63/229, p = 0.91), but there was a tendency for an improved survival in the older less mobile patients treated by Internal Fixation. For the survivors assessed at one, two and three years from injury there were no differences with regard to the outcome for pain and mobility. Limb shortening was more common after Internal Fixation (7.0 mm versus 3.6 mm, p = 0.004). We recommend that displaced intracapsular fractures in the elderly should generally be treated by arthroplasty but that Internal Fixation may be appropriate for those who are very frail.
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Internal Fixation or arthroplasty for displaced subcapital fractures in the elderly
Injury-international Journal of The Care of The Injured, 1992Co-Authors: M.j. ParkerAbstract:Abstract A series of 200 patients aged over 69 years admitted to this hospital with a non-pathological displaced subcapital fracture of the femur, haue been studied prospectively. Approximately one-half were treated by Internal Fixation and the remainder by a hemiarthroplasty, the method of treatment being dictated by the preference of the on-call consultant. This has enabled a comparison between the two groups. At 1 year from injury there was no significant difference in the mortality or function of the survivors. Internal Fixation resulted in fewer postoperative complications, a shorter hospital stay and a reduced cost of treatment. The reoperation rate for Internal Fixation was three times that after hemiarthroplasty. Despite the problem of non-union, this study suggests that Internal Fixation is the treatment of choice for displaced subcapital fractures in the elderly.
G A Pryor - One of the best experts on this subject based on the ideXlab platform.
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hemiarthroplasty versus Internal Fixation for displaced intracapsular hip fractures in the elderly a randomised trial of 455 patients
Journal of Bone and Joint Surgery-british Volume, 2002Co-Authors: M.j. Parker, Riaz J K Khan, John R Crawford, G A PryorAbstract:A total of 455 patients aged over 70 years with a displaced intracapsular fracture of the proximal femur was randomised to be treated either by hemiarthroplasty or Internal Fixation. The preoperative characteristics of the patients in both groups were similar. Internal Fixation has a shorter length of anaesthesia (36 minutes versus 57 minutes, p versus 177 ml, p versus 0.39 units, p versus 63/229, p = 0.91), but there was a tendency for an improved survival in the older less mobile patients treated by Internal Fixation. For the survivors assessed at one, two and three years from injury there were no differences with regard to the outcome for pain and mobility. Limb shortening was more common after Internal Fixation (7.0 mm versus 3.6 mm, p = 0.004). We recommend that displaced intracapsular fractures in the elderly should generally be treated by arthroplasty but that Internal Fixation may be appropriate for those who are very frail.
Michael J Bosse - One of the best experts on this subject based on the ideXlab platform.
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maintenance of hardware after early postoperative infection following fracture Internal Fixation
Journal of Bone and Joint Surgery American Volume, 2010Co-Authors: Marschall B Berkes, William T Obremskey, Brian P Scannell, Kent J Ellington, Robert A Hymes, Michael J BosseAbstract:Background: The development of a deep wound infection in the presence of hardware after open reduction and Internal Fixation presents a clinical dilemma, and there is scant literature to aid in decision-making. The purpose of the present study was to determine the prevalence of osseous union with maintenance of hardware after the development of postoperative infection within six weeks after Internal Fixation of a fracture. Methods: The present study included 121 patients from three level-I trauma centers, retrospectively identified from billing and trauma registries, in whom 123 postoperative wound infections with positive intraoperative cultures had developed within six weeks after Internal Fixation of acute fractures. The incidence of fracture union without hardware removal was calculated, and the parameters that predicted success or failure were evaluated. Results: Eighty-six patients (eighty-seven fractures; 71%) had fracture union with operative debridement, retention of hardware, and culture-specific antibiotic treatment and suppression. Predictors of treatment failure were open fracture (p = 0.03) and the presence of an intramedullary nail (p = 0.01). Several variables were not significant but trended toward an association with failure, including smoking, infection with Pseudomonas species, and involvement of the femur, tibia, ankle, or foot. Conclusions: Deep infection after Internal Fixation of a fracture can be treated successfully with operative debridement, antibiotic suppression, and retention of hardware until fracture union occurs. These results may be improved by patient selection based on certain risk factors and the specific bacteria and implants involved. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.
Patrick Vienne - One of the best experts on this subject based on the ideXlab platform.
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Internal Fixation of complex fractures of the proximal humerus
Journal of Bone and Joint Surgery-british Volume, 2004Co-Authors: Christian Gerber, Clement M L Werner, Patrick VienneAbstract:We treated 34 consecutive articular fractures of the proximal humerus in 33 patients with good bone quality by open reduction and Internal Fixation. Anatomical or nearly anatomical reduction was achieved in 30, at a mean follow-up of 63 months (25 to 131), complete or partial avascular necrosis had occurred in 12 cases (35%). Two patients subsequently underwent arthroplasty and six further patients required additional surgery. The 32 patients who did not require arthroplasty obtained a mean Constant score of 78 points or 89% of an age- and gender-matched normal score (66 points or 76% in the presence and 83 points or 96% in the absence of avascular necrosis (p < 0.0005)); 22 were painfree, and seven had mild pain and three moderate pain. The mean active anterior elevation was 156°. Internal Fixation of complex fractures of the proximal humerus restored good shoulder function if avascular necrosis did not develop.
