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1.
Unfallchirurg ; 114(11): 987-97, 2011 Nov.
Article in German | MEDLINE | ID: mdl-20640566

ABSTRACT

BACKGROUND: The objective of this systematic review was to summarize the current evidence on efficacy and safety of the various treatment options for midshaft clavicle fractures, taking into account fracture type and other variables. MATERIAL AND METHODS: A search for systematic reviews and controlled studies published between 1998 and 2009 was carried out. RESULTS: There is moderate evidence that operative treatment for midshaft clavicle fractures results in a lower rate of fracture non-union and improved patient-oriented outcome compared to non-operative treatment. However, because union rates are generally high and there are complications which are unique to surgical intervention, risks have to be considered and weighed before a decision on treatment is made. The most important risk factors for non-union are major displacement and fracture comminution. Of all surgical procedures the best evidence of efficacy is presently available for plate fixation and elastic stable intramedullary nailing. CONCLUSION: This paper presents an algorithm derived from the current evidence which may be useful for therapy decision-making in the clinical routine.


Subject(s)
Bone Plates/statistics & numerical data , Clavicle/injuries , Clavicle/surgery , Fracture Fixation, Internal/instrumentation , Fracture Fixation, Internal/statistics & numerical data , Fractures, Bone/epidemiology , Postoperative Complications/prevention & control , Algorithms , Fractures, Bone/surgery , Humans , Postoperative Complications/epidemiology , Prevalence , Risk Assessment , Treatment Outcome
2.
Handchir Mikrochir Plast Chir ; 40(6): 400-7, 2008 Dec.
Article in German | MEDLINE | ID: mdl-19065501

ABSTRACT

BACKGROUND: Brachial plexus injury is a rare entity, often resulting in lifelong motor and sensory dysfunctions. Sometimes neuropathic pain is predominant. The aim of this retrospective cohort study was to analyse current algorithms of diagnostics and treatment in brachial plexus injuries. The results have been compared to literature. PATIENTS AND METHODS: A retrospective analysis of 214 patients suffering from a brachial plexus injury was conducted. Our results were compared to those in the literature. RESULTS: A sufficient algorithm for the diagnosis of and therapy for brachial plexus injuries was not apparent. Only a few studies have been published concerning this problem. The incidence for Austria is 1.29 cases per 100 000 inhabitants; this represents the middle range compared to international data. The main causes of brachial plexus injury were falls (45 %) and traffic accidents (26.6 %). 20.1 % of patients were multitraumatised, 29.9 % had a closed head injury. In 3.7 % the brachial plexus lesion was associated with spinal cord trauma. In contrast to the literature data (9-13 %), we did not find any stab or gun shot wounds. 5.6 % sustained a vascular injury at the arm or shoulder level; two patients had to undergo an emergency surgical procedure because of this injury. Clinical assessment was generally insufficient. Electrophysiological assessment was performed in 34.6 % of the patients, MRI in 13.6 %. In 38.3 % of the patients no clinical improvement was observed after three months. An operative procedure was performed in 8.4 % of these patients. 61.1 % of these operated patients were not satisfied with the clinical results. Practically no reconstructive procedures had been performed. CONCLUSION: An algorithm for diagnosis and treatment needs to be established. Awareness for the sophisticated treatment of this type of injury has to be stimulated. Precise clinical assessment and knowledge of differentiated treatment options have to be available in order to improve the results.


Subject(s)
Brachial Plexus/injuries , Brachial Plexus/surgery , Accidental Falls , Accidents, Traffic , Adult , Aged, 80 and over , Algorithms , Austria , Cohort Studies , Craniocerebral Trauma/complications , Follow-Up Studies , Humans , Incidence , Magnetic Resonance Imaging , Multiple Trauma , Patient Satisfaction , Physical Therapy Modalities , Retrospective Studies , Spinal Cord Injuries/complications , Time Factors , Treatment Outcome
3.
Unfallchirurgie ; 14(1): 12-21, 1988 Feb.
Article in German | MEDLINE | ID: mdl-3284133

ABSTRACT

The effect of either (randomized) Heparin/Dihydroergotamine (HDHE) or heparin-acenocoumarin (Hep/S) on the incidence of deep-vein thrombosis in the legs was studied in 212 women of more than 60 years of age with hip fractures. All patients were screened with the 125-I-fibrinogen uptake test (FUT) confirmed by a bilateral ascending venogram upon positive FUT. This revealed good sensitivity and specificity (85/84%) for the FUT. Deep vein thrombosis developed in 37.6% of the HDHE group and in 59.1% of the Hep/S group which was significantly different (p less than 0.005). The calculated thrombosis risk was significantly diminished (by 38% - p less than 0.005) in the HDHE group. Therefore we conclude that in traumatology Heparin/Dihydroergotamine seems to be the prophylaxis of choice.


Subject(s)
Anticoagulants/therapeutic use , Bone Nails , Hip Fractures/surgery , Thrombosis/prevention & control , Acenocoumarol/administration & dosage , Aged , Aged, 80 and over , Dihydroergotamine/administration & dosage , Drug Therapy, Combination , Female , Heparin/administration & dosage , Hip Fractures/complications , Humans , Middle Aged , Thrombosis/etiology
4.
Acta Orthop Scand ; 57(4): 340-3, 1986 Aug.
Article in English | MEDLINE | ID: mdl-3788500

ABSTRACT

The effect of either heparin-dihydergot or heparin-acenocoumarin on the incidence of deep-vein thrombosis in the legs was studied in 181 women undergoing Ender nailing for intertrochanteric fracture of the femur. All the patients were screened with the 125-I-fibrinogen uptake test, confirmed by a bilateral ascending venogram. Deep-vein thrombosis developed in 40 per cent of the heparin-dihydergot group and in 61 per cent of the heparin-acenocoumarin group (p less than 0.015).


Subject(s)
Hip Fractures/complications , Acenocoumarol/administration & dosage , Aged , Aged, 80 and over , Bone Nails , Dihydroergotamine/administration & dosage , Drug Evaluation , Drug Therapy, Combination , Female , Fibrinogen , Heparin/administration & dosage , Hip Fractures/surgery , Humans , Iodine Radioisotopes , Iothalamate Meglumine , Middle Aged , Radiography , Radionuclide Imaging , Random Allocation , Thromboembolism/diagnostic imaging , Thromboembolism/prevention & control , Time Factors
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