ABSTRACT
The European best practice guidelines on the treatment of inguinal hernia were published in 2009. Publications on this subject in international journals were updated in 2012. In patients with asymptomatic inguinal hernia or with minimal symptoms, conservative treatment is safe, but they do need to be informed that the risk for undergoing surgery increases by nearly 10% a year. Conservative treatment is less useful in younger patients. All adult men with symptomatic inguinal hernia need to undergo surgery. They should be treated with a technique in which a synthetic prosthesis (mesh) is used. The Lichtenstein technique is advised for the open treatment of inguinal hernia, since this is the most thoroughly evaluated technique. For endoscopic treatment, the European best practice guidelines advise the total extra-peritoneal technique. Nowadays the focus in complications is on the prevention of postoperative chronic pain.
Subject(s)
Hernia, Inguinal/surgery , Practice Guidelines as Topic , Chronic Pain/prevention & control , Endoscopy , Hernia, Inguinal/therapy , Humans , Pain, Postoperative/prevention & control , Postoperative Period , Surgical MeshABSTRACT
BACKGROUND: To describe the rationale and design of a future study comparing results of plate fixation and Elastic Stable Intramedullary Nailing (ESIN) with a Titanium Elastic Nail (TEN) for adults with a dislocated midshaft clavicular fracture. METHODS/DESIGN: Prospective randomized multicenter clinical trial in two level 1 and one level 2 trauma centers. 120 patients between 18 and 65 years of age will be included. They are randomized to either plate fixation or ESIN with a TEN with a one year follow-up. Sixty patients will be treated with plate fixation and 60 patients will be treated with ESIN. Primary outcome parameter is the Disabilities of the Arm, Shoulder and Hand score after 6 months. Secondary outcome parameters are Constant Shoulder Score, complications, experienced pain, radiologic consolidation and cosmetics after both procedures. DISCUSSION: Prospective randomized studies comparing operative techniques for treatment of dislocated midshaft clavicular fracture are lacking. By studying shoulder function, complications, quality of life, radiographic union, cosmetics as well as experienced pain, a complete efficacy assessment of both procedures will be performed. TRIAL REGISTRATION: The POP study is registered in the Dutch Trial Register (NTR NTR2438).
