Biomedical subjects

Canadian Orthopaedic Trauma Society

Publications and source records attributed to Canadian Orthopaedic Trauma Society.

5 recordsLinked to original sources

PubMed2007

Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial.

BACKGROUND: Recent studies have shown a high prevalence of symptomatic malunion and nonunion after nonoperative treatment of displaced midshaft clavicular fractures. We sought to compare patient-oriented outcome and complication rates following nonoperative treatment and those after plate fixation of displaced midshaft clavicular fractures. METHODS: In a multicenter, prospective clinical trial, 132 patients with a displaced midshaft fracture of the clavicle were randomized (by sealed envelope) to either operative treatment with plate fixation (sixty-seven patients) or nonoperative treatment with a sling (sixty-five patients). Outcome analysis included standard clinical follow-up and the Constant shoulder score, the Disability of the Arm, Shoulder and Hand (DASH) score, and plain radiographs. One hundred and eleven patients (sixty-two managed operatively and forty-nine managed nonoperatively) completed one year of follow-up. There were no differences between the two groups with respect to patient demographics, mechanism of injury, associated injuries, Injury Severity Score, or fracture pattern. RESULTS: Constant shoulder scores and DASH scores were significantly improved in the operative fixation group at all time-points (p = 0.001 and p < 0.01, respectively). The mean time to radiographic union was 28.4 weeks in the non-operative group compared with 16.4 weeks in the operative group (p = 0.001). There were two nonunions in the operative group compared with seven in the nonoperative group (p = 0.042). Symptomatic malunion developed in nine patients in the nonoperative group and in none in the operative group (p = 0.001). Most complications in the operative group were hardware-related (five patients had local irritation and/or prominence of the hardware, three had a wound infection, and one had mechanical failure). At one year after the injury, the patients in the operative group were more likely to be satisfied with the appearance of the shoulder (p = 0.001) and with the shoulder in general (p = 0.002) than were those in the nonoperative group. CONCLUSIONS: Operative fixation of a displaced fracture of the clavicular shaft results in improved functional outcome and a lower rate of malunion and nonunion compared with nonoperative treatment at one year of follow-up. Hardware removal remains the most common reason for repeat intervention in the operative group. This study supports primary plate fixation of completely displaced midshaft clavicular fractures in active adult patients.

Adult↗

PubMed2006

Reamed versus unreamed intramedullary nailing of the femur: comparison of the rate of ARDS in multiple injured patients.

OBJECTIVE: To compare the rate of Acute Respiratory Distress Syndrome (ARDS) in multiply injured patients with femoral shaft fractures, treated with intramedullary femoral nails inserted with or without reaming. DESIGN: Prospective, randomized, multicenter, clinical trial. SETTING: Seven Level 1 trauma centers. PATIENTS: Three hundred fifteen patients with 322 femoral shaft fractures were stratified into 2 groups according to their estimated injury severity scores (ISS > or =18 vs. ISS<18) and then randomized to receive an IM nail with either reamed or unreamed insertion for primary stabilization of their femoral shaft fracture. One hundred forty seven patients with 151 fractures received an unreamed nail whereas 168 patients with 171 fractures, received a reamed nail. All fractures were nailed within 24 hours after their trauma. INTERVENTION: Closed intramedullary nailing for femoral shaft fractures. MAIN OUTCOME MEASUREMENTS: Determination of the rate of ARDS in patients undergoing intramedullary nailing of femoral shaft fractures. RESULTS: Three of the 63 multiply injured patients who received a reamed nail developed ARDS as compared with 2 out of 46 patients in the unreamed group. This difference was not statistically significant (P=0.42). (The power for this difference is only 5%. 39,817 patients are needed in each group to detect a difference that small.) This difference was not statistically significant. There were a total of 4 deaths, 2 each in both the reamed and unreamed group. No death resulted from ARDS. CONCLUSIONS: The overall incidence of ARDS was found to be low with primary stabilization of femoral shaft fractures with intramedullary nailing. There was no difference in the incidence of ARDS between the reamed and unreamed groups, given the sample size.

Adolescent↗

PubMed2006

Open reduction and internal fixation compared with circular fixator application for bicondylar tibial plateau fractures. Results of a multicenter, prospective, randomized clinical trial.

BACKGROUND: Standard open reduction and internal fixation techniques have been successful in restoring osseous alignment for bicondylar tibial plateau fractures; however, surgical morbidity, especially soft-tissue infection and wound necrosis, has been reported frequently. For this reason, several investigators have proposed minimally invasive methods of fracture reduction followed by circular external fixation as an alternative approach. To our knowledge, there has been no direct comparison of the two operative approaches. METHODS: We performed a multicenter, prospective, randomized clinical trial in which standard open reduction and internal fixation with medial and lateral plates was compared with percutaneous and/or limited open fixation and application of a circular fixator for displaced bicondylar tibial plateau fractures (Schatzker types V and VI and Orthopaedic Trauma Association types C1, C2, and C3). Eighty-three fractures in eighty-two patients were randomized to operative treatment (forty-three fractures were randomized to circular external fixation and forty to open reduction and internal fixation). Follow-up consisted of obtaining a history, physical examination, and radiographs; completion of the Hospital for Special Surgery (HSS) knee score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Short Form-36 (SF-36) General Health Survey; and recording of complication and reoperation rates. RESULTS: There were no significant differences between the groups in terms of demographic variables, mechanism of injury, or fracture severity and/or displacement. However, patients in the circular fixator group had less intraoperative blood loss than those in the open reduction and internal fixation group (213 mL and 544 mL, respectively; p=0.006) and spent less time in the hospital (9.9 days and 23.4 days, respectively; p=0.024). The quality of osseous reduction was similar in the groups. There was a trend for patients in the circular fixator group to have superior early outcome in terms of HSS scores at six months (p=0.064) and the ability to return to preinjury activities at six months (p=0.031) and twelve months (p=0.024). These outcomes were not significantly different at two years. There was no difference in total arc of knee motion, and the WOMAC scores at two years after the injury were not significantly different between the groups with regard to the pain (p=0.923), stiffness (p=0.604), or function (p=0.827) categories. The SF-36 scores at two years after the injury were significantly decreased compared with the controls for both groups (p=0.001 for the circular fixator group and p=0.014 for the open reduction and internal fixation group), although there was less impairment in the circular fixator group in the bodily pain category (a score of 46) compared with the open reduction and internal fixation group (a score of 35) (p=0.041). Seven (18%) of the forty patients in the open reduction and internal fixation group had a deep infection. The number of unplanned repeat surgical interventions, and their severity, was greater in the open reduction and internal fixation group (thirty-seven procedures) compared with the circular fixator group (sixteen procedures) (p=0.001). CONCLUSIONS: Both techniques provide a satisfactory quality of fracture reduction. Because percutaneous reduction and application of a circular fixator results in a shorter hospital stay, a marginally faster return of function, and similar clinical outcomes and because the number and severity of complications is much higher with open reduction and internal fixation, we believe that circular external fixation is an attractive option for these difficult-to-treat fractures. Regardless of treatment method, patients with this injury have substantial residual limb-specific and general health deficits at two years of follow-up.

Adult↗

PubMed2004

Displaced intraarticular calcaneal fractures: long-term outcome in women.

BACKGROUND: This study compared the outcomes of displaced intraarticular calcaneal fractures in women treated operatively or nonoperatively. This was part of a prospective, randomized, controlled, multi-center, clinical trial performed at four level I trauma hospitals. In addition, we compared the long-term outcomes in women with those reported in men in an earlier study. METHODS: Forty-one women (43 fractures) required treatment for displaced intraarticular calcaneal fractures. Patients' ages ranged from 17 to 65 years at the time of injury. All fractures were closed injuries and had posterior facet displacement of more than 2 mm. Patients were randomly assigned to either the nonoperatively or operatively treated groups. Nonoperative treatment included ice and elevation, while operative treatment consisted of open reduction and internal fixation using a standard lateral approach. Outcomes were measured using the validated Short Form-36 Health Survey (SF-36) and the Visual Analogue Scale (VAS). RESULTS: Women were 3.18 times (RR 3.18, 95% CI 1.03- 9.79) more likely to report high SF-36 scores after operative treatment than those who received nonoperative treatment. Operative outcomes in women were better than those reported in an earlier study in men (SF-36: 77.47 in women compared to 67.56 in men, p = .07; VAS: 81.47 in women compared to 67.04 in men, p = .01). In women the fractures generally were caused by low-energy trauma that produced less severe injuries (higher Bohler angles). Most patients were not receiving Workman's Compensation benefits and did light to moderate work. CONCLUSION: Operative treatment of the fractures showed statistically significant better results when compared to nonoperative treatment (SF-36: p = .04; VAS: p = .10) in women. Displaced intraarticular calcaneal fractures in women should be treated by open reduction and internal fixation through a lateral approach.

Adolescent↗

PubMed2003

Nonunion following intramedullary nailing of the femur with and without reaming. Results of a multicenter randomized clinical trial.

BACKGROUND: Intramedullary nailing of the femur without reaming of the medullary canal has been advocated as a method to reduce marrow embolization to the lungs and the rate of infection after open fractures. The use of nailing without reaming, however, has been associated with lower rates of fracture-healing. The purpose of this prospective study was to compare the rate of union of femoral shaft fractures following intramedullary nailing with and without reaming. METHODS: Two hundred and twenty-four patients were enrolled in a multicenter, prospective, randomized clinical trial to compare nailing without reaming and nailing with reaming. One hundred and six patients with 107 femoral shaft fractures were treated with a smaller diameter nail without reaming of the canal, and 118 patients with 121 fractures had reaming of the canal and insertion of a relatively larger diameter nail. Patients were followed at six-week intervals until union occurred or a nonunion was diagnosed. RESULTS: The two groups were comparable with regard to the measured patient and injury characteristics. Eight (7.5%) of the 107 fractures in the group without reaming had a nonunion compared with two (1.7%) of 121 fractures in the group with reaming (p = 0.049). The relative risk of nonunion was 4.5 times greater (95% confidence interval = 1 to 20) without reaming and with use of a relatively small-diameter nail. CONCLUSION: Intramedullary nailing of femoral shaft fractures without reaming results in a significantly higher rate of nonunion compared with intramedullary nailing with reaming.

Adult↗