Ball-thrower's fracture of the humerus.
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Adult↗
Biomedical subjects
Emil H Schemitsch
Publications and source records attributed to Emil H Schemitsch.
Fat embolism syndrome: history, definition, epidemiology.
The first clinical case of fat embolism was described over 100 years ago and significant progress has been made in the understanding of this condition since then. Gurd's criteria, consisting of major and minor clinical features, is the most commonly used diagnostic tool in the literature. Due to the lack of a gold standard for diagnosis, clinical criteria cannot be validated. It is now recognized that although fat embolization occurs in the majority of patients with long bone fractures, clinical signs and symptoms occur only in 1-10% of patients with fractures.
Embolism, Fat↗
Compression plating versus intramedullary nailing of humeral shaft fractures--a meta-analysis.
BACKGROUND: The choice of plates or intramedullary nails for operatively treated humeral shaft fractures remains controversial, since randomized controlled trials have lacked sufficient power. A meta-analysis of existing trials would improve inferences regarding the treatment effect. METHODS: We reviewed randomized trials in Medline, Cochrane and SciSearch, along with other sources of published randomized trials from 1969-2000. Of 215 citations identified, only 3 studies were included. RESULTS: The 3 studies (involving 155 patients) were pooled, since they were homogeneous (p > 0.1). Plate fixation gave a lower relative risk of reoperation than intramedullary nailing (RR = 0.26, 95% CI 0.007-0.9, p = 0.03). This translated to a risk reduction of 74% for reoperation when plate fixation was employed. Thus, 1 reoperation could be prevented for every 10 patients treated with plates. Plate fixation also reduced the risk of shoulder problems in comparison to intramedullary nails (RR = 0.10, 95% CI 0.03-0.4, p = 0.002). INTERPRETATION: Plate fixation of humeral shaft fractures may reduce the risk of reoperation and shoulder impingement. The cumulative evidence remains inconclusive, and a larger trial is needed in order to confirm these findings.
Bone Nails↗
Bone remodeling is different in metaphyseal and diaphyseal-fit uncemented hip stems.
Femoral component stability in uncemented total hip arthroplasties depends on periprosthetic bone remodeling. Stem design is an important factor influencing bone remodeling, however the design that promotes the most bone remodeling is unclear. We examined metaphyseal and diaphyseal-fit stems to determine the effect of stem design on bone remodeling and stability. Twenty-three patients who had total hip arthroplasties (28 hips) with metaphyseal-fit stems were matched with 27 patients (32 hips) who had uncemented total hip arthroplasties with diaphyseal-fit stems. We assessed preoperative radiographs for canal fill, canal shape, and bone quality. We then assessed postoperative radiographs for periprosthetic bone remodeling including spot welds, cortical hypertrophy, and pedestal formation. Patients were examined clinically using a modified Harris hip score. Patients with metaphyseal stems had increased cortical hypertrophy 1 year postoperatively. However, there was no functional difference 2 years postoperatively. Both stem designs resulted in bone remodeling by 2 years postoperatively with similar clinical results.
Adult↗
A randomized, controlled trial of distal radius fractures with metaphyseal displacement but without joint incongruity: closed reduction and casting versus closed reduction, spanning external fixation, and optional percutaneous K-wires.
OBJECTIVES: To compare closed reduction and casting with closed reduction and external fixation with optional K-wire fixation for distal radius fractures with metaphyseal displacement but without joint incongruity. DESIGN: Prospective study. SETTING: Multicenter study at 3 University teaching hospitals. PATIENTS/PARTICIPANTS: A total of 113 skeletally mature patients with distal radius fractures with metaphyseal displacement, but without joint incongruity, were randomized to receive 1 of 2 standardized treatment protocols. Patients were evaluated at 6 weeks, 6 months, 1 year, and 2 years. INTERVENTION: Closed reduction and casting (n = 59) or closed reduction and external fixation (n = 54). MAIN OUTCOME MEASUREMENTS: Upper extremity function was measured using upper extremity MFA domain scores, overall Jebsen Taylor scores, and pinch and grip strength tests. Global function and pain were measured using the SF-36. Radiographic evaluation and range of motion were documented. RESULTS: Upper extremity MFA scores, Jebsen Taylor scores, SF-36 bodily pain scores, and grip strength improved significantly during the first year for all patients. By 2 years, mean Jebsen Taylor scores and SF 36 bodily pain scores for patients in both groups were similar to scores for normal age- and gender-matched population controls. At all points, there was a trend for better function in the external fixation; however, this did not reach statistical significance. There was a trend for better length and palmar tilt restoration with external fixation. CONCLUSIONS: For distal radius fractures with metaphyseal displacement but with a congruous joint, there exists a trend for better functional, clinical, and radiographic outcomes when treated by immediate external fixation and optional K-wire fixation.
Adult↗
Deficits following nonoperative treatment of displaced midshaft clavicular fractures.
BACKGROUND: Displaced fractures of the midpart of the clavicular shaft are generally treated nonoperatively, and few functional deficits have been reported. Whereas prior investigators have presented radiographic and surgeon-based outcomes, we used a patient-based outcome questionnaire and objective muscle-strength testing to evaluate a series of patients who had received nonoperative care for a displaced midshaft fracture of the clavicle. METHODS: We identified thirty patients (twenty-two men and eight women with a mean age of thirty-seven years) who had sustained a displaced midshaft fracture of the clavicle. All patients were treated nonoperatively. At a mean of fifty-five months, and a minimum of twelve months, outcomes were measured with the Constant shoulder score and the DASH (Disabilities of the Arm, Shoulder and Hand) patient questionnaire. In addition, objective shoulder muscle-strength testing was performed with the Baltimore Therapeutic Equipment Work Simulator, with the uninjured arm serving as a control. RESULTS: The range of motion was well maintained, with flexion averaging 170 degrees +/- 20 degrees and abduction averaging 165 degrees +/- 25 degrees . Compared with the strength of the uninjured shoulder, the strength of the injured shoulder was reduced to 81% for maximum flexion, 75% for endurance of flexion, 82% for maximum abduction, 67% for endurance of abduction, 81% for maximum external rotation, 82% for endurance of external rotation, 85% for maximum internal rotation, and 78% for endurance of internal rotation (p < 0.05 for all values). The mean Constant score was 71 points, and the mean DASH score was 24.6 points, indicating substantial residual disability. CONCLUSIONS: Traditionally, good results with minimal functional deficits have been reported following nonoperative treatment of clavicular fractures. However, surgeon-based methods of evaluation may be insensitive to loss of muscle strength. We detected residual deficits in shoulder strength and endurance in this patient population, which may be related to the significant level of dysfunction detected by the patient-based outcome measures.
Adult↗
Survivorship analysis and radiographic outcome following tantalum rod insertion for osteonecrosis of the femoral head.
BACKGROUND: For early stages of osteonecrosis, preservation of the femoral head is the primary objective; however, there has not been a consensus on how best to achieve this goal. Core decompression alone is associated with a lack of structural support with inconsistent outcomes, whereas vascularized fibular grafting requires an extensive surgical procedure with high donor-site morbidity and prolonged rehabilitation. The adjunctive use of a porous tantalum implant offers the advantages of core decompression, structural support, minimally invasive surgery, and no donor-site morbidity. The purpose of this study was to assess the survivorship and to evaluate the clinical results and radiographic outcomes of hips in which osteonecrosis of the femoral head was treated with core decompression and a porous tantalum implant. METHODS: We evaluated fifty-four patients (sixty consecutive hips) in whom osteonecrosis of the femoral head was treated with core decompression and insertion of a porous tantalum implant. Fifty-two patients (fifty-eight hips) were available for follow-up at a mean of twenty-four months. All patients were sixty-five years of age or younger (mean age, thirty-five years). According to the classification system of Steinberg et al., one hip (2%) had stage-I disease, forty-nine hips (84%) had stage-II disease, and eight hips (14%) had stage-III disease. Outcome measures that were used included a limb-specific score (Harris hip score), radiographic outcome measures, and survivorship analysis with revision to total hip arthroplasty as the end point. RESULTS: Overall, nine hips (15.5%) were converted to total hip arthroplasty, including six with stage-II disease and three with stage-III disease. The overall survival rates were 91.8% (95% confidence interval, 87.8% to 95.8%) at twelve months, 81.7% (95% confidence interval, 75.8% to 87.6%) at twenty-four months, and 68.1% (95% confidence interval, 54.7% to 81.5%) at forty-eight months. The absence of chronic systemic diseases resulted in a survival rate of 92% at forty-eight months (95% confidence interval, 87.4% to 96.4%). CONCLUSIONS: Treatment of early stage osteonecrosis of the femoral head with core decompression and a porous tantalum implant can be accomplished with a minimally invasive technique and no donor-site morbidity. The early clinical results show encouraging survival rates in patients who do not have chronic systemic disease, especially in association with early stage disease. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors on jbjs.org for a complete description of levels of evidence.
Adolescent↗
Total hip arthroplasty following failure of free vascularized fibular graft.
BACKGROUND: Many treatments for osteonecrosis of the femoral head, including the use of a free vascularized fibular graft, have been advocated in an attempt to delay the need for hip arthroplasty. The purpose of this study was to document the clinical and radiographic results of total hip arthroplasty performed following failure of a free vascularized fibular grafting procedure. METHODS: Twenty total hip arthroplasties in eighteen patients who had previously undergone a free vascularized fibular grafting procedure for the treatment of osteonecrosis were retrospectively reviewed. A straight-stem femoral component was used in twelve hips, a tapered femoral component with removal of residual fibular graft was used in five hips, and a tapered stem without graft removal was used in three hips. The twelve hips with a straight-stem femoral component and previous vascularized fibular grafting were compared with thirty-six osteonecrotic hips in thirty other patients who had undergone total hip arthroplasty but had not had previous free vascularized fibular grafting. The radiographic outcomes with respect to initial femoral component alignment and subsequent migration and the clinical outcomes were compared. RESULTS: Analysis of the immediate postoperative radiographs demonstrated significantly improved alignment of the femoral component when a high-speed burr had been used to remove residual fibular graft (p = 0.001), although doing so did significantly increase both the intraoperative blood loss (p = 0.017) and the operative time (p = 0.0002). There was no significant difference in the amount of migration of either the acetabular or the femoral component between the control and study groups at the time of the most recent follow-up. When comparing patients with or without a previous free vascularized fibular graft, the mean postoperative scores at three years were significantly worse in patients who had undergone a previous free vascularized fibular graft (p = 0.03). One revision occurred in the study group at seventy-two months due to acetabular wear, and one revision occurred in the control group at 108 months due to aseptic loosening. CONCLUSIONS: This study raises concern that the outcome of total hip arthroplasty in patients who previously underwent a free vascularized fibular graft for the treatment of osteonecrosis of the femoral head may be worse than that in patients without previous free vascularized fibular grafting. The intraoperative use of a high-speed burr can improve the alignment of the femoral component by removing more of the residual graft. However, this technique does increase intraoperative blood loss and operative time. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors on jbjs.org for a complete description of levels of evidence.
Adult↗
Does flattery work? A comparison of 2 different cover letters for an international survey of orthopedic surgeons.
BACKGROUND: Surveys are an important tool for gaining information about physicians' beliefs, practice patterns and knowledge. However, the validity of surveys among physicians is often threatened by low response rates. We investigated whether response rates to an international survey could be increased using a more personalized cover letter. METHODS: We conducted an international survey of the 442 surgeon-members of the Orthopaedic Trauma Association on the treatment of femoral-neck fractures. We used previous literature, key informants and focus groups in developing the self-administered 8-page questionnaire. Half of the participants received the survey by mail, and half received an e-mail invitation to participate on the Internet. We alternately allocated participants to receive a "standard" or "test" cover letter. RESULTS: We found a higher primary response rate to the test cover letter (47%) than to the standard cover letter (30%) among those who received the questionnaire by mail. There was no difference between the response rates to the test and to the standard cover letters in the Internet group (22% v. 23%). Overall, there was a higher primary response rate for the test cover letter (34%) when both the mail and Internet groups were combined, compared with the standard cover letter (27%). CONCLUSIONS: Our test cover letter to surgeons in our survey resulted in a significantly higher primary response rate than a standard cover letter when the survey was sent by mail. Researchers should consider using a more personalized cover letter with a postal survey to increase response rates.
Adult↗
Isolated acetabular revision after total hip arthroplasty: results at 5-9 years of follow-up.
The purpose of the study was to determine whether isolated revision of the acetabular component can be successfully performed without disturbing the femoral stem and to determine the fate of the unrevised femoral stem following revision. Fifty-seven hips in 55 patients underwent isolated acetabular revision without removal of the femoral component. Thirty-three hips with minimal acetabular deficiency required no bone grafting; the remaining 24 hips were treated by morselized or structural allograft in addition to a new acetabular component. Twenty-two of these 24 hips demonstrated incorporation of the bone graft. A mean follow-up of 5.8 (5-9) years, all femoral and acetabular components were judged to be stable and well fixed.
Acetabulum↗
Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. Surgical technique.
BACKGROUND: The results of elbow dislocations with associated radial head and coronoid fractures are often poor because of recurrent instability and stiffness from prolonged immobilization. We managed these injuries with a standard surgical protocol, postulating that early intervention, stable fixation, and repair would provide sufficient stability to allow motion at seven to ten days postoperatively and enhance functional outcome. METHODS: We retrospectively reviewed the results of this treatment performed, at two university-affiliated teaching hospitals, in thirty-six consecutive patients (thirty-six elbows) with an elbow dislocation and an associated fracture of both the radial head and the coronoid process. Our surgical protocol included fixation or replacement of the radial head, fixation of the coronoid fracture if possible, repair of associated capsular and lateral ligamentous injuries, and in selected cases repair of the medial collateral ligament and/or adjuvant-hinged external fixation. Patients were evaluated both radiographically and with a clinical examination at the time of the latest follow-up. RESULTS: At a mean of thirty-four months postoperatively, the flexion-extension arc of the elbow averaged 112 degrees +/- 11 degrees and forearm rotation averaged 136 degrees +/- 16 degrees . The mean Mayo Elbow Performance Score was 88 points (range, 45 to 100 points), which corresponded to fifteen excellent results, thirteen good results, seven fair results, and one poor result. Concentric stability was restored to thirty-four elbows. Eight patients had complications requiring a reoperation: two had a synostosis; one, recurrent instability; four, hardware removal and elbow release; and one, a wound infection. CONCLUSIONS: Use of our surgical protocol for elbow dislocations with associated radial head and coronoid fractures restored sufficient elbow stability to allow early motion postoperatively, enhancing the functional outcome. We recommend early operative repair with a standard protocol for these injuries.
Collateral Ligaments↗
Operative management of displaced femoral neck fractures in elderly patients. An international survey.
BACKGROUND: Hip fractures occur in 280,000 North Americans each year. Although surgeons have reached consensus with regard to the treatment of undisplaced fractures of the hip, the surgical treatment of displaced fractures remains controversial. Identifying surgeons' preferences in techniques, and the rationale for their choices, may aid in focusing educational activities to the orthopaedic community as well as planning future clinical trials. Our objective was to clarify current opinion with regard to the operative treatment of displaced fractures of the femoral neck. METHODS: We used a cross-sectional survey design and a sample-to-redundancy strategy to examine surgeons' preferences in the treatment of displaced femoral neck fractures. We mailed this survey to members of the Orthopaedic Trauma Association and European-AO International-affiliated trauma centers. RESULTS: Of 442 surgeons who received the questionnaire, 298 (67%) responded. The typical respondent was a North American man over the age of forty years who was in academic practice, supervised residents, had fellowship training in trauma, and worked in a low-volume center (<100 hip fractures per year), treating an equal proportion of displaced and undisplaced femoral neck fractures. Most surgeons believed that internal fixation was the procedure of choice in younger patients (those who are less than sixty years old) with a displaced fracture (Garden type III or IV). For patients over eighty years old with Garden type-III or IV fractures, almost all surgeons preferred arthroplasty. Respondents varied widely in their preferences for the treatment of patients who were sixty to eighty years old with a displaced fracture (Garden type III or IV) or active patients with a Garden type-III fracture. Many surgeons believed there was no difference between arthroplasty and internal fixation when considering mortality (45%), infection rates (30%), and quality of life (37%). Surgeons also revealed variable preferences in their choice of the optimal approach to arthroplasty for patients between sixty and eighty years old with a type-IV fracture (32% preferred unipolar; 41%, bipolar; and 17%, total hip arthroplasty) and in the optimal choice of implant for internal fixation. CONCLUSIONS: While surgeons prefer internal fixation for younger patients and arthroplasty for older patients, they disagree about the optimal approach to the management of patients between sixty and eighty years old with a displaced fracture and active patients with a Garden type-III fracture. Surgeons also disagree on the optimal implants for internal fixation or arthroplasty.
Adult↗
An observational study of duplicate presentation rates between two national orthopedic meetings.
BACKGROUND: National meetings such as those of the American Academy of Orthopaedic Surgeons (AAOS) and the Canadian Orthopaedic Association (COA) are invaluable in the dissemination of new research findings. Given the limits of meeting agendas, investigators who present the same paper at multiple meetings prevent other presentations on potentially important original research. To determine the incidence of duplicate presentation of research between recent COA and AAOS meetings and between national meetings (AAOS and subspecialty), we conducted an observational study. METHODS: We hand-searched all podium papers and posters from the 2001 COA annual meeting for duplicate presentation at the 2001 and 2002 AAOS annual meetings and subspecialty meetings held in the USA. We evaluated summary data abstracted from the duplicate presentations for consistency. RESULTS: Of 148 presentations at the 2001 COA meeting, 29 presentations (paper and poster) were duplicated at the 2001 or 2002 AAOS meeting: effectively 1 paper in 5 (19.5%). Canadian investigators were significantly more likely to present the same paper at both meetings than Americans (79% v. 13%, respectively; p < 0.01). Those who presented papers at COA altered their AAOS presentations in a variety of ways: by changing the wording in the title of their paper (24% of the time), adding or removing authors (38%), changing authorship order (34%) and changing the sample size (31%). Duplicate presentation rates between AAOS and other orthopedic subspecialty meetings averaged 11.4% (range 3.4%-26.4%). CONCLUSIONS: We identified a 20% duplicate presentation rate between the COA and AAOS annual meetings, and an 11% rate between the AAOS and subspecialty meetings. Stricter enforcement of guidelines and improved dissemination of research findings at both national meetings may limit this practice.
Canada↗
The undue influence of significant p-values on the perceived importance of study results.
BACKGROUND: Statistically significant differences between treatments (i.e., results typically associated with p < 0.05) may not always correspond to important differences upon which to base orthopedic practice. If the hypothesis that p < 0.05 unduly influences the perception of importance of study results were true, we would expect that presenting such a p-value would lead to 1) greater agreement among clinicians about the importance of a study result, and 2) greater perceived importance of a study result, when compared with presenting the same results omitting the p-value. METHODS: The participants were 3 orthopedics residents, 5 fellows, and 4 attending orthopedic surgeons at a university hospital. We constructed a 40-item questionnaire with the comparison groups, primary outcome of interest, and the results from each of 40 studies. These studies represent a variety of interventions across orthopedic surgery assessed in 2-group comparative intervention studies (randomized trials, observational studies) and were published between 2000 and 2002 in the Journal of Bone and Joint Surgery--American Volume. For each question, respondents were asked to rate the importance of the study results. Participants answered the questionnaire first without p-values and then, 8 weeks later, with p-values (and a random sample of items without p-values). An intra-class correlation quantified agreement between clinicians when answering items with and without p-values. The difference in mean importance scores between the two presentations was also estimated. RESULTS: Of 40 eligible clinical comparative studies, 30 reported p < 0.05 for their primary comparison. Without presenting p-values, overall agreement regarding clinical significance among reviewers was fair (ICC = 0.35, 95% CI: 0.25-0.49). In the 30 studies with p < 0.05, mean importance scores (1 = low; 3 = high) were greater when p-values were presented (difference 0.6, CI 0.1-1.1). 10 of 12 reviewers perceived results to be more important when presented with significant p-values. INTERPRETATION: When significant, p-values unduly influence the perception of clinicians regarding the importance of study results.
Biomedical Research↗
Internet versus mailed questionnaires: a controlled comparison (2).
BACKGROUND: Low response rates among surgeons can threaten the validity of surveys. Internet technologies may reduce the time, effort, and financial resources needed to conduct surveys. OBJECTIVE: We investigated whether using Web-based technology could increase the response rates to an international survey. METHODS: We solicited opinions from the 442 surgeon-members of the Orthopaedic Trauma Association regarding the treatment of femoral neck fractures. We developed a self-administered questionnaire after conducting a literature review, focus groups, and key informant interviews, for which we used sampling to redundancy techniques. We administered an Internet version of the questionnaire on a Web site, as well as a paper version, which looked similar to the Internet version and which had identical content. Only those in our sample could access the Web site. We alternately assigned the participants to receive the survey by mail (n=221) or an email invitation to participate on the Internet (n=221). Non-respondents in the mail arm received up to three additional copies of the survey, while non-respondents in the Internet arm received up to three additional requests, including a final mailed copy. All participants in the Internet arm had an opportunity to request an emailed Portable Document Format (PDF) version. RESULTS: The Internet arm demonstrated a lower response rate (99/221, 45%) than the mail questionnaire arm (128/221, 58%) (absolute difference 13%, 95% confidence interval 4%-22%, P<0.01). CONCLUSIONS: Our Internet-based survey to surgeons resulted in a significantly lower response rate than a traditional mailed survey. Researchers should not assume that the widespread availability and potential ease of Internet-based surveys will translate into higher response rates.
Adult↗
Internet versus mailed questionnaires: a randomized comparison (2).
BACKGROUND: Low response rates among surgeons can threaten the validity of surveys. Internet technologies may reduce the time, effort, and financial resources needed to conduct surveys. OBJECTIVE: We investigated whether using Web-based technology could increase the response rates to an international survey. METHODS: We solicited opinions from the 442 surgeon-members of the Orthopaedic Trauma Association regarding the treatment of femoral neck fractures. We developed a self-administered questionnaire after conducting a literature review, focus groups, and key informant interviews, for which we used sampling to redundancy techniques. We administered an Internet version of the questionnaire on a Web site, as well as a paper version, which looked similar to the Internet version and which had identical content. Only those in our sample could access the Web site. We alternately assigned the participants to receive the survey by mail (n=221) or an email invitation to participate on the Internet (n=221). Non-respondents in the mail arm received up to three additional copies of the survey, while non-respondents in the Internet arm received up to three additional requests, including a final mailed copy. All participants in the Internet arm had an opportunity to request an emailed Portable Document Format (PDF) version. RESULTS: The Internet arm demonstrated a lower response rate (99/221, 45%) than the mail questionnaire arm (129/221, 58%) (absolute difference 13%, 95% confidence interval 4%-22%, P<0.01). CONCLUSIONS: Our Internet-based survey to surgeons resulted in a significantly lower response rate than a traditional mailed survey. Researchers should not assume that the widespread availability and potential ease of Internet-based surveys will translate into higher response rates.
Adult↗
Association between industry funding and statistically significant pro-industry findings in medical and surgical randomized trials.
BACKGROUND: Conflicting reports exist in the medical literature regarding the association between industry funding and published research findings. In this study, we examine the association between industry funding and the statistical significance of results in recently published medical and surgical trials. METHODS: We examined a consecutive series of 332 randomized trials published between January 1999 and June 2001 in 8 leading surgical journals and 5 medical journals. Each eligible study was independently reviewed for methodological quality using a 21-point index with 5 domains: randomization, outcomes, eligibility criteria, interventions and statistical issues. Our primary analysis included studies that explicitly identified the primary outcome and reported it as statistically significant. For studies that did not explicitly identify a primary outcome, we defined a "positive" study as one with at least 1 statistically significant outcome measure. We used multivariable regression analysis to determine whether there was an association between reported industry funding and trial results, while controlling for study quality and sample size. RESULTS: Among the 332 randomized trials, there were 158 drug trials, 87 surgical trials and 87 trials of other therapies. In 122 (37%) of the trials, authors declared industry funding. An unadjusted analysis of this sample of trials revealed that industry funding was associated with a statistically significant result in favour of the new industry product (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.3-3.5). The association remained significant after adjustment for study quality and sample size (adjusted OR 1.8, 95% CI 1.1-3.0). There was a nonsignificant difference between surgical trials (OR 8.0, 95% CI 1.1-53.2) and drug trials (OR 1.6, 95% CI 1.1-2.8), both of which were likely to have a pro-industry result (relative OR 5.0, 95% CI 0.7-37.5, p = 0.14). INTERPRETATION: Industry-funded trials are more likely to be associated with statistically significant pro-industry findings, both in medical trials and surgical interventions.
Conflict of Interest↗
Fractures of the shaft of the ulna.
BACKGROUND: The optimal management for ulnar shaft fractures remains debatable. Investigators have advocated nonoperative management as well as internal fixation of these fractures. OBJECTIVE: The primary objective of this study was to determine the effect of alternative management strategies of fractures of the ulnar shaft on rates of union, infection, and functional outcomes. A secondary objective was to examine outcomes after alternative strategies in managing patients with bone defects.
Fracture Fixation↗