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The Bone & Joint Journal
Vol. 102-B, Issue 9 | Pages 1113 - 1121
14 Sep 2020
Nantha Kumar N Kunutsor SK Fernandez MA Dominguez E Parsons N Costa ML Whitehouse MR

Aims

We conducted a systematic review and meta-analysis to compare the mortality, morbidity, and functional outcomes of cemented versus uncemented hemiarthroplasty in the treatment of intracapsular hip fractures, analyzing contemporary and non-contemporary implants separately.

Methods

PubMed, Medline, EMBASE, CINAHL, and Cochrane Library were searched to 2 February 2020 for randomized controlled trials (RCTs) comparing the primary outcome, mortality, and secondary outcomes of function, quality of life, reoperation, postoperative complications, perioperative outcomes, pain, and length of hospital stay. Relative risks (RRs) and mean differences (with 95% confidence intervals (CIs)) were used as summary association measures.


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_15 | Pages 45 - 45
1 Nov 2018
Barlow C Dominguez E Dixon G Crouch-Smith H Wallace R Simpson H Al-Hourani K
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Femoral shaft fractures are potentially devastating injuries. Despite this, clinical studies of the biomechanics of this injury are lacking. We aimed to clinically evaluate bone behaviour under high and low energy trauma in paediatric, adult and older patients. Single-centre retrospective study identifying all diaphyseal femoral fractures between Feb 2015-Feb 2017. Peri-prosthetic and pathological fractures were excluded. Patients were subdivided into groups 1 (paediatric, <16yo), 2 (adult, 17–55yo) and 3 (older, >55yo) to reflect immature, peak bone age and osteoporotic bone respectively. Chi-Squared analysis assessed significance of bone age to degree of comminution and fracture pattern. A p-value <0.05 was significant. A total 4130 radiographs were analysed with 206 femoral shaft fractures identified. Forty-three patients were excluded with 163 remaining. Group 1, 2 and 3 included 38, 37 and 88 patients respectively. Mean age 50.8 (SD 32.8) with male-to-female ratio of 1:1.2. Groups 1 and 3 included majority simple fractures (35/38 and 62/88 respectively). Group 2 included more comminuted injuries (33/37). Bone age to degree of comminution proved significant (p<0.05) with a bimodal distribution of simple fractures noted in groups 1 and 3. Energy to fracture was significant in group 2, where a high energy injury was associated with comminution (p<0.05). This study is the first to demonstrate an association between fracture comminution and age. Simple femoral shaft fractures showed a bimodal age distribution in paediatric and older patients regardless of mechanism energy. High energy mechanism trauma was directly related to fracture comminution at peak bone age.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 483 - 483
1 Sep 2012
Moldovan R Lamas C Natera L Castellanos J Dominguez E Monllau J
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Purpose

Evaluation of our experience on the treatment of comminuted, radial head fractures, and of the outcomes of pyrocarbon prosthetic replacement in such cases.

Materials and Methods

We evaluated 47 cases of prosthetic replacement, performed from May 2003 to July 2008. There were 18 males and 29 females with an average follow-up of 48 months (12 to 60). The Hotchkiss classification was used to characterize the fractures. The indicators for the procedure were type III fractures in 27 cases, type IV fractures in 10 cases, comminuted radial head fractures (associated with disruption in medial collateral ligament) in 3 cases, Monteggia variant in 5 cases, and Essex Lopresti in 2 cases. Functional outcomes were assessed using the Mayo Elbow Performance Index and the Visual Analog Scales (VAS) of pain, joint motion, and stability.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_II | Pages 132 - 133
1 May 2011
Izquierdo O Alvarez R Aparicio P Castellanos J Dominguez E
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Introduction: Activated platelets release various growth factors, some ot which are recognize to improve nerve regeneration. The present study evaluated the effect of platelet-rich-plasma (PRP) in end to end neurorraphy.

Material and method: A total of 38 Spragle-Dawley rats were used. The PRP was obteined from each rat and applicated to the same rat. The left hind limb were used as experimental, with the right as control. The animals were treated in two grups. In both groups the sciatic nerve was dissected from the sciatic notch to the bifurcation. The nerve was transected an repaired with epineural suture (ethilon 9–0). Group A (n=12): suture without PRP. Group B (n=15) suture with PRP. The rats were anestherized and electromyographic studie was performed after the following, 120,5 days for group A and 125,86 for group B. Prior to sacrifice muscular and nerve tissue harvesting was performed.

The amplitude was expressed as the amplitude at the experimental sde divided by the amplitude at the contralateral, untreated side, multiplied by 100%. Recording was done in gastrocnemius and tibialis anterior muscle.

Results: The stimulation was performed in supramaximal form on both groups: Group A: (without PRP)

The mean of intensity was 1.49 mA and the mean of threshold was 0,56 mA

The mean of amplitude was 19,53mV for tibialis anterior and 42,83 mV for gastrocnemius

The mean of latency was 2,28ms for tibialis anterior and 2,19ms for gastrocnemius Group B: (with PRP)

The mean of intensity was 1,46 mA and the mean of threshold was 0,53 mA

The mean of amplitude was 21,83mV for tibialis anterior and 19,32mV for gastrocnemius

The mean of latency was 2,43ms for tibialis anterior and 2,29ms for gastrocnemius

No stadistical difference on both groups was found.

Histological studies were performed and results are no available at the moment of send this abstract

Conclusions:

No evidence has been found that the use of PRP has a beneficial effect on peripheral nerve regeneration

Further studies should be do to elucited the real role of PRP on peripheral nerve regeneration.