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SHR Neuro Krebs Kardio Lipid

Gross, T; Huettl, T; Audigé, L; Frey, C; Monesi, M; Seibert, FJ; Messmer, P.
How comparable is so-called standard fracture fixation with an identical implant? A prospective experience with the antegrade femoral nail in South Africa and Europe.
Injury. 2010; 41(4):388-395
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Autor/innen der Med Uni Graz:
Seibert Franz
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Abstract:
The utilisation and consequences of standardised operative procedures may importantly differ between different healthcare systems. This is the first investigation comparing the treatment and outcome of femoral shaft fractures stabilised with an identical implant between trauma centres in 2 continents (Europe, EU and South Africa, SA). Following standardised introduction of the technique, the prospective, observational multicentre study enrolled 175 patients who underwent intramedullary fracture fixation using the antegrade femoral nail (AFN) for femoral shaft fractures. Eleven EU hospitals recruited 86 patients and 1 SA centre 89 patients in the study period. Comparison of epidemiologic data, operative characteristics as well as subjective (e.g., pain, SF-36) and objective (e.g., X-ray, range of motion [ROM]) 3-month and 1-year outcomes were performed (p<0.05). Compared to EU centres, several significant differences were observed in SA: (1) on average, patients operated on were younger, had less concomitant diseases and had more severe open fractures; (2) operative stabilisation was more often undertaken by young, unsupervised residents, with shorter operating and intraoperative fluoroscopy times; (3) mean hospital stay was shorter, with less recorded complications, but a higher loss to follow-up rate. Non- or malunion rates and subjective outcomes were similar for both groups, with the physical component of the SF-36 at the 1-year follow-up not fully restoring to baseline values. Our investigation demonstrates the importance of several major differences between 2 different regions of the world in the treatment of femoral shaft fractures, despite involving only high level trauma centres and using an identical implant. The intercontinental comparison of results from clinical studies should be interpreted very carefully considering the heterogeneity of populations and clinical settings. Copyright (c) 2009 Elsevier Ltd. All rights reserved.
Find related publications in this database (using NLM MeSH Indexing)
Adolescent -
Adult -
Aged -
Aged, 80 and over -
Bone Nails -
Confounding Factors (Epidemiology) -
Cross-Cultural Comparison -
Developing Countries -
Developing Countries - epidemiology
Female -
Femoral Fractures - complications
Femoral Fractures - mortality
Femoral Fractures - surgery
Fracture Fixation, Intramedullary - adverse effects
Fracture Fixation, Intramedullary - instrumentation
Fracture Fixation, Intramedullary - methods
Fracture Healing - physiology
Fractures, Open - complications
Fractures, Open - surgery
Healthcare Disparities -
Humans -
Male -
Middle Aged -
Multiple Trauma - complications
Multiple Trauma - surgery
Multivariate Analysis -
Outcome and Process Assessment (Health Care) -
Pain - etiology
Postoperative Complications - epidemiology
Prospective Studies -
Prosthesis Failure -
Range of Motion, Articular -
Reoperation -
Reoperation - epidemiology
Trauma Centers - statistics & numerical data
Treatment Outcome -
Young Adult -

Find related publications in this database (Keywords)
Fracture fixation
Femur
Intramedullary nailing
Outcome
Intercontinental comparison
Observational study
Developing countries
South Africa
Europe
Trauma centre
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