A comparative analysis of distal locked and unlocked long proximal femoral nail antirotation (PFNA-II) in the fixation of stable intertrochanteric fractures / 中华创伤杂志(英文版)

PURPOSE@#Long proximal femoral nail anti-rotation (PFNA-II) is a preferred implant in recent years for fixation of pertrochanteric fractures, especially in osteoporotic patients. The purpose of this study is to prospectively investigate the effect of distal locking in long PFNA-II fixation of stable intertrochanteric fractures.@*METHODS@#A total of 58 patients with isolated stable intertrochanteric fractures and treated in our hospital during the study period of 2017-2019 by distal locked or unlocked long PFNA-II fixation were included in this study. Patients who had multiple injuries or open fractures were excluded. There were 40 female and 18 male patients, with 33 affecting the left side and 25 the right side. Of them, 31 belonged to the distal locked group (group A) and 27 to the unlocked group (group B). Surgical procedures and implants used in both groups were similar except for the distal locking of the nails. General data (age, gender, fracture side, etc.) showed no significant difference between two groups (all p > 0.05). The intraoperative parameters like operative time, radiation exposure and follow-up parameters like functional and radiological outcomes were recorded and compared. Statistical tests like the independent samples t-test Fischer's exact and Chi-square test were used to analyze association.@*RESULTS@#The distribution of the fractures according to AO/OTA classification and 31A1.2 type of intertrochanteric fractures were most common in our study. All the included fractures united and the average functional outcome in both groups were good and comparable at the end of one year. The operative time (mL, 107.1 ± 12.6 vs. 77.0 ± 12.0, p < 0.001) and radiation exposure (s, 78.6 ± 11.0 vs. 40.3 ± 9.3, p < 0.001) were significantly less among the patients in group B. Fracture consolidation, three months after the operative procedures, was seen in a significantly greater proportion of patients in group B (92.6% vs. 67.7%, p = 0.025). Hardware irritation because of distal locking bolt was exclusively seen in group A, however this was not statistically significant (p = 0.241).@*CONCLUSION@#We conclude that, in fixation of stable intertrochanteric fractures by long PFNA-II nail, distal locking not only increases the operative time and radiation exposure but also delays the fracture consolidation and increases the chances of hardware irritation, and hence is not required.

Telecarers improve osteoporosis treatment and compliance rates in secondary osteoporosis prevention for elderly hip fracture patients

INTRODUCTION@#A significant treatment gap has been observed in patients with osteoporosis. Our previous audit found a 31.5% rate of anti-osteoporosis medication initiation after fragility fractures at one year. We piloted the use of telecarers to monitor osteoporosis treatment and compliance.@*METHODS@#From January 2017 to January 2018, all hip fracture patients at Changi General Hospital, Singapore, were automatically enrolled into the Health Management Unit valued care hip fracture programme. Telecarer calls were scheduled at discharge, 3, 6 and 12 months. We assessed the acceptability, completion and treatment rates of patients enrolled in this programme.@*RESULTS@#A total of 537 patients with a hip fracture were enrolled in the telecarer programme over one year. Their average age was 79.8 ± 8.23 years, and 63.1% of them were female. A total of 341 patients completed 12 months of follow-up, of which 251 (73.6%) patients were on treatment at 12 months. The most common cause of lack of initiation of secondary osteoporosis treatment was patient or family rejection (34.4%), followed by physician failure to prescribe (24.4%) and renal impairment (24.4%). 16.7% of patients were deemed to have advanced dementia with a life-limiting illness and were, thus, deemed unsuitable for treatment.@*CONCLUSION@#Telecarers may be a useful adjunct in the monitoring of osteoporosis treatment after hip fractures in an elderly population. The main limitations are patient or family rejection and physician inertia. Further studies should focus on a combination of interventions for both patients and physicians to increase awareness of secondary fracture prevention.

Intervención educativa en pacientes mayores de 60 años sobre fractura de cadera / Educational Intervention about Hip Fracture in Patients Older Than 60 Years

Introducción: La fractura de cadera es una entidad prevalente en el grupo etario de edad avanzada, y constituye una de las causas más frecuentes de ingreso hospitalario en personas mayores de 65 años. Objetivo: Evaluar el impacto de una intervención educativa sobre el conocimiento que poseen los adultos mayores sobre fractura de cadera en el Policlínico Docente Universitario Chiqui Gómez Lubián, de Santa Clara, durante el año 2019. Métodos: Se realizó una intervención educativa cuasi-experimental, sin grupo control en adultos mayores pertenecientes a un círculo de abuelos. Se evaluó el conocimiento que estos tenían sobre fractura de cadera antes y después de la intervención educativa durante el año 2019 en el Policlínico Chiqui Gómez de Santa Clara. La investigación tuvo como muestra 18 adultos mayores los cuales fueron seleccionados por el método no probabilístico. Resultados: Como consecuencia de la aplicación de la intervención educativa, el 100 por ciento de los encuestados demostró conocimientos adecuados acerca de las fracturas de cadera. Conclusiones: La intervención educativa fue efectiva pues demostró un incremento en el nivel de conocimientos en el adulto mayor sobre fractura de cadera(AU)

Introduction: Hip fracture is a prevalent entity in the elderly age group, and it constitutes one of the most frequent causes of hospital admission in persons over 65 years of age. Objective: To evaluate the impact of an educational intervention on the knowledge that older adults have about hip fracture at Chiqui Gómez Lubián University Teaching Polyclinic, Santa Clara, during 2019. Methods: A quasi-experimental educational intervention with no control group was carried out in older adults from a grandparents´ s club, to assess their knowledge about hip fracture. This assessment was conducted before and after the educational intervention during 2019 at Chiqui Gómez Polyclinic in Santa Clara. Eighteen aged adults made up the research sampled, who were selected by the non-probabilistic method. Results: As a result of the educational intervention, 100 percent of the respondents showed adequate knowledge about hip fractures. Conclusions: The educational intervention was effective as it showed growth in the level of knowledge in the elderly about hip fracture(AU)

Anatomía articular y parámetros radiográficos de la cadera como factor de riesgo de fractura: una mirada actualizada / Joint Anatomy and Radiographic Parameters of the Hip as Risk Factor for Fracture: An Updated Look

RESUMEN Introducción: Existe un aumento de la evidencia de que la estructura geométrica de la anatomía de la cadera juega un importante papel en la etiología de la fractura. Objetivo: Sistematizar los conocimientos más actuales referentes a las características anatómicas de los parámetros radiográficos de la articulación de la cadera, y su relación con la fractura. Métodos: Se realizó una investigación documental, con los artículos científicos publicados en las bases de datos médicas informáticas como PubMed, Ebsco y SciELo en los últimos 5 años. Resultados: La mayoría de las publicaciones analizan el ángulo cervicodiafisario y el eje de la cadera. Otras medidas analizadas son el eje femoral, la longitud y el ancho del cuello femoral, así como medidas acetabulares. No existe un consenso en la medida del largo del cuello femoral o del eje femoral, a pesar de ser un componente importante de la estructura. El conocimiento de las particularidades de la anatomía y de las características biomecánicas de la cadera permite establecer una base para la comprensión de los factores que afectan esta articulación. Conclusiones: Los estudios que se han realizado sobre las características de los componentes estructurales, demuestran que existe una asociación entre sus dimensiones y la ocurrencia de fractura de cadera, en algunos casos independientes de la densidad mineral ósea(AU)

ABSTRACT Introduction: There is increasing evidence that the geometric structure of the hip anatomy plays an important role in the etiology of the fracture. Objective: To systematize the most current knowledge regarding the anatomical characteristics of the radiographic parameters of the hip joint, and their relationship with the fracture. Methods: A documentary research was carried out, with the scientific articles published, in the last 5 years, in medical computer databases such as PubMed, Ebsco and SciELo. Results: Most of the publications analyze the cervicodiaphyseal angle and the axis of the hip. Other measurements analyzed are the femoral axis, the length and width of the femoral neck, as well as acetabular measurements. There is no consensus on the length of the femoral neck or the femoral shaft, despite being an important component of the structure. Knowledge of the particularities of the anatomy and biomechanical characteristics of the hip allows to establish basis for understanding the factors that affect this joint. Conclusions: The studies that have been carried out on the characteristics of the structural components show that there is association between their dimensions and the occurrence of hip fracture, in some cases independent of bone mineral density(AU)

Fracture risk assessment in home care patients using the FRAX® tool / Estimativa do risco de fratura óssea em pacientes em Atenção Domiciliar por meio da ferramenta FRAX®

ABSTRACT Objective To assess the ten-year risk of hip and osteoporotic fracture in home care patients using the FRAX® tool. Methods A retrospective, cross-sectional observational study including patients aged ≥ 40 and ≤ 90 years and receiving home care from a private provider. The risk of fracture was calculated using an online calculator. High risk was defined as risk of hip fracture greater than 3% or risk of osteoporotic fracture greater than 20%. Data were expressed as absolute number (n), relative frequency (%), mean, standard deviation (±) and probability value (p). Results Eighty-three (37.7%) out of 222 patients were at high risk of fracture. Of these, 81 (36.7%) were at high risk of hip fracture, as follows: 18 patients aged 70-80 years (17 female) and 63 patients aged 80-90 years (51 female). High risk of osteoporotic fracture was limited to two female patients (0.1%) aged over 80 years. Conclusion FRAX® analysis revealed similar fracture risks in the sample and the older adult population overall. Prospective investigation of fracture rates in home care patients, identification of true risk factors and construction of a home care patient-specific clinical score are warranted.

RESUMO Objetivo Avaliar o risco de fratura de quadril e fratura osteoporótica, em 10 anos, em pacientes em atenção domiciliar, de acordo com a ferramenta FRAX®. Métodos Estudo transversal, retrospectivo, observacional realizados com pacientes de uma empresa de Assistência Domiciliar com idade ≥40 e ≤90 anos. Foi avaliado o risco de fratura por meio da calculadora on-line, tendo sido considerado elevado risco de fratura de quadril acima de 3% e elevado risco de fratura osteoporótica quando acima de 20%. Os dados foram expressos em número absoluto (n), frequência relativa (%), média, desvio padrão (±) e valor de significância (p). Resultados Dos 222 pacientes, 83 (37,7%) apresentaram alto risco de fratura, sendo 81 (36,7%) casos por elevado risco de fratura de quadril. Destes, 18 deles tinham idade entre 70 e 80 anos (sendo 17 do sexo feminino) e 63 entre 80 e 90 anos (sendo 51 do sexo feminino). O risco elevado de fratura osteoporótica ocorreu em apenas duas pacientes do sexo feminino (0,1%), ambas com idade acima de 80 anos. Conclusão O risco de fratura óssea verificado pela ferramenta FRAX® foi semelhante na população do estudo em relação ao da população idosa em geral. A avaliação prospectiva da incidência de fraturas nos pacientes em Atenção Domiciliar, a identificação dos reais fatores de risco e a personalização do escore clínico para este grupo de pacientes se fazem necessárias.

Differences in the prevalence of vitamin D deficiency and hip fractures in nursing home residents and independently living elderly

ABSTRACT Objective To compare the prevalence of vitamin D deficiency and fracture history in nursing home residents and community-dwelling elderly subjects and to explore the association of vitamin D levels with various characteristics. Materials and methods Sixty-six nursing home residents and 139 community-dwelling elderly subjects participated. Marital status, medical history, medication including vitamin D supplements, smoking, past fractures were assessed. Weight and height were measured and body mass index calculated. Serum 25-hydroxyvitamin D (25-OHD), PTH, Ca, phosphate, creatinine and eGFR were determined. Results In the nursing home residents 25-OHD was lower (17.8 nmol/l, [9.4-28.6] vs. 36.7 nmol/l, [26.9-50], p < 0.001), PTH was higher (5.6 pmol/l, [3.9-8.9] vs. 4.7 pmol/l [3.6-5.8], P = 0.003) and 25-OHD deficiency was more prevalent (65.2% [53.7-76.7] vs. 22.3% [15.4-29.2], p < 0.001) as was elevated PTH (23% [12.8-33] vs. 5.8% [2-10], p = 0.001). 25-OHD correlated negatively with PTH (institutionalized r = -0.28, p = 0.025 and community-dwelling r = -0.36, p < 0.001). Hip fractures were reported by 8% of the residents and 2% of the independent elderly. The only predictor for hip fracture was elevated PTH (OR = 7.6 (1.5-36.9), p = 0.013). Conclusion The prevalence of vitamin D deficiency and secondary hyperparathyroidism was high in the institutionalized subjects. Hip fracture risk was associated with elevated PTH and not directly with vitamin D levels or the residency status.

Prevalencia de insuficiencia y deficiencia de vitamina D en adultos mayores con fractura de cadera en Chile / Vitamin D levels among Chilean older subjects with low energy hip fracture

Background: Vitamin D deficiency is a common condition affecting 40-100% of geriatric population. Aim: To determine the prevalence of vitamin D insufficiency and deficiency in geriatric population surgically treated for hip fracture. Patients and Methods: Analysis of a database of patients aged over 60 years operated for a low energy hip fracture in a three years period. Vitamin D was measured in identified patients, using a blood sample obtained on admission to the hospital. A logistic regression was carried out to evaluate age, gender, morbidity index and season as predictors of vitamin D deficiency. Results: Two hundred and twenty-eight patients aged 84 ± 7 years (82% females), were included in the analysis. One hundred eighty-three patients (80%) presented vitamin D levels below 20 ng/dl (deficiency) and 39 patients (18%) presented with levels between 20 and 30 ng/dl (insufficiency), totaling 98% of patients with hypovitaminosis D. Vitamin D deficiency was especially common among patients with higher American Society of Anesthesiologists (ASA) Physical Status Classification System and during winter-spring period. A negative correlation between age and the proportion of subjects with vitamin D deficiency was found. There was no relation between gender and vitamin D levels. Conclusions: Vitamin D deficiency is especially prevalent in older subjects with hip fracture, reaching 98% in the studied population.

Benzodiazepinas y fractura de cadera: estudio de casos y controles / Benzodiazepines and hip fracture: case-control study

Introducción: las benzodiazepinas (BZD) son medicamentos ampliamente usados en la práctica clínica. Son eficaces en el tratamiento sintomático de ansiedad, insomnio a corto plazo, crisis epilépticas, síndrome de abstinencia alcohólica e inducción anestésica. En ancianos pueden tener efectos adversos como incoordinación motora y debilidad muscular que llevan a caídas, aumentando el riesgo de fractura de cadera. Objetivo: determinar si existe asociación entre el consumo de BZD y el riesgo de fractura de cadera. Material y método: se diseñó un estudio de casos y controles (1:2) durante seis meses (tres meses en 2013 y tres meses en 2014). Se definió “caso” a los pacientes con fractura traumática de cadera. Se definió “control” a pacientes de igual sexo y edad (± 5 años) que hubieran ingresado en la misma semana por una causa diferente (médica o quirúrgica). Se relevaron datos demográficos y consumo de medicamentos potencialmente involucrados en fracturas de cadera. Se consideró consumo de BZD, haberlas recibido durante cinco días previos a la fractura. Se calcularon odds ratios (OR) e intervalo de confianza 95%. Resultados: se obtuvieron 29 casos y 60 controles. La media de edad (DE) en el grupo casos fue de 82,8 (6,4) años y 82,1 (5,2) años en el grupo control (p > 0,05). Sexo femenino: 25 (86%) en el grupo casos y 49 (82%) en el grupo control (p > 0,05). Las BZD fueron consumidas por 16/29 (61,5%) casos y 13/60 (21,7%) controles (p < 0,05). Todos los pacientes que consumían BZD en ambos grupos lo hicieron por más de seis semanas. El OR de fractura de cadera en pacientes que consumían BZD fue de 4,5 (IC 95% 1,7-11,6). Conclusiones: se destaca que las BZD aumentan el riesgo de fractura de cadera y que se consumen por períodos no aconsejables. Deben desarrollarse políticas nacionales orientadas al uso racional de estos medicamentos.

Introduction: benzodiazepines (BZD) are widely used drugs in the clinical practice. They are effective in the symptomatic treatment of anxiety, short-term insomnia, epileptic seizures, alcohol withdrawal effect and anesthetic induction. In the elderly, they may cause adverse effect such as lack of motor coordination and muscle weakness which can lead to falling, increasing the risk of hip fracture. Objective: to determine whether the consumption of benzodiazepine may be associated with hip fracture. Method: a case-control study was designed (1:2) and conducted (three months in 2013 and three months in 2014) . A “case” was defined for patients with a traumatic hip injury. “Control” was defined for patients of same sex and age (± 5 años) who had been admitted in the same week for a different cause (medical or surgical). Demographic data was collected, as well as the consumption of drugs potentially involved in hip fracture. The study considered patients had consumed benzodiazepine when it had been received within five days prior to the fracture. Odd ratios were calculated and confidence intervals were 95%. Results: 29 cases and 60 controls were obtained. Average age (standard deviation) in the cases group was 82,8 (6.4) years old and 82.1 (5.2) years old in the control group (p > 0.05). Female: 25 (86%) in the cases group and 49 (82%) in the control group (p > 0.05). BZD were consumed by 16/29 (61.5%) cases and 13/60 (21.7%) controls (p < 0.05). All patients who had consumed BZD in both groups had done so for over six weeks. The odd ratio for hip fracture in patients who consumed BZD was 4.5 (confidence interval 95% - 1.7-11.6). Conclusions: the study points out that BZD increases the risk of hip fracture, and that patients consume it for non-advisable periods of time. National policies should be devised to encourage a rational use of these drugs.

Introdução: os benzodiazepínicos (BZD) são medicamentos muito utilizados na prática clínica. São eficazes no tratamento sintomático da ansiedade, insônia em curto prazo, crises epilépticas, síndrome de abstinência alcoólica e indução anestésica. Em pacientes idosos podem ter efeitos adversos como comprometimento da coordenação motora e debilidade muscular que podem causar quedas, aumentando o risco de fratura de qua­dril. Objetivo: determinar a existência de uma associa­ção entre o consumo de BZD e o risco de fratura de quadril. Material e método: um estudo de casos e controles (1:2) foi realizado durante seis meses (três meses em 2013 e três em 2014). Definiu-se como “caso” os pacientes com fratura traumática de quadril. Definiu-se como “controle” os pacientes de mesmo sexo e idade (± 5 anos) que foram admitidos na mesma semana por uma causa diferente (médica ou cirúrgica). Foram coletados dados demográficos e de consumo de medicamentos potencialmente relacionados com fratura de quadril. Considerou-se como consumo de BZD a ingestão durante os cinco dias prévios a fratura. Foram calculados o odds ratio (OR) e o intervalo de confiança 95%. Resultados: foram estudados 29 casos e 60 controles. A idade média (DE) no grupo casos foi 82,8 (6,4) anos e 82,1 (5,2) anos no grupo controle (p > 0,05). Sexo feminino: 25 (86%) no grupo casos e 49 (82%) no grupo controles (p > 0,05). Os BZD haviam sido consumidos por 16/29 (61,5%) casos e 13/60 (21,7%) controles (p < 0,05). Todos os pacientes, em ambos grupos, haviam consumido BZD por seis semanas. O OR de fratura de quadril em pacientes que consumiam BZD foi de 4,5 (IC 95% 1,7-11,6). Conclusões: destaca-se que os BZD aumentam o risco de fratura de quadril e que são consumidos por períodos não aconselháveis. Ë necessário desenvolver políticas nacionais buscando o uso racional destes medicamentos.

Cuidadores informais de idosos em pós-operatório de cirurgia de fêmur proximal: prevenção de novas quedas / Informal caregivers of older people recovering from surgery for hip fractures caused by a fall: fall prevention

Os objetivos foram caracterizar sociodemograficamente os cuidadores informais de idosos vítimas de queda seguida por fratura de fêmur proximal e verificar o conhecimento mínimo que possuíam acerca da prevenção de novas quedas, assim como caracterizar a relação entre esse conhecimento e o emprego de medidas preventivas. Trata-se de estudo transversal, com amostragem intencional, realizado em 12 meses, incluindo 89 cuidadores. Predominaram cuidadores do sexo feminino (76,4%) e filhas(os) (64%). A modificação ambiental foi a medida preventiva predominante apontada por eles (88,2%). Houve associação significativa (p = 0,002), entre os 58,1% dos cuidadores que achavam ser possível prevenir quedas e os relatos sobre mudanças na casa e/ou rotina do idoso. Observou-se que cuidadores informais que apresentavam conhecimento sobre prevenção de quedas em idosos, mesmo que incompletos, empregavam medidas de prevenção para novos eventos. Esses achados sinalizam que o número de quedas entre idosos pode ser reduzido significantemente se os programas de atenção à saúde ampliarem suas ações apoiando-as no modelo de prevenção de quedas da Organização Mundial de Saúde. .

The objectives of this study were to investigate the sociodemographic characteristics of informal caregivers of elderly persons who had undergone surgery for hip fractures caused by a fall, explore the level of caregiver's knowledge regarding fall prevention, and assess the relationship between this knowledge and the use of preventative measures in practice. This investigation consists of a cross-sectional study using nonprobability sampling methods conducted over a period of 12 months and involving 89 caregivers. The majority of caregivers were female (76.4%) and sons or daughters of the patients (64%). Environmental modification was the predominant preventative measure used by caregivers (88.2%). 58.1% of caregivers believed it was possible to prevent falls in the elderly and there was a significant association (p = 0,002) between believing it was possible to prevent falls and carrying out modifications in the home and/or to the daily routine of the older person. Informal caregivers with wide or partial knowledge of fall prevention put preventative measures into practice. These findings demonstrate that the number of falls among older persons could be significantly reduced if health care programmes widened their actions to include the guiding principles of the WHO falls prevention model.

Functional evaluation of patients with injury of the distal insertion of the biceps brachii muscle treated surgically / Avaliação funcional dos pacientes com lesão da inserção distal do músculo bíceps braquial tratados cirurgicamente

OBJECTIVE: to functionally evaluate patients with injury of the distal insertion of the biceps brachii muscle that was treated surgically. METHODS: between April 2002 and June 2011, 15 elbows of 14 patients underwent surgical treatment performed by the Shoulder and Elbow Surgery Group, Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de São Paulo. The minimum follow-up was six months, with a mean of 28 months. The patients' ages ranged from 28 to 62 years, with a mean age of 40 years. All the patients were male and the dominant arm was affected in 64.2%. The clinical evaluation on the results was conducted using the criteria of the American Medical Association (AMA), as modified by Bruce, with evaluation of the joint range of motion (flexion-extension and pronosupination), the presence of pain and the patient's degree of satisfaction. RESULTS: from the AMA criteria, as modified by Bruce, we obtained 100% satisfactory results, of which 85.7% were considered to be excellent and 14.3% good. We observed that when distal injuries of the biceps brachii muscle affected young and active patients, surgical treatment was a good option...

OBJETIVO: avaliar funcionalmente os pacientes com lesão da inserção distal do músculo bíceps braquial tratados cirurgicamente. MÉTODOS: entre abril de 2002 e junho de 2011, 15 cotovelos de 14 pacientes foram submetidos a tratamento cirúrgico pelo Grupo de Cirurgia de Ombro e Cotovelo do Departamento de Ortopedia e Traumatologia da Faculdade de Ciências Médicas da Santa Casa de São Paulo. O seguimento mínimo foi de seis meses, com média de 28. A idade variou de 28 a 62 anos, com média de 40. Todos os pacientes eram do sexo masculino e o membro dominante foi acometido em 64,2%. A avaliação clínica dos resultados foi feita pelos critérios da American Medical Association (AMA), modificados por Bruce, pelo grau de amplitude articular (flexoextensão e pronossupinação), pela presença de dor e pelo grau de satisfação do paciente. RESULTADOS: pelos critérios da AMA, modificados por Bruce, obtivemos 100% de resultados satisfatórios, 85,7% considerados excelentes e 14,3% bons. Observamos que quando as lesões distais do músculo bíceps braquiais acometem pacientes jovens e ativos, o tratamento cirúrgico é uma boa opção...

Transtrochanteric fractures: evaluation of data between hospital admission and discharge / Fraturas transtrocantéricas - Avaliação dos dados da admissão à alta hospitalar

OBJECTIVE: to evaluate the data obtained from patients with transtrochanteric fractures who were attended at a tertiary-level trauma referral hospital, between admission and discharge, gathered prospectively by means of the SINPE(c) software. METHODS: 109 consecutive patients who were admitted between April 2011 and January 2012 were evaluated using an electronic storage and analysis database in SINPE(c) . The data were gathered prospectively, including evaluations on personal information about the patients, history-taking, fracture classification (Evans-Jensen, AO/OTA and Tronzo), treatment and discharge. RESULTS: the sample was composed of 43 men and 66 women. Their ages ranged from 20 to 105 years, with a mean of 69 years. Falling was the trauma mechanism for 92 patients and traffic accidents for 17. The most prevalent chronic diseases were systemic arterial hypertension and diabetes mellitus. According to the AO/OTA classification, the commonest fracture type was 31 A1. According to the Tronzo classification, type III was commonest. The fracture was fixed by means of a cephalomedullary nail in 64 cases and a sliding screw-plate in 44 cases. One fracture was fixed with a 95◦ screw-plate. Seven patients presented some form of clinical complication and three died during the hospital stay. All the patients who were discharged were instructed to only partially bear weight on the repair. CONCLUSION: through SINPE(c) , it was possible to evaluate the personal information, history-taking, classification, treatment and discharge of patients with transtrochanteric fractures, from hospital admission to discharge...

OBJETIVO: avaliar os dados obtidos de pacientes com fratura transtrocantérica atendidos em um hospital de referência terciária de trauma, desde a admissão até a alta hospitalar, coletados prospectivamente por meio do Sinpe(c) . MÉTODOS: foram avaliados 109 pacientes consecutivos admitidos de abril de 2011 até janeiro de 2012. Usou-se uma base eletrônica de armazenamento e análise de dados, o software Sinpe(c) . A coleta dos dados deu-se de maneira prospectiva e informações sobre dados pessoais do paciente, anamnese, classificação das fraturas (Evans-Jensen, AO/OTA e Tronzo), tratamento e alta foram avaliadas. RESULTADOS: a amostra foi composta por 43 homens e 66 mulheres. A idade variou de 20 a 105 anos, com média de 69. A queda foi o mecanismo de trauma em 92 pacientes e os acidentes de trânsito foram em 17. As doenças crônicas mais prevalentes foram a hipertensão arterial sistêmica e o diabetes mellitus. Pela classificação AO/OTA, o tipo mais comum de fratura foi a 31 A1. Pela classificação de Tronzo, a tipo III foi a mais comum. A fratura foi fixada com haste cefalomedular em 64 casos e com placa-parafuso deslizante em 44 casos. Uma fratura foi fixada com placa-parafuso 95◦ . Sete pacientes apresentaram alguma complicação clínica e três foram a óbito durante o internamento. Todos os pacientes que receberam alta foram orientados a fazer apoio parcial. CONCLUSÃO: por meio do Sinpe(c) foi possível avaliar as informações relacionadas a dados pessoais, anamnese, classificação, tratamento e alta de pacientes com fratura transtrocantérica desde a admissão até a alta hospitalar...

Subtrochanteric Femoral Fracture during Trochanteric Nailing for the Treatment of Femoral Shaft Fracture

We report on three cases of subtrochanteric femoral fractures during trochanteric intramedullary nailing for the treatment of femoral shaft fractures. Trochanteric intramedullary nails, which have a proximal lateral bend, are specifically designed for trochanteric insertion. When combined with the modified insertion technique, trochanteric intramedullary nails reduce iatrogenic fracture comminution and varus malalignment. We herein describe technical aspects of trochanteric intramedullary nailing for femoral shaft fractures to improve its application and prevent implant-derived complications.

Proximal femoral epiphysis anatomy in chilean population: orthopedic and forensic aspects / Anatomía del epífisis proximal del fémur en la población chilena. Aspectos traumatológicos y forenses

From a biomechanical standpoint, bone geometry and density are factors correlated to the bone resistance of the femur when supporting body weight, with geometric parameters like the diameter of the femoral head and neck, the length of the femoral neck, and the femoral neck angle as determinant factors in the incidence of hip fractures, which increase in frequency and seriousness in osteoporotic patients. In Chile, morphometric data that contributes to relating the anatomy of the proximal epiphysis of the femur as an associated factor in hip fractures does not exist; likewise, there are no anthropometric indexes that may contribute to the forensic sciences. The purpose of this study is to establish average measurements of the proximal epiphysis of the femur in the adult Chilean population. Descriptive Study. The proximal epiphyses of 81 dry adult femurs were analyzed (44 right and 37 left bones), measuring the following parameters: length of the femoral neck (LN), femoral neck angle (FNA), circumference of the femoral head (CH) and circumference of the femoral neck (CN). The statistical relationship between the measurements and the side of each sample was analyzed (t-test p=0.05). The average lengths were LN= 3.59cm (+/- 0.43 cm); FNA= 124.17 (+/- 6.37), CH= 14.34 cm (+/- 1.27 cm) and CN= 9.7 cm (+/- 0.87 cm). No significant differences between the left and right sides were found. Average numbers were obtained for the anatomy of the proximal femoral epiphysis from a sample in the Chilean population. With the data obtained, we propose to carry out anatomo-clinical, epidemiologic and forensic studies in this population.

Desde un punto de vista biomecánico, la geometría y la densidad ósea son factores correlacionados con la resistencia del hueso del fémur al apoyar el peso corporal, con los parámetros geométricos, como el diámetro de la cabeza femoral y el cuello, la longitud del cuello del fémur, y el ángulo del cuello femoral factores determinantes en la incidencia de fracturas de cadera, que aumentan en frecuencia y gravedad en los pacientes con osteoporosis. En Chile, no existen datos morfométricos que relacionen la anatomía de la epífisis proximal del fémur como un factor asociado a las fracturas de cadera ni índices antropométricos que pueden contribuir a las ciencias forenses. El propósito de este estudio es establecer las medidas promedio de la epífisis proximal de fémur en población adulta chilena. Estudio Descriptivo. Se analizaron la epífisis proximal de 81 fémures adultos secos (44 derechos y 37 izquierdos), midiendo los siguientes parámetros: longitud del cuello femoral (LC) , ángulo cérvico-diafisiario femoral (ACD), circunferencia de la cabeza femoral (CCa) y circunferencia del cuello femoral (CCu). Se analizó la relación estadística de las medidas con el lado de cada muestra (test Chi cuadrado p:0,05) Las longitudes promedios fueron LC: 3,59 cm (+/- 0,43 cm); ACD: 124,17 (+/- 6,37 cm); CCa: 14,34 cm (+/- 1,27 cm) y CCu: 9,7 cm (+/- 0,87 cm). No se encontraron diferencias significativas entre el lado derecho e izquierdo. Los resultados proponen la necesidad de realizar estudios anatomo-clínicos y epidemiológicos actualizados en población chilena donde la geometría de la epífisis proximal del fémur se incluya dentro del análisis.

Osteoporosis transitoria del embarazo: caso clínico / Transient osteoporosis of pregnancy: clinical case

La osteoporosis transitoria del embarazo es una entidad rara y autolimitada, de etiología desconocida. Se presenta el caso clínico de una mujer de 29 años que comenzó en semana 34 con un cuadro de dolor localizado en cadera derecha con impotencia funcional e inestabilidad en la bipedestación y dificultad para la marcha. Tras finalizar su gestación en semana 39 con un parto eutócico sin complicaciones, se incrementó el cuadro doloroso durante el puerperio precoz, con bloqueo de rotación interna y externa de miembro inferior derecho a la exploración. En la radiografía y en la resonancia magnética se evidenció una fractura intracapsular desplazada de fémur derecho, que precisó corrección quirúrgica. A pesar del tratamiento quirúrgico, el cuadro empeoró, localizándose posteriormente también en el miembro contralateral. Las pruebas de imagen fueron compatibles con una osteoporosis transitoria de ambas caderas. La clínica remitió paralelamente a la resolución radiológica del cuadro de forma definitiva a los 8 meses.

The transient osteoporosis of pregnancy is a rare and self-limited disease with an unknown etiology. We present the case of a 29 years old woman, who started at the 34th week of pregnancy with focalised pain on the right hip, with functional disability and instability in standing and gait difficulty. During the 39th week of pregnancy after giving birth without complication, the pain increased during the early puerperium. The medical examination revealed that the internal and external rotation of the inferior limb was blocked. X-ray and MRI showed a displaced intracapsular fracture in the right femur, which needed a surgical correction. Despite of the treatment, the pain worsened and focalised itself also on the left hip. Imaging tests were consistent with transient osteoporosis of both hips. The pain eased in parallel with the radiological resolution of the osteoporosis until its permanent resolution after 8 months.

Fractura de cadera en pacientes con insuficiencia renal crónica / End-stage renal disease and hip fractures: analysis of 15 patients

Introduction: Chronic renal failure represents the loss of the ability of the kidney to purify blood and produce some hormones (vitamina D hydroxylation and erythropoietin secretion). Hemodialysis represents the end-stage renal disease. At this point all the patients have renal osteodistrophy; alteration of bone remodelling that increases the risk of hip fracture. The renal osteodistrophy does not depend only on the renal disease but also on its treatment. The objectives of this publication are: to describe the epidemiological factors, management and outcome of patients with end-stage renal disease who suffered a hip fracture and were treated in the Orthopedic department of Barro Luco Trudeau Hospital between 1997 and 2001. 15 patients under hemodialysis suffered a hip fractures between 1997 and 2001. 15 patients account for 18 hip fractures , 3 were bilateral, 7 women, average age 70.4 years, 8 men average age 66 years. Average time of hemodialysis 5 years. We reviewed their medical records for demographic, clinic and outcome data. Results: Mechanism and type of fracture: 11 patients minor trauma (73 percent), 4 (26.7 percent) spontaneous fractures. 7 were extra capsular fractures, 11 were intra capsular. 14 patients were operated on (17 fractures), 10 postoperative complications (58.8 percent): fever syndrome in 5, urinary tract infection in 2, anemia in 2 and angina in one. None of the infections were associated with the surgical procedure. Annual mortality of patients operated on was 21.4 percent. Discussion: The mortality rate observed in our study was 21.4 percent in the first year post-fractures, is better than other published series. There are few cases reported in the literature of bilateral spontaneous fracture of the femoral neck in patients under hemodialysis, in our series we found two patients, both with renal osteodistrophy and secondary hyperparathyroidism diagnosis. Conclusions: Although morbidity is higher than...

Introducción: La insuficiencia renal crónica (IRC) representa la pérdida de la capacidad de depuración sanguínea y de producción hormonal; hidroxilación de vitamina D y secreción de eritropoyetina. Cuando se inicia la hemodiálisis la totalidad de los pacientes presentan osteodistrofia renal (OR); alteración multifactorial de la remodelación ósea que incrementa el riesgo de fractura de cadera: La OR depende de la enfermedad renal y del tratamiento: Los objetivos de este trabajo son: describir los factores epidemiológicos, manejo y evolución de pacientes co IRC y fractura de cadera que fueron tratados en el Servicio de Traumatología del Hospital Barros Luco Trudeau entre 1997 y 2001. Pacientes y Método: Estudio retrospectivo descriptivo. Quince pacientes, 18 fracturas de cadera, 3 bilaterales. Siete mujeres, edad promedio 70,4 años, 8 hombres edad promedio de 66 años. Tiempo promedio de hemodiálisis 5 años. Se revisaron sus fichas clínicas, se extrajo información epidemiológica y clínica. Posteriormente se citó a los a pacientes a control para evaluación alejada. Resultados: mecanismo y tipo de fractura: 11 pacientes (73,3 por ciento) caída a nivel y 4 (26,7 por ciento) fractura espontánea. Siete extracapsulares, 11 fueron intracapsulares. Catorce pacientes se operaron (17 fracturas) 1 se trató ortopédicamente. Diez complicaciones postoperatorias (58,8 por ciento): 5 síndrome febril, 2 infección de tracto urinario, 2 anemia y 1 angina. Ninguno de los cuadros infecciosos se relacionó con el procedimiento quirúrgico. Mortalidad anual de los pacientes operados 21,4 por ciento. Discusión: La mortalidad de 21,4 por ciento anual en los pacientes operados fue menor a las publicadas por grupos con la misma asociación de patologías. Existen pocos casos descritos en la literatura de fractura espontánea bilateral de cuello femoral en pacientes hemodializados, en nuestra serie encontramos dos pacientes, ambos con diagnóstico de osteodistrofia renal e hiperparatiroidismos...

Evolución clínica de pacientes sometidos a artroplastia de cadera en el HEODRA, departamento de ortopedia y traumatología en el período comprendido entre 2007-2009, León, Nicaragua

La fractura de cadera es una grave lesión habitual que ocurre principalmente en personas ancianas, por lo que se deseaba conocer ¿Cuál es la evolución clínica post quirúrgica en pacientes sometidos a artroplastía de cadera HEODRA 2007 - 2009? yobtener el resultado de la evolución clínica post-quirúrgica de dichos pacientes, por lo que se llevó a cabo el presente estudio para conocer la situación socio-demográfica,complicaciones, material utilizado y su evolución posterior. La artroplastía de cadera es un procedimiento ortopédico capaz de aliviar el dolor, restablecer la función y mejorar la calidad de vida de los pacientes que presentan dolor en la articulación de la cadera de diferente etiología. Se estima que cada añose realizan más de 500.000 artroplastias de cadera en todo el mundo por diferentes causas. En el presente estudio se revisaron un total de 36 pacientes, a los cuales se lesrealizó cirugías a 28, ya que el restante abandonaron por falta de dinero paracomprar el material en el periodo comprendido de 2007 - 2009. Las características socio-demográficas de los pacientes que se sometieron aartroplastia predominaron las del sexo femenino, mayores de 60 años y con unpromedio de edad de 75 años y procedieron de la zona urbana.Los resultados funcionales de los pacientes sometidos al procedimiento quirúrgico fueron evaluados mediante la escala funcional de Harris, obteniendo resultados satisfactorios funcionales en 82.1 %, lo que indica que este procedimiento es una muy buena opción...

Fallecidos por fractura de cadera: provincia de Matanzas / Diseases for hip fracture: Matanzas province

Se realizó un estudio descriptivo de 609 fallecidos por fractura de cadera en la provincia de Matanzas desde el año 2001 al 2007. Se evidenció ligero incremento del promedio de años de vida vividos por fallecido y una reducción del promedio de años de vida perdidos por fallecido. La mortalidad proporcional (Mort Proporc) ascendió hacia el final del período (1.6 por ciento vs. 2.0 por ciento). La razón fallecidos por Fracturas de caderas/fallecidos por accidentes fue igualmente ascendente (32.2 vs. 46.1). Se observó incremento de la tasa de mortalidad total y en ambos sexos directamente proporcional a la edad, pero las mujeres tuvieron mayor tasa. El promedio de años de vida vividos por fallecidos fue semejante entre los sexos (82.5 y 82.2) y menor el promedio de años de vida perdidos por fallecidos entre los hombres (-2.8 vs -3.4).

We carried out a descriptive study of 609 deceases for hip fracture at Matanzas province from 2001 to 2007. There was evidence of a slight increase in the average lived years per patient (ALY/P), as well as a reduction in the average lost years of life per patient who died (ALYL/P). The proportional mortality increased toward the end of the period (1.6 por ciento vs. 2.0 por ciento). The ratio hip fracture/deceases for accident (HF/DEC ACC) also experienced an increase (32.2 vs. 46.1). It was observed a proportionally direct-to-age increase in the total mortality rate and in both sexes, but women had the highest rate. The average lived years per death patient was similar between sexes (82.5 y 82.2) and the average lost years of life per patient who died was smaller among men (-2.8 vs. -3.4).

Caso clínico radiologico / Radiological clinical case

La osteoporosis transitoria de la cadera es una entidad poco frecuente de causa desconocida que se presenta como coxalgia cuyo diagnóstico se realiza con el estudio por imágenes, especialmente con resonancia magnética. Presentamos el caso de una paciente que presentó este cuadro con su estudio imagenológico. Se discuten aspectos clínicos, diagnósticos y terapéuticos de esta entidad. La osteoporosis es una osteopatía metabólica de alta prevalencia. Es la principal causa de fracturas óseas en mujeres después de la menopausia y ancianos en general. Es asintomática y por lo general su primer signo visible es una fractura de cadera, muñeca o de los cuerpos vertebrales que originan dolor o deformidad. Presentamos el caso de una paciente portadora de osteoporosis que presenta fracturas vertebrales. Se discuten aspectos del diagnóstico por imágenes.

Transient Osteoporosis of the hip is an uncommon clinical condition. The etiology is unknown. It could be confused with other diagnosis that causes hip pain. We present a case report of a woman with transient osteoporosis. We discuss clinical, diagnostic and therapeutic aspects of this entity Osteoporosis is a metabolic condition with high prevalence. It is the principal cause of fracture in women after menopause and elderly population in general. Usually the first sign is a hip, wrist or vertebral fracture that causes pain and deformity. We present a case report of a woman with osteoporosis and vertebral fractures. We discuss the radiologic diagnostic.