Femoral fracture in the elderly: dependence on nursing care

Introduction: Due to the aging of the population, nursing processes have been adapted to these patients, who require a high level of care and guidance. Objective: Analyzing the degree of dependence on nursing care by elderly patients (65 years or older) with femur fractures. Materials and Methods: retrospective, with a quantitative approach, carried out in a private hospital from April 2021 to April 2022. The sample comprehends 41 patients, analyzed epidemiological data and degree of dependence Study of nursing care during hospitalization, environment of hospitalization and discharge, according to the SCP. Results: Composed of 41 patients, mean age of 84 years and female predominance (75.61%). With regard to fractures, there was a greater occurrence due to falls from standing height and predominance of neck fractures, with an average time until surgery of less than 16 hours. Systemic Arterial Hypertension and Diabetes Mellitus were predominant. The average of the SCP estimates presented 24.26 in the 1st, 26.12 in the 2nd and 26.24 in the 3rd. The length of hospital stay was 7 days and no deaths were reported. Discussion: The findings on sociodemographic data, reasons for falls, location, comorbidities, degree of dependence and length of hospital stay are similar to those available in databases. They differ, in better quality, under time until surgery and clinical. Conclusions: The study presents specific knowledge to carry out the care of the intra-hospital nursing process, thus allowing the systematization of the team's assistance.

Long-term consequences of osteoporosis therapy with bisphosphonates

ABSTRACT Bisphosphonates (BPs) are medications widely used in clinical practice to treat osteoporosis and reduce fragility fractures. Its beneficial effects on bone tissue have been consolidated in the literature for the last decades. They have a high affinity for bone hydroxyapatite crystals, and most bisphosphonates remain on the bone surface for a long period of time. Benefits of long-term use of BPs: Large and important trials (Fracture Intervention Trial Long-term Extension and Health Outcomes and Reduced Incidence with Zoledronic acid Once Yearly-Pivotal Fracture Trial) with extended use of alendronate (up to 10 years) and zoledronate (up to 6 years) evidenced significant gain of bone mineral density (BMD) and vertebral fracture risk reduction. Risks of long-term use of BPs: The extended use of antiresorptive therapy has drawn attention to two extremely rare, although severe, adverse events. That is, atypical femoral fracture and medication-related osteonecrosis of the jaw are more common in patients with high cumulative doses and longer duration of therapy. BPs have demonstrated safety and effectiveness throughout the years and evidenced increased BMD and reduced fracture risks, resulting in reduced morbimortality, and improved quality of life. These benefits overweight the risks of rare adverse events.

Bilateral high origin and superficial trajectory of the deep femoral artery: clinical and applied anatomy

ABSTRACT The anatomy of the femoral triangle is explored in various approaches, ranging from pulse verification to invasive catheterization procedures. Within the femoral triangle, the deep femoral artery is one of the vessels reported to present several anatomical variations that must be considered before clinical or surgical interventions. Here, we are reporting a unique bilateral variation of the deep femoral artery for medical education purposes and reflecting on its applied, surgical, and clinical anatomy. During the dissection of the femoral triangle, we observed that the deep femoral artery originated in the vicinity of the inguinal ligament and ran in parallel with the femoral artery in a superficial trajectory on both sides of the donor. On the right side, the DFA continued superficial for 8.8 cm, with an origin of 1.2 cm inferior to the inguinal ligament. On the left side, it presented a similar anatomical arrangement, though with an origin of 1.6cm inferior to the inguinal ligament and a superficial course of 5cm. The position of the lateral circumflex femoral vein posterior to the deep femoral artery played a role in this distinctive, lengthy, and superficial presentation of the deep femoral artery. This anatomical variation directly affects surgical procedures, diagnostics, and endovascular interventions. A deep femoral artery with such a lengthy superficial trajectory can be mistakenly used for catheterization instead of the femoral artery or be injured, disrupting the main blood supply of the thigh muscles.

Scintigraphie osseuse trois temps dans la caractérisation de l'ostéonécrose aseptique de la tête fémorale / Three-stage bone scintigraphy in the characterization of aseptic osteonecrosis of the femoral head

Objectifs. Déterminerla place de la scintigraphie osseuse 3 temps dans le diagnostic del'ostéonécrose avasculaire de la tête fémorale (OATF).Matérielset Méthode. Nousavons colligérétrospectivement62 scintigraphies osseuses (SO+)mettant en évidence uneOATF. Ces SO+ ont été réalisées au Service de Médecine Nucléaire du CHU YOde Ouagadougou,de 2017à 2022. Un formulaire de recueil de données a permis de collecter les données générales et les résultats de la scintigraphie osseuse. L'étude descriptive consistait à calculer les fréquences pour les variables qualitatives et les moyennes pour les variables quantitatives.La SO en trois temps a été faite chez tous les patients après injection de 296 à 925 MBq d'un dérivé diphosphonate : l'hydroxyméthyléne diphosphonate(HMDP) marqué au technétium 99 m (Tc99m). Résultats. 62patients ont présenté une SO+ à la recherche scintigraphique de l'OATF de 2016 à 2021. Leur âge moyen est de 35 ± 14,18 ans avec une nette prédominance féminine (75,8%). La principale étiologie retrouvée etaitla drépanocytose. La douleur coxale avec ou sans boiterie a indiquéla réalisation de la SO dans 41,66 % des cas. Lesvingt-cinqpatients (40,3%) qui avaient bénéficié d'une TDM de la hanche concernée ont été adressés pour confirmation du diagnostic (n=4), bilan pré opératoire (n=9), recherche d'autres foyers(n=12). Pour lesonzepatients atteints de pathologie cancéreuse,le diagnostic d'OATF était fortuit au décours d'une SO réalisée dans le cadre de leur bilan d'extension. Sur les images scintigraphiques tardives, les atteintes de type II de GOLLSHALK étaient majoritaires,suivies des atteintes de type III puis de type I. Il n'y avait pas d'atteinte de type IV. Conclusion. La SO est efficace dans la caractérisation de l'OATF avant l'apparition de la symptomatologie clinique et de la traduction radiologique. Lorsque l'IRM est disponible et n'est pas contre indiquée, la SO est la modalité diagnostique à utiliser en deuxième intention.

Objective: Determine the role of three-step bone scintigraphy (BS) in the diagnosis of aseptic osteonecrosis of the femoral head (AOFH).Materials and Method: Retrospectively we collected 62 positive bone scans (BS+) at aseptic osteonecrosis of the femoral (AOFH). These BS+ were carried out at the Nuclear Medicine Department of CHU YO, from 2017 to 2022. A data collection form has been prepared. It made it possible to collect general data and the results of the bone scintigraphy. The descriptive study consisted of calculating the frequencies for the qualitative and the the means for the quantitative variables. The three-step BS was performed in all patients after injection of 296 to 925 MBq of a diphosphonate derivative: hydroxy methylene diphosphonate (HMDP) labeled with technetium 99 m (Tc99m).Results: 62 patients were positive (BS +) in the aseptic avascular osteonecrosis of the femoral head scintigraphic research from 2016 to2021. Their average age is 35 ± 14.18 years with a clear female predominance (75.8%). The main etiology fremains sickle cell anemia. Hip pain with or without lameness indicated the realization of SO in 41.66% of cases. The twenty-five patients (40.3%) who had undergone CT of the affected hip were referred for confirmation of the diagnosis (n=4), preoperative workup (n=9), search for other foci (n=12). For the eleven patients with cancerous pathology, the diagnosis of AOFH was fortuitous after an BS performes as part of their extension workup. On the late scintigraphic images, type II involvement of GOLLSHALK was predominant, followed by by type then type I. There was no type IV involvement. Conclusion: BS is sensitive in the detection of aseptic avascular osteonecrosis of the femoral head before the onset of clinical symptoms and radiological translation. When MRI is available and not contraindicated, BS is the second-line modality

Bushen Huoxue Prescription Regulates PINP and β-CTX in Treatment of Femoral Head Necrosis with Syndrome of Liver and Kidney Deficiency / 中国实验方剂学杂志

ObjectiveTo explore the therapeutic mechanism of Bushen Huoxue prescription from the perspective of bone metabolism by observing the clinical efficacy of this prescription in treating femoral head necrosis （ONFH， syndrome of liver and kidney deficiency） and its influences on bone metabolism indexes： N-terminal propeptide （PINP） and β-collagen degradation product （β-CTX）. MethodSixty-six ONFH patients with the syndrome of liver and kidney deficiency in Zhengzhou Traditional Chinese Medicine Hospital of Orthopedics from December 2021 to September 2022 were selected. The patients were randomized into an experimental group and a control group by the parallel control method， with 33 patients in each group. The experimental group received Bushen Huoxue prescription orally， while the control group received Xianlinggubao Capsules orally， with a treatment cycle of 6 months. The visual analogue scale （VAS） score， Harris score， Association Research Circulation Osseous （ARCO） staging， imaging changes， quantitative scores of TCM symptoms， and serum levels of PINP and β-CTX were determined before and after treatment. The occurrence of adverse events and reactions was recorded. ResultThe total response rate in the experimental group was 83.87% （26/31）， which was higher than that （68.75%， 22/32） in the control group （Z=-2.096， P<0.05）. After treatment， the single and total scores of TCM symptoms， VAS score， and β-CTX level decreased in the two groups （P<0.05）. Moreover， the decreases in the scores of hip pain， lower limb mobility， soreness of waist and knees， and lower limb flaccidity， total score of TCM symptoms， VAS score， and β-CTX level in the experimental were larger than those in the control group （P<0.05）. After treatment， the imaging results showed no significant improvement in the two groups. The Harris score and PINP level in both groups increased after treatment （P<0.05）， and the increases were more obvious in the experimental group than in the control group （P<0.05）. No serious adverse event or adverse reaction appeared during the observation period. ConclusionBushen Huoxue prescription can relieve pain and TCM symptoms and improve the hip joint function in treating ONFH patients with the syndrome of liver and kidney deficiency. It can inhibit the development of ONFH， increase PINP， and decrease β-CTX. No obvious side effect appears during the clinical observation period， which shows that Bushen Huoxue prescription has good safety.

Role and mechanism of macrophage-mediated osteoimmune in osteonecrosis of the femoral head / 中国修复重建外科杂志

OBJECTIVE@#To summarize the research progress on the role of macrophage-mediated osteoimmune in osteonecrosis of the femoral head (ONFH) and its mechanisms.@*METHODS@#Recent studies on the role and mechanism of macrophage-mediated osteoimmune in ONFH at home and abroad were extensively reviewed. The classification and function of macrophages were summarized, the osteoimmune regulation of macrophages on chronic inflammation in ONFH was summarized, and the pathophysiological mechanism of osteonecrosis was expounded from the perspective of osteoimmune, which provided new ideas for the treatment of ONFH.@*RESULTS@#Macrophages are important immune cells involved in inflammatory response, which can differentiate into classically activated type (M1) and alternatively activated type (M2), and play specific functions to participate in and regulate the physiological and pathological processes of the body. Studies have shown that bone immune imbalance mediated by macrophages can cause local chronic inflammation and lead to the occurrence and development of ONFH. Therefore, regulating macrophage polarization is a potential ONFH treatment strategy. In chronic inflammatory microenvironment, inhibiting macrophage polarization to M1 can promote local inflammatory dissipation and effectively delay the progression of ONFH; regulating macrophage polarization to M2 can build a local osteoimmune microenvironment conducive to bone repair, which is helpful to necrotic tissue regeneration and repair to a certain extent.@*CONCLUSION@#At present, it has been confirmed that macrophage-mediated chronic inflammatory immune microenvironment is an important mechanism for the occurrence and development of ONFH. It is necessary to study the subtypes of immune cells in ONFH, the interaction between immune cells and macrophages, and the interaction between various immune cells and macrophages, which is beneficial to the development of potential therapeutic methods for ONFH.

Estudio comparativo de herniorrafía en emergencia y en situaciones electivas / Comparison study of herniorrhaphy at emergency and elective situations

La hernia inguinal es uno de los problemas urgentes más comunes encontrados por los cirujanos. Hubo 145 pacientes tratados debido al diagnóstico de hernia inguinal. De 44 pacientes que fueron operados en condiciones de emergencia. Alrededor de 131 casos (106 hombres y 25 mujeres) fueron tratados con reparación de malla preperitoneal abierta unilateral. Los pacientes fueron examinados en términos de complicaciones postoperatorias. Los datos recopilados incluidos como edad, sexo, historial médico, afecciones de cirugía, encarcelamiento y estrangulamiento. Hubo un total de 145 pacientes incluidos en el estudio; en el que 44 de ellos (29 hombres y 15 mujeres, rango de edad: 30-72) (Grupo I) fueron operados en condiciones de emergencia y 101 de ellas (51 hombres y 50 mujeres, rango de edad: 25-78) (grupo Ii) fueron operados en condiciones electivas. Hubo comorbilidad en 31 pacientes de grupo I y 77 pacientes del grupo II. Alrededor del 47.7% (n = 21) de los casos que se sometieron a cirugía emergente debido al encarcelamiento, mientras que el 43.6% (n = 44) de los casos que fueron operados en condiciones electivas. Había 12 hernias femorales en el Grupo I y 19 Hernia femoral en el Grupo II. No hay diferencia entre la complicación postoperatoria y las tasas de recurrencia en los casos de hernia inguinal operados en condiciones electivas y en condiciones de emergencia. Es más barato que la reparación laparoscópica, el control del dolor de plomo y la falta de dolor neuropático, tiene complicaciones menos testiculares, y es más ventajoso que otros enfoques abiertos

Inguinal hernia is one of the most common urgent problems encountered by surgeons. There were 145 patients treated due to inguinal hernia diagnosis. Out of 44 patients who were operated under emergency conditions. About 131 cases (106 male and 25 female) were treated with unilateral open preperitoneal mesh repair. Patients were examined in terms of postoperative complications. Data collected included as age, gender, medical history, surgery conditions, incarceration and strangulation. There were total of 145 patients included in the study; in which 44 of them (29 male and 15 female, range of age: 30- 72) (group I) were operated under emergency conditions and 101 of them (51 male and 50 female, range of age: 25-78) (group II) were operated under elective conditions. There was comorbidity in 31 patients of group I and 77 patients of group II. About 47.7% (n=21) of cases who underwent emergent surgery due to incarceration, while 43.6% (n=44) of cases who were operated under elective conditions. There were 12 femoral hernias in group I and 19 femoral hernia in group II. There is no difference between postoperative complication and recurrence rates in inguinal hernia cases operated under elective conditions and under emergency conditions. It is cheaper than laparoscopic repair, lead pain control and lack of neuropathic pain, has less testicular complications, and it is more advantageous than other open approaches.

Necrosis avascular de la cabeza del fémur en un paciente pediátrico con drepanocitosis: a propósito de un caso / Avascular necrosis of the femoral head in a sickle cell disease pediatric patient: case report

Resumen La drepanocitosis o anemia de células falciformes es una hemoglobinopatía hereditaria que se transmite de forma autosómica recesiva, la cual está asociada con episodios de dolor agudo y daño progresivo a órganos blanco que producen un gran impacto en la esperanza y la calidad de vida de quienes la padecen. La necrosis avascular de la cabeza del fémur es una complicación bien conocida en los pacientes con drepanocitosis presente hasta en un 25 % de los pacientes adultos y tanto en un 12 % de los pacientes pediátricos. A continuación, se presenta el caso de un paciente masculino de 9 años con drepanocitosis, quien en cita de control refirió 15 días de coxalgia y claudicación de la marcha. Tras realizar estudios radiológicos se documentó una necrosis avascular de la cabeza del fémur, convirtiéndose de esta manera en el primer caso documentado en el Hospital Nacional de Niños de Costa Rica de un paciente pediátrico con una necrosis avascular de la cadera del fémur como complicación de su drepanocitosis.

Sickle cell disease is an autosomic recessive hereditary hemoglobin disorder, associated with episodes of acute pain and progressive organ damage with great impact on a patient's life expectancy and quality of life. Avascular necrosis of the femoral head is a well-known complication of sickle cell disease affecting almost 25% of adult patients and just in 12% of pediatric patients. Below is the case of a 9-year-old male patient with sickle cell disease, who on a control appointment reported 15 days of hip pain and gait claudication. After performing radiological studies, avascular necrosis of the femoral head was diagnosed, becoming the first case documented at the National Children Hospital of Costa Rica of avascular necrosis of the femoral head as a complication in a pediatric patient with sickle cell disease.

Modified Dunn Technique for Unstable Slipped Capital Femoral Epiphysis: A Midterm Single Center Experience / Técnica de Dunn modificada no escorregamento da epífise femoral proximal com instabilidade: Experiência unicêntrica de médio prazo

Abstract Objective To evaluate the safety and reproducibility of the surgery for unstable slipped capital femoral epiphysis (SCFE) through the modified Dunn technique in a single center cohort from Brazil. Methods We retrospectively analyzed a cohort of patients submitted to this procedure by a single surgeon who was a hip preservation specialist. Demographic data and radiographic angles were evaluated for the relative risk (RR) of avascular necrosis (AVN) using a log-binomial regression model with simple and random effects. Results Among the 30 patients (30 hips) with a mean age of 11.79 years at the time of the operation, there were 17 boys and 18 left hips, which were operated on in a mean of 11.5 days after the slip. The mean follow-up was of 38 months. The preoperative Southwick angle averaged 60.69° against 4.52° postoperatively (p< 0.001). A larger preoperative slip angle was associated with the development of AVN (RR: 1.05; 95% confidence interval [95%CI]: 1.02-1.07; p< 0.01). The overall AVN rate was of 26.7%. Function was good or excellent in 86% of uncomplicated hips, and poor in 87.5% of the partients who developed AVN, as graded by the Harris Hip Score. There was no statistical relationship between epiphyseal bleeding and AVN development (p= 0.82). Conclusion The modified Dunn technique is associated with restoration of the femoral alignment and function after unstable SCFE, when uncomplicated. Moreover, it was shown to be reproducible in our population, with a rate of 26% of femoral head necrosis.

Resumo Objetivo Avaliar a segurança e a reprodutibilidade da cirurgia para escorregamento da epífise femoral proximal (EEPF) com instabilidade por meio da técnica de Dunn modificada em uma coorte unicêntrica no Brasil. Métodos Analisamos de forma retrospectiva uma coorte de pacientes submetidos a esse procedimento por um único cirurgião especialista em preservação do quadril. Avaliamos os dados demográficos e os ângulos radiográficos quanto ao risco relativo (RR) de necrose avascular (NAV) por meio do modelo de regressão log-binomial com efeitos simples e aleatórios. Resultados Entre os 30 pacientes (30 quadris) com idade média de 11,79 anos no momento da cirurgia, havia 17 meninos e 18 quadris esquerdos. O procedimento ocorreu em média 11,5 dias após o escorregamento. O tempo médio de acompanhamento foi de 38 meses. O ângulo de Southwick pré-operatório foi, em média, de 60,69° contra 4,52° após o procedimento (p< 0,001). O maior ângulo de escorregamento pré-operatório foi associado ao desenvolvimento de NAV (RR: 1,05; intervalo de confiança de 95% [IC95%]: 1,02-1,07; p< 0,01). A frequência geral de NAV foi de 26,7%. De acordo com a Escala de Quadril de Harris (Harris Hip Score), a função foi boa ou excelente em 86% dos quadris sem complicações, e ruim em 87,5% dos casos com NAV. Não houve relação estatística entre sangramento epifisário e desenvolvimento de NAV (p= 0,82). Conclusão A técnica de Dunn modificada restaura o alinhamento femoral e a função articular após o EEPF com instabilidade na ausência de complicações. Além disso, mostrou-se passível de reprodução em nossa população, com frequência de necrose da cabeça femoral de 26%.

Refixation of the Excised Acetabular Labrum can Affect the Structural Changes of Cartilage Surface in the Hip Joint / La Refijación del Labrum Acetabular Extirpado Puede Afectar los Cambios Estructurales de la Superficie del Cartílago en la Articulación Coxal

SUMMARY: Refixation of the damaged acetabular labrum is a method of surgical treatment of the hip joint that can promote the repair of joint function after injury and prevent premature osteoarthritis. We sought to determine the condition of the hip joint in rabbits 4 months after excision of the acetabular labrum and the condition of the joint after labral refixation. The articular cartilage of the femoral head and acetabulum was examined by histological methods, multipoint measurement of cartilage thickness, and the ratio between cartilage matrix and chondrocytes lacunae, and the condition of cartilage according to the OARSI grading scale was carried out. On this model, a correlation analysis was performed between the results of the OARSI grading scale and the data of linear morphometry. All these parameters made it possible to better assess changes in articular cartilage. The ratio between matrix and chondrocyte lacunae turned out to be a method that allows establishing early cartilage damage when erosion, fibrosis or deformation did not occur. We found significant differences between the condition of the cartilage after exicion of acetabular labrum and after labral refixation, which give hope to confirm that this surgical technique can delay or prevent progressive changes in the cartilage of the damaged hip joint.

La refijación del labrum acetabular dañado es un método de tratamiento quirúrgico de la articulación coxal, que puede promover la reparación de la función articular después de una lesión y prevenir la osteoartritis prematura. Intentamos determinar el estado de la articulación coxal en conejos de 4 meses después de la escisión del labrum acetabular y observar el estado de la articulación después de la refijación del labrum. El cartílago articular de la cabeza femoral y el acetábulo se examinó por métodos histológicos, se midió a través de multipunto el grosor del cartílago y se realizó la relación entre la matriz del cartílago y las lagunas de condrocitos, y se llevó a cabo la condición del cartílago según la escala de clasificación OARSI. Sobre este modelo se realizó un análisis de correlación entre los resultados de la escala de calificación OARSI y los datos de la morfometría lineal. Todos estos parámetros permitieron evaluar mejor los cambios en el cartílago articular. La relación entre la matriz y las lagunas de condrocitos resultó ser un método que permite establecer temprano el daño del cartílago cuando no se presentó erosión, fibrosis o deformación. Encontramos diferencias significativas entre la condición del cartílago después de la extirpación del labrum acetabular y después de la refijación del labrum, lo que da la esperanza de confirmar que esta técnica quirúrgica puede retrasar o prevenir cambios progresivos en el cartílago de la articulación coxal dañada.

Pipkin Type-II Femoral Head Fracture: A Biomechanical Evaluation by the Finite-Element Method / Fratura da cabeça femoral de tipo II de Pipkin: Avaliação biomecánica pelo método de elementos finitos

Abstract Objective To evaluate the biomechanical capacity of two forms of fixation for Pipkin type-II fractures, describing the vertical fracture deviation, the maximum and minimum principal stresses, and the Von Mises equivalent stress in the syntheses used. Materials and Methods Two internal fasteners were developed to treat Pipkin type-II fractures through finite elements: a 3.5-mm cortical screw and a Herbert screw. Under the same conditions, the vertical fracture deviation, the maximum and minimum principal stresses, and the Von Mises equivalent stress in the syntheses used were evaluated. Results The vertical displacements evaluated were of 1.5mm and 0.5mm. The maximum principal stress values obtained in the upper region of the femoral neck were of 9.7 KPa and 1.3 Kpa, and the minimum principal stress values obtained in the lower region of the femoral neck were of-8.7 KPa and -9.3 KPa. Finally, the peak values for Von Mises stress were of 7.2 GPa and 2.0 GPa for the fixation models with the use of the 3.5-mm cortical screw and the Herbert screw respectively. Conclusion The fixation system with the Herbert screw generated the best results in terms of reduction of vertical displacement, distribution of the maximum principal stress, and the peak Von Mises equivalent stress, demonstrating mechanical superiority compared to that of the 3.5-mm cortical screw in the treatment of Pipkin type-II fractures.

Resumo Objetivo Avaliar a capacidade biomecánica de duas formas de fixação de fraturas tipo II de Pipkin descrevendo o desvio da fratura no sentido vertical, as tensões máxima e mínima principais, e a tensão equivalente de Von Mises nas sínteses utilizadas. Materiais e Métodos Dois fixadores internos foram desenvolvidos para tratar a fratura tipo II de Pipkin por meio de elementos finitos: parafuso cortical de 3,5 mm e parafuso de Herbert. Sob as mesmas condições, foram avaliados o desvio da fratura no sentido vertical, as tensões máxima e mínima principais, e a tensão equivalente de Von Mises nas sínteses utilizadas. Resultados Os deslocamentos verticais avaliados foram de 1,5 mm e 0,5 mm. Os valores de tensão máxima obtidos na região superior do colo femoral foram de 9,7 KPa e 1,3 KPa, e os valores de tensão mínima obtidos na região inferior do colo femoral foram de -8,7KPa e -9,3 KPa. Por fim, os valores de pico da tensão equivalente de Von Misesforam de 7,2 GPa e2,0 GPa paraosmodelos de fixação com o uso do parafuso cortical de 3,5 mm e do parafuso de Herbert, respectivamente. Conclusão Osistema de fixação com parafuso de Herbert gerou os melhores resultados em termos de redução do deslocamento vertical, distribuição da tensão máxima e do pico da tensão equivalente de Von Mises, o que demonstra sua superioridade mecânica comparada à do parafuso cortical de 3,5 mm no tratamento da fratura tipo II de Pipkin.

Risk Factors of avascular Osteonecrosis of the Femoral Head in Children at the National ReferenceCenter for Sickle Cell Disease in Brazzaville, Congo

Introduction: The avascular osteonecrosis of the femoral head (AOFH) is a common complication of sickle cell disease (SCD). It exposes to lameness and sometimes to a very debilitating handicap. It is a source of desocialization, particularly in developing countries where prosthetic surgery remains inaccessible to the majority. This survey aimed to identify the risk of occurence AOFH. Materials and Methods: It was a case-control study carried between october 2017 and september 2021 at the National Reference Center for SCD « Antoinette Sassou Nguesso » in Brazzaville. It concerned 31 children with clinical and radiographic signs of AOFH. Clinical (age at diagnosis of SCD, frequency of vasoocclusive crises and hospitalization for vasoocclusive crises, number of blood transfusion) as well as hematological examination (blood count in the intercritical period) and hydroxyurea treatment were compared with those of 62 children with no clinical and radiographic signs of AOFH. The chi2 statistical test and the odds ratio were used for the comparison (P ˂ 0.05).Results: The sex ratio was 1.38 versus 0.93 (p = 0.50). The mean age of diagnostic of SCD was 3.76 ± 2.56 years versus 3.94 ± 2.01 years (p = 0.81). Logistic regression showed that SCD children with AOFH had a significantly higher rate of annual frequency of VOC (4.16 1.18 vs 2.91 1.68; P = 0.015), annual frequency of hospitalization for VOC (3.741.65 vs 1.451.28; P = 0.000) and number of blood transfusions (3.38 ± 2.69 vs 2.42 ± 2.32; P = 0.03).Conclusion: Emphasis should be placed on the prevention and early management of acute complications of SCD. The role of hydroxyurea should be clarified by further work.

The Efficacy of Topical Tranexamic Acid in Femoral Neck Fractured Patients Undergoing Cemented Bipolar Hemiarthroplasty: A Randomized Double Blinded Controlled Trial / A eficácia do ácido tranexâmico tópico em pacientes com fraturas no pescoço femoral submetidos a hemiartroplastia bipolar cimentada: Um ensaio controlado duplo-cego randomizado

Abstract Objective Tranexamic acid (TXA) is an antifibrinolytic that is widely used for decreasing blood loss and blood transfusion rates in total hip arthroplasty. However, there is limited evidence of topical TXA usage in hip hemiarthroplasty for femoral neck fractures. The present study aimed to evaluate the effects of topical TXA on blood loss and on blood transfusions in femoral neck fracture patients who underwent cemented bipolar hemiarthroplasty. Methods Twenty-six patients with femoral neck fractures who were scheduled for bipolar cemented arthroplasty were randomized into two groups. The first group of 12 patients received topical TXA during their operation, whereas 14 patients in the second group received a placebo. Hematocrit was measured at 6 and 24 hours postoperatively. Blood transfusions and postoperative complications were also recorded. Results Total blood loss was not different between the TXA group and the control group (TXA group: 459.48 ± 456.32 ml, and control group: 732.98 ± 474.02 ml; p = 0.14). However, there were no patients within the TXA group who required a blood transfusion, while there were 4 patients in the control group who received allogenic blood transfusions (p = 0.044). There were no postoperative complications, such as wound complication, venous thromboembolism, or cardiovascular complications within either group. Conclusion Topical TXA could not decrease total blood loss but was able to reduce transfusion rates in patients who underwent cemented bipolar hip hemiarthroplasty in femoral neck fractures. Further studies in doses of topical TXA in a larger sample size would be beneficial. Level of Evidence II.

Resumo Objetivo O ácido tranexâmico (TXA) é um antifibrinolítico amplamente utilizado para diminuir as taxas de perda de sangue e de transfusão de sangue na artroplastia total do quadril. No entanto, há evidências limitadas de uso tópico de TXA na hemiartroplastia do quadril para fraturas no pescoço femoral. O presente estudo teve como objetivo avaliar os efeitos do TXA tópico na perda de sangue e transfusões de sangue em pacientes com fratura femoral que foram submetidos a hemiartroplastia bipolar cimentada. Métodos Vinte e seis pacientes com fraturas no pescoço femoral e programados para artroplastia cimentada bipolar foram randomizados em dois grupos. O primeiro grupo de 12 pacientes recebeu TXA tópico durante a operação; no segundo grupo, 14 pacientes receberam placebo. O hematócrito foi medido às 6 e 24 horas no pósoperatório. Também foram registradas transfusões de sangue e complicações pósoperatórias. Resultados A perda total de sangue não foi diferente entre o grupo TXA e o grupo controle (grupo TXA: 459,48 ±456,32 ml; e grupo controle: 732,98 ±474,02 ml; p = 0,14). No entanto, não houve pacientes dentro do grupo TXA que necessitaram de transfusão de sangue, enquanto 4 pacientes no grupo controle fizeram transfusões de sangue halogênicas (p = 0,044). Não houve complicações pós-operatórias, tais como complicação da ferida, tromboembolismo venoso ou complicações cardiovasculares dentro de qualquer grupo. Conclusão O TXA tópico não conseguiu diminuir a perda total de sangue, mas foi capaz de reduzir as taxas de transfusão, em pacientes submetidos a hemiartroplastia de quadril bipolar cimentada em fraturas no pescoço femoral. Outros estudos com doses de TXA tópico em um tamanho amostral maior seriam benéficos. Nível de Evidência II.

Factors Associated with Readmission within 30 Days after Discharge and In-Hospital Mortality after Proximal Femoral Fracture Surgery in the Elderly: Retrospective Cohort / Fatores associados à reinternação em até 30 dias após a alta e à mortalidade intra-hospitalar após cirurgia por fratura do fêmur proximal em idosos: coorte retrospectiva

Abstract Objective To evaluate the factors associated with readmission within 30 days after discharge (R30) and in-hospital mortality (IHM) in elderly patients undergoing proximal femur fracture surgery (PFF). Methods Retrospective cohort with data from 896 medical records of elderly (≥ 60 years) patients submitted to PFF surgery in a Brazilian hospital between November 2014 and December, 2019. The patients included were followed-up from the date of hospitalization for surgery up to 30 days after discharge. As independent variables, we evaluated gender, age, marital status, pre- and postoperative hemoglobin (Hb), international normalized ratio, time of hospitalization related to the surgery, door-surgery time, comorbidities, previous surgeries, use of medications, and the American Society of Anesthesiologists (ASA) score. Results The incidence of R30 was 10.2% (95% confidence interval [CI]: 8.3-12.3%), and the incidence of IHM was 5.7% (95%CI: 4.3-7.4%). Regarding R30, hypertension (odds ratio [OR]: 1.71; 95%CI: 1.03-2.96), and regular use of psychotropic drugs (OR: 1.74; 95%CI: 1.12-2.72) were associated in the adjusted model. In the case of IHM, higher chances were associated with chronic kidney disease (CKD) (OR: 5.80; 95%CI: 2.64-12.31), longer hospitalization time (OR: 1.06; 95%CI: 1.01-1.10), and R30 (OR: 3.60; 95%CI: 1.54-7.96). Higher preoperative Hb values were associated with a lower chance of mortality (OR: 0.73; 95%CI: 0.61-0.87). Conclusion Findings suggest that the occurrence of these outcomes is associated with comorbidities, medications, and Hb.

Resumo Objetivo Avaliar os fatores associados à reinternação em até 30 dias após a alta (R30) e à mortalidade intra-hospitalar (MIH) em idosos submetidos a cirurgia por fratura do fêmur proximal (FFP). Métodos Coorte retrospectiva com dados de 896 prontuários de idosos (≥ 60 anos) submetidos a cirurgia de FFP em hospital brasileiro, no período entre novembro de 2014 a dezembro de 2019. Os pacientes incluídos foram acompanhados desde a data de internação para a cirurgia até 30 dias após a alta. Como variáveis independentes, foram avaliados o sexo, idade, estado civil, hemoglobina (Hb) pré e pós-operatória, razão normalizada internacional, tempo da internação relacionada à cirurgia, tempo porta cirurgia, comorbidades, cirurgias prévias, uso de medicamentos e escore da American Society of Anesthesiologists (ASA). Resultados A incidência de R30 foi de 10,2% (intervalo de confiança [IC] 95%: 8,3-12,3%) e a de MIH foi 5,7% (IC95%: 4,3-7,4%). Referente a R30, no modelo ajustado, associaram-se ter hipertensão (odds ratio [OR]: 1,71; IC95%: 1,03-2,96), uso regular de medicamentos psicotrópicos (OR: 1,74; IC95%: 1,12-2,72). Tratando-se da MIH, maiores chances estiveram associadas à doença renal crônica (DRC) (OR: 5,80; IC95%: 2,64-12,31), maior tempo de internação (OR: 1,06; IC95%: 1,01-1,10) e R30 (OR: 3,60; IC95%: 1,54-7,96). Maiores valores de Hb pré-operatória associaram-se à menor chance de mortalidade (OR: 0,73; IC95%: 0,61-0,87). Conclusão Os achados sugerem que a ocorrência destes desfechos está associada à comorbidades, medicamentos e Hb.

Outcome of treatment of Unstable Intertrochanteric Fracture by Proximal Femoral Nail (PFN)

Background: Proximal Femoral Nail (PFN) is a surgical technique used to treat unstable intertrochanteric fractures, which are fractures that occur in the upper portion of the thigh bone (femur). The procedure involves using a nail-like device that is inserted into the femur and secured in place with screws to stabilize the fracture and promote healing. It is a commonly used treatment option for this type of fracture and can lead to good outcomes in most cases. The aim of the study was to observe the outcome of Unstable Intertrochanteric fracture by Proximal Femoral Nail (PFN). Material & Methods: This prospective observational study was conducted at the Department of Orthopedics, National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh. The study duration was 2 years, from July 2017 to June 2019. A total of 34 cases were included in the study sing purposive sampling (non-randomized) according to availability of the patients and considering inclusion and exclusion criteria. Results: The participants’ age range was 16-90, with a mean of 56.91 ± 17.76. Most (35.29%) were 61-75 years old. 61.76% were female and 38.24% were male. 50% were housewives, 14.71% ex-service holders, 14.71% service holders, 11.76% businessmen, 5.88% students, and 2.94% farmers. The leading cause of injury was falls on slippery ground (55.88%), followed by motor vehicle injuries (44.12%). 70.59% of injuries occurred on the right side and 29.41% on the left. 76% had Kyle Type III fractures, 24% had type IV. 85.29% had open reduction, 14.71% had closed reduction. The mean duration of injury to operation was 15.59 days and the mean hospital stay was 19.15 days. 70.59% had no complications and 55.88% reported no pain at last follow-up. 58.82% had a good Harris hip score and 58.82% had excellent outcomes by final follow-up. Conclusion: The majority of patients in this study were in the 61-75 age range and female, with the most common cause of injury being falls on slippery ground. The most common fracture type was Kyle type IV, with a major portion of cases requiring open reduction. The rate of complications was relatively low, and the functional outcomes were acceptable and comparable to other studies. The duration of injury to operation and hospital stay were slightly longer than other studies, likely due to the busy nature of the study location. Overall, the Proximal Femoral Nail is a safe and effective treatment option for unstable proximal femoral fractures.

Resultados de la osteosíntesis en fracturas intertrocantéricas inestables de fémur con clavo femoral proximal

Introducción: Las fracturas intertrocantéricas del extremo proximal del fémur constituyen el grupo nosológico con mayor morbilidad y mortalidad de las lesiones traumáticas del esqueleto. Objetivo: Evaluar la reducción, la colocación del implante y el tiempo de consolidación. Métodos: Se realizó un estudio descriptivo, longitudinal y prospectivo de 114 pacientes con diagnóstico de fracturas del extremo proximal del fémur tratadas con clavo femoral proximal, y un seguimiento posoperatorio de un año. Resultados: Se alcanzó un resultado clínico funcional de excelente a bueno en el 82,4 % de los casos. Se evidenciaron signos radiológicos de consolidación en un promedio de 4,2 meses en la mayor parte de la muestra. Conclusiones: La pérdida de la fijación constituyó la complicación más frecuente; por tanto, se considera que el enclavado femoral proximal ofrece buenos resultados en el tratamiento de fracturas intertrocantéricas inestables del fémur.

Introduction: Intertrochanteric fractures of the proximal end of the femur constitute the nosological group with the highest morbidity and mortality of traumatic skeletal injuries. Objective: To evaluate reduction, implant placement and consolidation time. Methods: A descriptive, longitudinal and prospective study was carried out in 114 patients with diagnosis of fractures of the proximal end of the femur treated with proximal femoral nailing, and a one-year postoperative follow-up. Results: A functional clinical result from excellent to good was achieved in 82.4% of the cases. Radiological signs of consolidation were evidenced in an average of 4.2 months in most of the sample. Conclusions: Loss of fixation was the most frequent complication; therefore, proximal femoral nailing is considered to offer good results in the treatment of unstable intertrochanteric fractures of the femur.

Luxación bilateral central femoral tras crisis convulsiva. Anillo antiprotrusivo y cotilo de doble movilidad como opción terapéutica. A propósito de un caso / Bilateral central femoral dislocation after seizure. Antiprotrusive ring and dual mobility cup as a therapeutic option. Apropos of a case

Resumen: Introducción: las crisis convulsivas pueden desencadenar fracturas y luxaciones. Las lesiones dependen de la severidad, duración y el tipo de crisis. Presentamos un caso clínico de un varón que presentó una fractura luxación central bilateral de cadera tras episodio de crisis convulsiva. Un caso pocas veces descrito en la literatura con un manejo complejo y poco habitual. Caso clínico: paciente de 77 años con antecedentes de deterioro cognitivo moderado que sufrió una luxación bilateral central de cadera en contexto de una crisis convulsiva generalizada. Clínicamente, a su llegada a urgencias, el paciente presentaba un acortamiento de la extremidad inferior derecha en comparación con la contralateral, rotación externa y bloqueo articular a la realización del log roll test en ambas extremidades. Se realizó estudio de imagen y optimización clínica previo a cirugía. Se realizó en dos tiempos: primero la cadera izquierda al octavo día de ingreso y la cadera derecha al decimoquinto. En ambas cirugías se realizó el mismo procedimiento mediante implantación de anillo antiprotrusivo y prótesis con cotilo de doble movilidad con vástago femoral no cementado. En el postoperatorio inmediato, el paciente no presentó ninguna complicación asociada a la cirugía. En el seguimiento a los 12 meses, el paciente realiza carga completa con un Harris hip score (HHS) de 77 cadera derecha y 79 en la izquierda; 12 puntos en la escala WOMAC. No ha presentado complicaciones postoperatorias hasta el momento. Conclusiones: estas lesiones son poco comunes en nuestra práctica diaria, donde disponemos de múltiples opciones para abordarlas. En nuestro paciente, el empleo de la artroplastía y de anillos antiprotrusivos nos ofrecen ventajas respecto a las técnicas de síntesis de la fractura, como una movilización precoz y evitar desarrollo prematuro de una artrosis postraumática, con resultados buenos, funcionales y pocas complicaciones postoperatorias.

Abstract: Introduction: seizures can trigger fractures and dislocations. Injuries depend on the severity, duration and type of seizure. We present a case report of a male patient who presented with a bilateral central dislocation fracture of the hip following an episode of seizure. A case rarely described in the literature with complex and unusual management. Case report: a 77-year-old man with a history of moderate cognitive impairment suffered a bilateral central dislocation of the hip in the context of a generalized epileptic seizure. Clinically on arrival at the emergency department, the patient presented shortening of the right lower extremity compared to the contralateral, external rotation and joint locking on log roll test in both extremities. An imaging study and clinical optimization were performed prior to surgery. It was performed in two stages. First the left hip on the 8th day of admission, and the right hip on the 15th. In both surgeries the same procedure was performed, with implantation of an antiprotrusive ring and a double mobility cup prosthesis with an uncemented femoral stem. In the immediate postoperative period, the patient did not present any complications associated with the surgery. At 24-month follow-up, the patient performed full weight bearing with a Harris hip score (HHS) of 77 on the right hip and 79 on the left; 12 points on the WOMAC scale. No postoperative complications have occurred so far. Conclusions: these injuries are uncommon in our daily practice, where multiple options are available to address them. In our patient, the use of arthroplasty and antiprotrusive rings offers advantages over fracture synthesis techniques, such as early mobilization with moderate functional results and few postoperative complications.

Abnormal obturator artery with ipsilateral inferior epigastric artery passed behind the femoral vein / Arteria obturatriz anómala con arteria epigástrica inferior ipsilateral que cruza posterior a la vena femoral

SUMMARY: Clear awareness of the vascular variations is critical in surgeries, which may cause massive hemorrhage during surgical procedures. During educational dissection of a male cadaver, we encountered a combined variation of the left obturator artery and ipsilateral aberrant inferior epigastric artery. The left obturator artery originated from the external iliac artery, then coursed inward, adherent to the superior pubic ramus. The left inferior epigastric artery originated from the femoral artery, and coursed behind the femoral vein. These anatomical variations shown in one person were extremely rare. This is particularly true with regard to these variations while performing pelvic and inguinal region surgeries.

El conocimiento claro de las variaciones vasculares es fundamental en las cirugías, ya que pueden causar una hemorragia masiva durante los procedimientos quirúrgicos. Durante la disección educativa de un cadáver de sexo masculino, encontramos una variación combinada de la arteria obturatriz izquierda y la arteria epigástrica inferior ipsilateral aberrante. La arteria obturatriz izquierda se originaba en la arteria ilíaca externa, luego discurrió hacia medial, adhiriéndose a la rama púbica superior. La arteria epigástrica inferior izquierda se originaba en la arteria femoral y discurría por detrás de la vena femoral. Estas variaciones anatómicas mostradas en una sola persona son extremadamente raras. Esto es importante de conocer estas variaciones cuando se realizan cirugías de las regiones pélvica e inguinal.

Geriatric intertrochanteric fractures – A challenge to manage

Background: Intertrochanteric fractures are among the frequently seen fractures in the elderly population. Treating these fractures is very challenging considering the fact that the quality of bone is poor and highly osteoporotic. The high failure rates with dynamic hip screw (DHS) especially in unstable fractures lead to the development of intramedullary devices such as proximal femoral nail (PFN) which has got multiple advantages over DHS. Materials and Methods: This prospective study included 30 patients above the age group of 60 years with unstable intertrochanteric fractures conducted in a tertiary institute between February 2021 and June 2022. Results were analyzed clinically and radiologically using the Modified Harris hip score. Results: Patients’ age group was 61–85 years with a mean age of 69 years, comprising 63% female and 37% male. The average Harris hip score was 83.76 at 24 weeks’ follow-up with 33.33% excellent, 56.66% good, 3.33% fair, and 6.67% poor. Postoperative complications included revision surgery in two patients, superficial infection in one patient, Z effect in one patient, peri-implant fracture in one patient. Conclusion: Treatment with PFN for unstable intertrochanteric fracture has the advantages of closed reduction, less tissue damage, early rehabilitation, and return to work. Osteosynthesis with short PFN resulted in good-to-excellent functional and radiological outcomes.

Radiographic findings in the coxofemoral joint of Australian Cattle Dogs / Achados radiográficos em articulação coxofemoral de cães da raça Australian Cattle Dog

Australian Cattle Dogs (ACD) are medium-sized animals widely used in fieldwork for managing cattle and sheep. There needs to be more information about the conditions these dogs can develop despite being well-characterized animals since the beginning of the 20th century. Hip dysplasia (HD) is a developmental abnormality between the femoral head and the acetabular fossa, which can be debilitating. However, the available literature has no studies on the prevalence of this condition in dogs of this breed. This study aimed to evaluate radiographs of ACD qualitatively and quantitatively. For this purpose, 49 dogs considered healthy without clinical signs of HD were radiographically assessed, and the animals were classified as dysplastic (D) and non-dysplastic (ND). A frequency of 46.9% of dysplastic dogs was observed, with males being more affected. The cortical index (CI) and angle of inclination (AI) could not differentiate D from ND animals; only the Norberg angle (NA) was effective in this differentiation. No correlation was observed between AI, CI, and AN.(AU)

Os cães da raça Autralian Cattle Dog (ACD) são animais de porte médio, muito utilizados no trabalho de campo para manejo de gado e ovelha. Apesar de serem animais bem caracterizados desde o início do século XX, há poucas informações sobre afecções que esses cães podem desenvolver. A displasia coxofemoral (DCF) é uma anormalidade do desenvolvimento entre a cabeça do fêmur e a fossa acetabular podendo ser debilitante. Contudo, não há estudos, na literatura disponível, sobre a prevalência desta afecção em cães dessa raça. O objetivo deste trabalho foi avaliar qualitativamente e quantitativamente radiografias de cães da raça ACD. Para tanto, foram avaliados radiograficamente 49 cães considerados hígidos e sem sinais clínicos de DCF. Os animais foram classificados em displásicos (D) e não displásicos (ND). Observou-se a frequência de 46,9% de cães displásicos, sendo os machos mais acometidos. O índice cortical (IC) e o ângulo de inclinação (AI) não foram capazes de diferenciar os animais D dos ND, apenas o ângulo de Norberg (AN) foi eficaz nessa diferenciação. Não houve correlação entre AI, IC e AN.(AU)