Résumé
Purpose@#This study compared the functional and cosmetic treatment outcomes of intramedullary nailing (IM nail) and minimally invasive plate osteosynthesis (MIPO) for distal tibia shaft fractures. @*Materials and Methods@#Forty-eight patients with distal tibia shaft fractures (distal 1/3 of the diaphysis, AO/OTA [AO Foundation/ Orthopaedic Trauma Association]) 43 managed by an IM nail (n=30) or MIPO (n=18) who had minimum one-year follow-up were enrolled in this study. The radiological, functional, and cosmetic outcomes in the two groups were compared retrospectively. @*Results@#All patients achieved bone union. The mean bone union time of the IM nail and MIPO groups was 18.5 and 22.6 weeks, respectively (p=0.078). One patient in the MIPO group showed posterior angulation and valgus deformity of more than five degrees. The mean American Orthopaedic Foot and Ankle Society (AOFAS) functional scores were similar: 83.3 in the IM nail group and 84.6 in the MIPO group (p=0.289). The most salient difference was the cosmetic result of the surgical scar. The length of the scars around the ankle in the IM nail group was significantly smaller than the MIPO group (2.6 cm vs. 10.6 cm; p=0.035). The patient satisfaction survey of surgical scars revealed a significantly higher satisfaction rate in the IM nail group than in the MIPO group (93% vs. 44%; p<0.001). @*Conclusion@#This study showed that both treatment methods for distal tibia shaft fractures have similar therapeutic efficacy regarding the radiological and functional outcomes. On the other hand, the IM nail technique showed superior cosmetic outcomes than the MIPO technique. IM nails may be more recommended in patients with high demand for cosmetic results.
Résumé
BACKGROUND: To determine whether olecranon fractures have osteoporotic features such as age-dependent, low bone attenuation and low-energy trauma as a cause of injury. METHODS: Elbow computed tomography (CT) and medical record review were performed in 114 patients (53 males and 61 females) with acute olecranon fractures. The mean age was 57 years. Bone attenuation was measured on the central part of the olecranon on sagittal CT images avoiding the fracture, and on the distal humerus (distal metaphysis and medial and lateral condyles) on coronal CT images. We compared bone attenuation and causes of injury (high or low energy trauma) between younger (<50 years) and older (≥50 years) patients in each gender. Multiple regression analysis was performed to determine the effect of age and gender on bone attenuation. RESULTS: Mean bone attenuation in older male and female patients was significantly lower than in younger patients, except at the medial condyle in men. The proportion of low-energy trauma in older male patients was significantly higher than in younger male patients. In female patients, low-energy trauma was predominant in both younger and older patients. Age and female gender had significantly negative effects on bone attenuation. CONCLUSIONS: This study demonstrated that olecranon fractures have osteoporotic features, including age-dependent low bone attenuation and low-energy trauma as the predominant cause of injury. Our results suggest that osteoporosis evaluation should be considered for patients aged 50 years or more with olecranon fractures.