Comparison between flexible nailing and external fixation, methods to stabilize femoral shaft fractures in the immature skeleton: a systematic review and meta-analysis / Comparação entre os métodos de estabilização das fraturas diafisárias do fêmur no esqueleto imaturo, entre haste flexíveis e fixador externo: revisão sistemática e metanálise

ABSTRACT Flexible intramedullary nailing and external fixation have become the main methods to surgically treat femur fractures in children. This study aimed to search the current literature and evaluate the clinical and radiographic results of surgical treatment by comparing these methods and investigating their associated complications. This systematic review was carried out following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) recommendations. Searches were carried out on the PubMed, Embase, and Web of Science databases. The search for journals in these databases was carried out from January 2023 to August 2023, retrieving 695 studies. This systematic review included 11 articles, which encompassed 718 patients who underwent surgical external fixation and flexible nailing. The most frequently observed complications referred to late or malunion, superficial and deep infections, skin irritation, angular deformity, and length discrepancy between lower limbs. Both methods of stabilization of pediatric femoral fractures can provide good clinical and radiographic results. However, the choice of treatment with flexible nails is certainly more valid and has greater acceptance than external fixation. Level of Evidence III, Systematic Review .

RESUMO Para o tratamento cirúrgico das fraturas do fêmur em crianças, as hastes intramedulares flexíveis e os fixadores externos tornaram-se os principais métodos utilizados. Este estudo teve como objetivo pesquisar a literatura atual e avaliar os resultados clínicos e radiográficos do tratamento cirúrgico confrontando estes métodos e investigar as complicações associadas. Trata-se de uma revisão sistemática, realizada segundo as recomendações PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis), cujas buscas foram realizadas nas bases de dados (PubMed, Embase e Web of Science). A busca dos periódicos nessas bases de dados foi realizada entre janeiro de 2023 e agosto de 2023, e foram encontrados 695 estudos. Um total de 11 artigos foram incluídos nesta revisão sistemática, que engloba 718 pacientes que foram operados pelas técnicas cirúrgicas de fixação externa e haste flexível. As complicações mais frequentemente observadas foram a consolidação tardia ou viciosa, infecção superficial e profunda, irritação da pele, deformidade angular e discrepância no comprimento entre os membros inferiores. Verificou-se que ambos os métodos de estabilização das fraturas femorais pediátricas podem proporcionar bons resultados clínicos e radiográficos. No entanto, a escolha do tratamento com hastes flexíveis é certamente mais válida e tem maior aceitação, comparada à fixação externa. Nível de evidência III, Revisão Sistemática.

Analysis of the Morbidimortality of Patients with Peritrochanteric Fractures Surgically Treated with Proximal Femoral Intramedullary Rod / Análise da morbimortalidade dos pacientes com fraturas peritrocantéricas tratadas cirurgicamente com haste intramedular de fêmur proximal

Abstract Objective To analyze the morbimortality of patients with peritrochanteric fractures treated with intramedullary rod and its relationship to the length of hospital stay, the time until surgery and the comorbidities of the patients. Methods An observational, analytical and retrospective study was carried out through the evaluation of the medical records of 74 patients who underwent surgical treatment of peritrochanteric fractures with intramedullary proximal femoral rods from 2011 to 2014 in a hospital unit. Results The mean age at the moment of the fracture was 79.7 years, and the mean total hospitalization time was 16.7 days, with an average of 11.3 days until surgery and 5.4 days from surgery to discharge. The incidence of complications during hospitalization in the group aged ≥ 78.5 years was of 47.6%, while in the younger group it was of 19.4% (p= 0.013). The incidence of hospitalization complications in the group that underwent surgery more than 6 days after the fracture was significantly higher: 42.9% (p= 0.019). It was also observed that the incidence of complications during hospitalization was significantly associated with a surgical risk index ≥ 3 (p= 0.001) and diabetes mellitus (p= 0.001). Conclusion Complications related to peritrochanteric fractures are significantly related with a high surgical risk index (grades 3 and 4), diabetes mellitus, age (> 78.5 years), and prolonged preoperative hospitalization (> 6 days).

Resumo Objetivo Analisar a morbimortalidade dos pacientes com fraturas peritrocantéricas tratadas com haste intramedular e sua relação com o tempo de internação, com o tempo para fazer o procedimento cirúrgico, e com as comorbidades dos pacientes. Métodos Foi feito um estudo observacional, analítico e retrospectivo por meio da avaliação dos prontuários de 74 pacientes submetidos ao tratamento cirúrgico de fraturas peritrocantéricas com haste intramedular de fêmur proximal de 2011 a 2014 em uma unidade hospitalar. Resultados A idade média no momento da ocorrência da fratura foi de 79,7 anos, e o tempo de internação total médio foi de 16,7 dias, com média de 11,3 dias até a cirurgia e 5,4 dias da cirurgia à alta. A incidência de complicações na internação no grupo com idade ≥ 78,5 anos foi de 47,6%, enquanto no grupomais novo ela foi de 19,4% (p= 0,013). A incidência de complicações na internação no grupo que fez a cirurgia após 6 dias foi significativamente maior (42,9%; p= 0,019). Observou-se também que a incidência de complicação na internação está significativamente associada ao risco cirúrgico de grau ≥ 3 (p= 0,001) e à diabetes mellitus (p= 0,001). Conclusão As complicações relacionadas às fraturas peritrocantéricas estão significativamente associadas ao risco cirúrgico elevado (graus 3 e 4), diabetesmellitus, idade (> 78,5 anos) e tempo de internação pré-operatório prolongado (>6 dias).

Treatment of Pathological Humerus-Shaft Tumoral Fractures with Rigid Static Interlocking Intramedullary Nail-22 Years of Experience / Tratamento de fraturas patológicas tumorais diafisárias do úmero com haste intramedular rígida bloqueada estática - Experiência de 22 anos

Abstract Objective This was a retrospective observational study in patients submitted to intramedullary nail fixation after established or impeding pathological humerus-shaft tumoral fracture in the context of disseminated tumoral disease along 22 years of experience at the same institution. Methods Sample with 82 patients and 86 humeral fixations with unreamed rigid interlocking static intramedullary nail by the antegrade or retrograde approaches. Results The most prevalent primary tumors were breast carcinoma (30.49%), multiple myeloma (24.39%), lung adenocarcinoma (8.54%), and renal cell carcinoma (6.10%). The average surgical time was 90.16 ± 42.98 minutes (40-135 minutes). All of the patients reported improvement in arm pain and the mean Musculoskeletal Tumor Society (MSTS) score rose from 26% in the preoperative period to 72.6% in the evaluation performed in patients still alive 3 months after the surgery. The overall survival was 69.50% 3 months after the surgery, 56.10% at 6 months, 26.70% at 1 year, and 11.90% at 2 years. No death was related to the surgery or its complications. There were only 4 surgery-related complications, 1 intraoperative and 3 late, corresponding to a 4.65% complication risk. Conclusion Closed unreamed static interlocking intramedullary nailing (both in the antegrade or retrograde approaches) of the humerus is a fast, safe, effective, and low morbidity procedure to treat pathological fractures of the humerus shaft, assuring a stable arm fixation and consequently improving function and quality of life in these patients during their short life expectation.

Resumo Objetivo Estudo retrospectivo observacional em pacientes submetidos à fixação com haste intramedular de fratura patológica tumoral consumada ou iminente da diáfise do úmero em contexto de doença tumoral disseminada ao longo de 22 anos na mesma instituição. Métodos Amostra com 82 pacientes e 86 fixações do úmero com haste intramedular rígida bloqueada estática não fresada anterógrada ou retrógrada. Resultados Os tumores primários mais prevalentes foram carcinoma da mama (30,49%), mieloma múltiplo (24,39%), adenocarcinoma do pulmão (8,54%) e carcinoma das células renais (6,10%). O tempo médio de intervenção cirúrgica para fixação com haste foi 90,16 ± 42,98 minutos (40-135). Todos os pacientes referiram melhoria das queixas álgicas no nível do braço e velicou-semelhoria do scoreMSTSmédio de 26% no pré-operatório para 72,6% na avaliação efetuada nos pacientes ainda vivos aos três meses de pós-operatório. A taxa de sobrevivência aos três meses após a cirurgia foi de 69,50%, 56,10% aos seis meses, 26,70% em um ano e 11,90% em dois anos. Nenhuma dasmortes decorreu da cirurgia ou de complicações dela. Apenas se registaramquatro complicações relacionadas com a cirurgia, uma intraoperatória e três tardias, corresponderam a risco de complicações de 4,65%. Conclusão O uso de haste intramedular não fresada estática bloqueada (anterógrado ou retrógrado) no úmero é um método rápido, seguro, eficaz e com baixa morbilidade no tratamento das fraturas patológicas da diáfise umeral, garante fixação estável do braço e consequentemente melhora a funcionalidade e a qualidade de vida desses pacientes durante a sua curta expectativa de vida.

Resultados funcionales y complicaciones del uso del clavo cefalomedular en el tratamiento de las fracturas de cadera / Functional results and complications of the use of the proximal femoral nail in the treatment of intertrochanteric hip fractures

Resumen: Introducción: El clavo cefalomedular es utilizado para el tratamiento de la fractura de cadera; sin embargo, existen pocos estudios que permitan identificar datos sobre las complicaciones del uso de estos dispositivos y los resultados en términos de restauración de la funcionalidad del paciente. Métodos: Se realizó un estudio de corte transversal en pacientes con fractura de fémur durante el período de Enero de 2008 a Diciembre de 2012. Se recopiló información de variables demográficas y clínicas. Se llevó a cabo un seguimiento telefónico hasta seis meses postoperatorios. Se efectuó un análisis descriptivo utilizando medidas de frecuencia absolutas y relativas. Las variables cuantitativas se presentan con promedios y desviación estándar o mediana y rango intercuartil, según la normalidad de los datos. Resultados: De los pacientes, 82.9% logró caminar con o sin ayuda dentro de los seis meses posteriores a la cirugía. El tiempo de hospitalización fue de cuatro días en promedio; las principales complicaciones fueron anemia (16.2%), infección urinaria (9.7%), neumonía (9.5%) e infarto del miocardio (0.7%). De quienes fueron incluidos, 57.1% tenían un nivel ASA ≥ 3; se identificó una mortalidad de 16% en ellos. Discusión: El clavo cefalomedular muestra resultados positivos en cuanto a recuperación funcional de la movilidad y una baja prevalencia de complicaciones, con una mortalidad similar a la reportada en la literatura dentro de los primeros 6 meses de nuestro seguimiento.

Abstract: Introduction: Cephalomedullary nails are used for the treatment of hip fractures; however, there are few studies that allow identifying data on the complications of the use of these devices and the results in terms of restoration of the functionality of the patient. Methods: A cross-sectional study of patients with femur fracture was conducted during the period from January 2008 to December 2012. Data on demographic and clinical variables were collected. Telephone follow-up was performed up to six postoperative months. A descriptive analysis was done using absolute and relative frequency measurements. Quantitative variables are presented with averages and standard deviation or median and interquartile range, according to the normality of the data. Results: 82.9% of the patients managed to walk with or without help within six months after surgery; anemia (16.2%), urinary tract infection (9.7%), pneumonia (9.5%) and myocardial infarction (0.7%) were the main complications. Of the patients included, 57.1% had an ASA level ≥ 3; a mortality rate of 16% was identified. Discussion: Cephalomedullary nails show positive results regarding recovery of functional mobility and a low prevalence of complications, with similar mortality to that reported in the literature at 6 months of follow up.

Treatment of Proximal Femur Osteomyelitis Occurred after Proximal Femoral Nail Antirotation Fixation, with Antibiotic Cement-coated Tibia Intramedullary Nail: A Case Report / 대한고관절학회지

Antibiotic cement-coated intramedullary nails maintain a locally high antibiotic concentration while contributing to bone stability. We present a case of femoral subtrochanteric fracture in a patient with an infected nonunion who was successfully treated for an infection and nonunion using an antibiotic cement-coated tibial intramedullary nail. A 79-year-old woman with a right femoral subtrochanteric fracture underwent internal fixation using proximal femoral nail antirotation (PFNA). She developed osteomyelitis with nonunion at the surgical site 10 months postoperatively. We decided to insert an antibiotic cement-coated tibial intramedullary nail. After coating the nail with bone cement mixed with antibiotics, bone fixation was achieved by inserting the nail at the site of the PFNA. The patient's symptoms improved, symptoms from the infection disappeared, and bone union was confirmed. Osteomyelitis occurred because of postoperative infection following a proximal femoral fracture. Antibiotic cement-coated tibial intramedullary nails are an effective option to treat patients with osteomyelitis of the femur and achieve bone union where nonunion persists with shallow a intramedullary femoral canal.

Outcomes of Cephalomedullary Nailing in Basicervical Fracture / 대한고관절학회지

PURPOSE: A basicervical femoral fracture is defined as a fracture of base of neck of femur that occurs medially from intertrochanteric line above lesser trochanter. In this study, we intended to evaluate radiological and clinical results of basicervical femoral fractures treated by intramedullary nailing. MATERIALS AND METHODS: Fifteen patients, who underwent intramedullary nailing among 50 patients, out of 50 who were diagnosed with basicervical femoral fractures from July 2012 to May 2015 were studied. All of 15 patients' fracture were two-part basicervical fractures. Using radiography, we characterized the: i) state of reduction, ii) location of the lag screw, iii) tip apex distance (TAD), and iv) sliding distance of lag screw and bone union. Additionally, we performed clinical assessment before injury and at final follow-up. RESULTS: In radiological assessment, we achieved acceptable reduction state in all patients. All lag screws were fixated on appropriate locations. Mean TAD was 17.3 mm (11.0–21.1 mm), which showed insertion point of < 25 mm in all cases. The mean sliding distance of the lag screw was 5.1 mm (0.1–16.0 mm) at the final follow-up. The mean bone union period was 4.8 months (3–10 months) with achieving in all cases. In clinical assessment, Harris hip score, visual analogue scale score and Western Ontario and McMaster Universities Arthritis Index score, all of them significantly improved postoperatively compared with preoperative scores (P < 0.05). CONCLUSION: In elderly patients with basicervical femoral fractures, treatment with intramedullary nailing showed satisfactory results, considered to be a useful method if performed with skilled technique.

Intramedullary nail fixation in treatment of unstable femoral intertrochanteric fractures in elderly patients / 第二军医大学学报

Objective To explore the surgical technique and efficacy of intramedullary nails fixation in treatment of unstable femoral intertroehanteric fracture in elderly patients. Methods We retrospectively analyzed the data of 64 elderly patients with unstable intertrochanteric fractures who were treated with intramedullary nall fixation in our department from Jul. 2014 to Dec. 2015. There were 21 males and 43 females, with a mean age of (81. 9±5. 2) years old, ranging from75 to 96 years. Thirty-one cases were type 31-A2. 2, 23 were type 31-A2. 3, and 10 were type 31-A3. 3 according to AO classification. All patients were treated with intramedullary nail fixation and were divided into Group 1 (limited open reduction and temporary fixation by accessory appliances, n=19) and Group 2 (direct close reduction and fixation, n=45). The operation time, intraoperative blood loss, follow-up and fracture healing time, and Harris score of the hip at the last follow-up of patients were compared between the two groups. Results Compared with the Group 2, the intraoperative blood loss in the Group 1 was significantly higher ([365. 8 ± 81. 2] mL vs [238. 9 ± 56. 7] mL, P0. 05). There were no complications such as deep infection, avascular necrosis of the femoral head, hip varus deformity, femoral shatt fractures, implant failure or fracture in the two groups. Conclusion Unstable femoral intertrochanteric fractures is common in elderly patients. The limited open reduction combined with temporary fixation by accessory appliances is required for good reduction when the closed reduction is hard to reset Although the technique will greatly increase intraoperative blood loss and operation time, it does not affect the overall clinical effectiveness.

Clinical efficacy of PFNA and InterTan nail in treatment of unstable femoral intertrochanteric fractures in elderly patients: A prospective comparative study / 第二军医大学学报

Objective To compare the clinical efficacy of proximal femoral nail antirotation (PFNA) and InterTan nail in the treatment of unstable femoral intertrochanteric fractures in elderly patients. Methods Totally 102 elderly patients (≥65 years old) with A2. 2., A2. 3 and A3 type unstable femoral intertrochanteric fractures were enrolled in this prospective study. The patients were divided into PFNA group (n = 48., with a mean age of [75. 6±6. 7] years) and InterTan group (n = 54, with a mean age of [75. 3±6. 6] years) according to the surgical method. During follow-up, the Harris hip score was recorded at the last outpatient review, and the survival information of patients was obtained by telephone interview and census register database. Results There was no significant difference in baseline characteristics of patients between the two groups. The operation time, intraoperative fluoroscopy time and bleeding volume of patients in the InterTan group were significantly higher than those in the PFNA group (P0. 05). Screw cut-out occurred in 4 patients in the PFNA group, and the hospital death occurred in 3 (2.9%) patients in the two groups. There was no significant difference in the healing time and Harris hip score between the two groups during follow-up (P>0. 05). The median survival time of patients in the PFNA group and the InterTan group was 33. 9 and 27. 4 months, respectively, with no significant difference between the two groups (P>0. 05). Conclusion PFNA and InterTan nail have similar therapeutic effect on elderly patients with unstable femoral intertrochanteric fractures. PFNA is better in improving operation time, intraoperative fluoroscopy time and intraoperative bleeding volume, but has the risk of screw cutting-out.

Safety of early minimally invasive surgical treatment of elderly patients with hip fractures without ceasing anti-platelet drugs / 第二军医大学学报

Objective To explore the safety of early minimally invasive surgery without stopping anti-platelet drugs in treatment of elderly patients with hip fractures. Methods Data of elderly patients with femoral intertrochanteric fractures treated with proximal femoral intramedullary nail between Jan. 2012 and Dec. 2013 were collected, in which 32 patients who took long-term oral anti-platelet drugs due to cardiovascular and cerebrovascular disorders received early closed reduction of minimally invasive intramedullary nail treatment without stopping anti-platelet drugs. Retrospective study was performed to analyze the clinical data of 32 patients, including gender, age, ASA score, fracture AO type, time from injured to surgery, pre-and post-operative hemoglobin, hospital stays, ICU stays, bleeding volume, post-operative blood transfusions, incision complications, systemic complications and intra-1-month and 1-year mortality. Results Thirty-two patients were aged 65-81 years old, with 11 males and 21 females. Twenty-five patients were taking only clopidogrel and 7 patients were taking both clopidogrel and aspirin. The mean time from injured to surgery was (4.8±2.5) d (range 2-13 d), and the mean operative time was (89.0±33.2) min. The mean inter-operation bleeding volume, post-operative drainage volume, post-operation hemoglobin and post-operative blood transfusions were (242.9±83.7) mL, (259.8±94.9) mL, (73±11) g/L, and (390.2±103.1) mL, respectively. The ICU stays was (1.7±0.9) d and the hospital stays was (12.5±2.5) d. Three patients experienced post-operative incision complications (9.4%), with 2 poor incision and 1 incisional hematoma. During the first month after surgery, acute cardiovascular event was found in 3 cases (9.4%), acute stroke in 2 cases (6.2%), pneumonia in 2 cases (6.2%), and pressure ulcer in 1 case (3.1%). Three patients (9.4%) died during the first month after surgery and 12 patients (37.5%) died in the first year. Conclusion Early minimally invasive surgery without stopping anti-platelet drugs in elderly patients with femoral intertrochanteric fractures will not increase the incidence of local and systemic complications within 1 year.

NON-UNIONS AFTER FIXATION OF HUMERAL FRACTURES USING HACKETHAL'S BUNDLE NAILING TECHNIQUE

ABSTRACT Objective: The aim of the study was to identify factors contributing to the development of non-union after fixation of diaphyseal humeral fractures using Hackethal's intramedullary nailing technique. Methods: In the time period from 2001 to 2010 156 patients with diaphyseal humeral fractures were treated surgically using Hackethal's technique. Six of them (3.8%) developed non-union. This group included three women and two men aged 63-69 years and one woman aged 37 years. The following parameters of the patients were recorded: age, gender, comorbidities, substance abuse, mechanism of injury, fracture type and location according to the AO/ASIF classification, and the operative technique. Results: A non-union developed in six patients treated with Hackethal´s method (3.8%). Five of six non-unions (83%) were observed in patients in their sixties. In the subgroup of sexagenarians, non-union developed in 20.8% of surgically treated patients, as compared to 3.8 % in entire group. In the union group, fractures have been caused by high energy trauma in 52% of patients. In patients who developed non-union, high energy trauma caused 67% of fractures. With correct surgical technique the development of a non-union was observed in 0.7% of patients, with incorrect technique in 35.7% (p<0.001). Conclusion: Treatment of diaphyseal humeral fractures with Hackethal's intramedullary elastic bundle nailing resulted in an overall high union rate. Factors contributing to the development of non-union were extension of this method to AO type B3 and C fractures and technical imperfection during implantation. Level of Evidence III, Prospective, Case-Control Study.

Fracturas diafisiarias de la clavícula: revisión de la evidencia publicada / Diaphyseal clavicle fracture: review of published evidence

Introducción: La clavícula es uno de los huesos más propensos a lesiones, debido a su localización subcutánea y relativamente anterior; su manejo, ortopédico o quirúrgico, sigue siendo controvertido. Por este motivo, el objetivo que guió la revisión fue justamente identificar las tendencias actuales en cuanto al diagnóstico y al manejo de la fractura de clavícula. Materiales y Métodos: Se realizó una revisión de artículos, usando las bases de datos PubMed/Medline, ScienceDirect, Embase, Ovid, SpringerLink. Se seleccionaron 57 referencias, con base en la calidad de la evidencia presentada por las mismas. Resultados y Discusión: La elección del tratamiento más adecuado para la fractura de clavícula sigue constituyéndose en un reto para el ortopedista. El análisis se debe basar en las características individuales de cada paciente, de una cuidadosa consideración de los beneficios y en los daños relativos de cada intervención, como también en las preferencias del paciente. Para avanzar en la definición de estándares terapéuticos se requiere la realización de estudios que tengan en cuenta un mayor número de individuos especialmente en los extremos de la vida y que permitan generar un mejor nivel de evidencia.

Introduction: The clavicle is one of the bones more prone to injury because due to their subcutaneous and relative anterior position. Its management, either orthopedic or surgical, remains controversial. Therefore, the objective that guided this review was to identify current trends in the diagnosis and management of broken clavicle. Materials and Methods: a review of articles was conducted using PubMed / Medline, ScienceDirect, Embase, Ovid, and SpringerLink databases. Fifty-seven (57) references were selected based on the quality of the evidence they presented. Results and Discussion: Choosing the most appropriate treatment for broken clavicle continues to be a challenge for the orthopedist. The analysis should be based on the individual characteristics of each patient, a careful consideration of the benefits and the relative harms of each intervention, as well as patient preferences. To advance in the definition of therapeutic standards, are required the performance of studies that take into account a greater number of individuals particularly in the extremes of life, which allow generating a higher level of evidence.

Treatment of two-part fractures of the surgical neck of the humerus using a locked metaphyseal intramedullary nail proximally with angular stability / Tratamento das fraturas em duas partes do colo cirúrgico do úmero com o uso de haste intramedular metafisária bloqueada proximalmente com estabilidade angular

To evaluate the functional results from patients with surgical neck fractures treated with a locked metaphyseal intramedullary nail and angular stability. METHODS: Twenty-two patients between the ages of 21 and 69 years were evaluated prospectively between January 2010 and January 2011. Their time taken for consolidation, age, sex, complications and functional results were correlated using the modified protocol of the University of California at Los Angeles (UCLA). RESULTS: The mean time taken for consolidation was 9.26 weeks ± confidence interval (CI) of 0.40 weeks. One case (4.5%) did not become consolidated. There were no cases of infection. There was one case (4.5%) of adhesive capsulitis with good evolution through clinical treatment. Five patients (22.7%) presented occasional mild pain and one case (4.5%) reported medium-intensity pain associated with the subacromial impact of the implant. The mean score on the modified UCLA scale was 30.4 ± CI 1.6 points, obtained at the end of 12 weeks of evaluation: 18 cases (81.8%) with "excellent" and "good" scores, three cases (13.6%) with "fair" scores and one case (4.5%) with a "poor" score. CONCLUSION: In the group of patients evaluated, treatment of two-part surgical neck fractures by means of a locked metaphyseal intramedullary nail and angular stability demonstrated satisfactory functional results and a low complication rate, similar to what is seen in the literature...

Avaliar os resultados funcionais de pacientes com fraturas do colo cirúrgico tratados com haste intramedular metafisária bloqueada (HIMB) e estabilidade angular. MÉTODOS: Foram analisados 22 pacientes prospectivos entre 21 e 69 anos, avaliados entre janeiro de 2010 e janeiro de 2011, e correlacionados tempo de consolidação, idade, sexo, complicações e resultado funcional com o protocolo da University of California at Los Angeles (UCLA) modificado. RESULTADOS: O tempo de consolidação médio foi de 9,26 ± intervalo de confiança (IC) de 0,40 semana. Um caso (4,5%) não se consolidou. Não houve infecção. Houve um caso (4,5%) de capsulite adesiva com boa evolução ao tratamento clínico. Cinco pacientes (22,7%) apresentaram leve dor eventual e um caso (4,5%) referiu dor de média intensidade associada a impacto subacromial do implante. O escore médio UCLA modificado foi 30,4 ± IC 1,6 ponto obtidos no fim de 12 meses de avaliação, 18 casos (81,8%) com escore "excelente" e "bom", três casos (13,6%) com escore "razoável" e um caso (4,5%) com escore "ruim". CONCLUSÃO: No grupo de pacientes avaliados, o tratamento das fraturas em duas partes do colo cirúrgico com HIMB e a estabilidade angular demonstraram resultados funcionais satisfatórios e baixo índice de complicações, semelhantes aos encontrados na literatura...

Iatrogenic Femur Proximal Shaft Fracture during Nailing Using Lateral Entry Portal on Femur Shaft Fracture / 대한정형외과학회잡지

PURPOSE: We attempted to determine the cause of iatrogenic fractures and to prevent their occurrence during nailing using lateral entry portal on femur shaft fracture. MATERIALS AND METHODS: We conducted a retrospective study of 160 patients who had been treated with nailing using a lateral entry portal for femur shaft fractures. We compared 18 patients (group 1) with iatrogenic fractures on the femur proximal portion with 18 patients (group 2) who had no fracture, and then surveyed and analyzed the characters of the fracture, position of the portal, nail size, and complications. RESULTS: In distribution of primary femur shaft fractures, there were eight cases of proximal portion, nine cases of mid-portion, and one case of distal portion. In that of iatrogenic fractures, there were nine cases of medial fractures, five cases of lateral fractures, four cases of anterior fractures. In the entry portal of group 1, mean 1.82 mm leaned to the lateral side in antero-posteriorview, mean 5 mm leaned to the anterior side in lateral view. Anterior leaning of the entry portal was statistically significant with iatrogenic fracture. CONCLUSION: The more the entry portal leaned to the lateral and anterior side, the greater the frequency of occurrence of iatrogenic fractures. To prevent iatrognic fracture, through preoperative X-ray, we must have a precise understanding and measure anatomical bowing and variance of the femur, and must pay attention to operative procedures during the operation.

Alteration of the Patella Tendon Length after Intramedullary Nail in Tibial Shaft Fractures

PURPOSE: To compare and analyze length change of patella tendon after intramedullary nailing of tibial shaft fracture using transtendinous approach. MATERIALS AND METHODS: Thirty-two cases were analyzed from December, 1999 to December, 2005. Insall Salvati ratios were estimated. Severity of initial trauma, duration of nail retension, knee function and pain on change of length of patellar tendon was evaluated. RESULTS: Mean duration of nail retention was twenty-two months. The shortening of patella tendon was observed in 25 cases (p0.05, p=0.778). Lysholom score decrease to 89.5. There was no significant difference between the shortening of patellar tendon length and knee pain (p=0.058). CONCLUSION: After intramedullary nailing for closed tibia fracture, shortening of patellar tendon length is observed. That is irrelevant to the fracture type and the duration of nail retension. The shortening of patella tendon length may contribute to decreasing of knee function, but it was no significance of knee pain after intramedullary nailing.

Resultados do tratamento das fraturas da diáfise do fêmur ipsilaterais às do colo ou transtrocantérica / Outcomes in treatment of diaphiseal femur fractures ipsilateral to the neck or transtrocanteric fracture

OBJETIVO: Avaliação radiográfica, funcional e das complicações do tratamento cirúrgico das fraturas diafisárias do fêmur associadas à fratura transtrocantérica ou do colo do mesmo fêmur. MÉTODOS: De 2002 a 2007 foram tratados 17 pacientes. Eram masculinos 88 por cento e a idade média foi de 31 anos e três meses. Dez (59 por cento) apresentavam associação com fratura do colo do fêmur e sete (41 por cento) com a fratura transtrocantérica. Foram avaliados a dor residual e a amplitude de movimento articular do quadril e joelho, a consolidação radiográfica e o tipo de implante utilizado, pela avaliação atual e retrospectivamente pelo prontuário, com um seguimento médio de 48 meses. RESULTADOS: Todas as fraturas transtrocantéricas evoluíram para consolidação sem deformidade residual. Das fraturas do colo, três (30 por cento) apresentaram retardo da consolidação, e duas consolidaram em varo. Dois pacientes apresentaram retardo de consolidação da fratura diafisária. Todas as fraturas associadas trans-diáfise apresentaram resultado funcional excelente ou bom. Das associadas colo-diáfise, sete (70 por cento) apresentaram resultado funcional excelente ou bom, dois regular e um ruim. CONCLUSÃO: As fraturas associadas da diáfise do fêmur com fratura transtrocantérica apresentaram melhor resultado radiográfico e funcional com menos complicações que a associação da fratura diafisária com a fratura do colo do fêmur.

OBJECTIVE: To perform a radiographic and functional evaluation of the complications of diaphyseal fractures of the femur associated with ipsilateral fractures of the trochanter or the neck of the femur. METHODS: From 2002 to 2007, seventeen patients were treated, of which 88 percent were men, with a mean age of thirty-one years and three months. Ten (59 percent) had associated fractures of the femoral neck and seven (41 percent) had associated trochanteric fractures. The final range of motion of the hip and knee, the radiographic fracture consolidation, and the type of implant, used were evaluated, both at the time and retrospectively, based on the patients' records. The mean follow-up time was 48 months. RESULTS: All the trochanteric fractures consolidated without residual deformities. Of the femoral neck fractures, three (30 percent) presented delayed consolidation and two consolidated with in varus deformity. Two patients had delayed diaphyseal consolidation. All the ssociated diaphyseal/trochanteric fractures had good or excellent functional outcomes. Of the associated neck fractures, seven (70 percent) had excellent or good results, two had regular results, and one had a bad result. CONCLUSIONS: The association of diaphyseal with trochanteric femur fractures showed better radiographic and functional results, with less complications, than the association of diaphyseal and femoral neck fractures.

Osteossínteses com hastes intramedulares em crianças: [revisão] / Osteosynthesis with intramedullary nails on children: [review]

Os autores fazem uma ampla revisão da literatura destacando o emprego de hastes intramedulares flexíveis no tratamento de fraturas em crianças. Destacam o tratamento das fraturas diafisárias do fêmur e dos ossos do antebraço e enfatizam também a importância da abordagem não cirúrgica. A idade e o peso limite das crianças ainda não estão bem definidos para o emprego do método. A retirada de implantes tem destaque controverso na literatura, com tendência da permanência dos implantes.

The authors present a comprehensive review of the literature emphasizing the use of flexible intramedullary nails in the treatment of fractures in children, focusing the treatment of femoral shaft and forearm fractures and emphasizing the importance of the non-surgical approach. Children's age and weight threshold are not well defined for the use of the method. The removal of implants is a controversial matter in the literature, with a trend towards keeping the implants.

Osteossíntese provisória das fraturas expostas da diáfise da tíbia com fixador externo não transfixante / Provisional osteosynthesis of open diaphyseal fractures of the tibia with pinless external fixator

OBJETIVO: Avaliar a eficácia do fixador externo não transfixante como tratamento provisório das fraturas expostas Gustilo e Anderson graus I e II. MÉTODOS: Em estudo prospectivo, 36 fraturas expostas da diáfise da tíbia foram tratadas seqüencialmente com fixador não transfixante seguido por haste intramedular maciça bloqueada não fresada. A média de idade foi de 28 anos e 88,9 por cento dos pacientes eram do sexo masculino. O mecanismo de trauma foi: acidente motociclístico em 47,1 por cento, atropelamento em 36,1 por cento. Entre os pacientes, nove (25,0 por cento) apresentaram lesões associadas. Segundo a classificação AO, 12 pacientes (33,3 por cento) haviam sofrido fraturas do tipo A, 18 (50,0 por cento) do tipo B e seis (16,6 por cento) fraturas tipo C. Segundo a classificação de Gustilo e Anderson, 13 pacientes (36,1 por cento) eram portadores de fraturas expostas grau I e 23 (63,9 por cento), de fraturas grau II. O tempo médio de fixação externa foi de seis dias, variando de três a 22 dias. RESULTADOS: Entre os pacientes, 32 evoluíram satisfatoriamente. As complicações relacionadas ao fixador existiram em quatro pacientes: em três houve impossibilidade de conversão com o fixador instalado e em um ocorreu neurapraxia do fibular superficial. CONCLUSÃO: O fixador externo não transfixante é útil como fixação provisória das fraturas expostas da diáfise da tíbia quando se visa a conversão para osteossíntese intramedular.

OBJECTIVE: To evaluate the effectiveness of the pinless external fixator for the provisional treatment of Gustilo and Anderson grade I and II open fractures. METHODS: In a prospective study, 36 open diaphyseal fractures of the tibia were sequentially treated with a pinless fixator followed by massive, blocked, non-edged intramedullary nail. Mean age was 28 years, and 88.9 percent of the patients were male. The mechanism of trauma was: motorcycle accident in 47.1 percent, being run over by vehicle in 36.1 percent. Among the patients, 9 (25.0 percent) had associated lesions. According to the AO classification, 12 patients (33.3 percent) had suffered type A fractures, 18 patients (50.0 percent), type B fractures, and 6 patients (16.6 percent), type C fractures. According to the Gustilo and Anderson classification, 13 patients (36.1 percent) had grade I opened fractures, and 23 (63.9 percent) had grade II fractures. The mean time of external fixation was six days, ranging from 3 to 22 days. RESULTS: 32 patients had a satisfactory evolution. Fixator-related complications were seen in four patients: in three, the installed fixator could not be converted, and one had surface fibular neurapraxia. CONCLUSION: The pinless external fixation helps as provisional fixation of open diaphyseal fractures of the tibial when the intention is to later convert to intramedullary osteosynthesis.

Causes analysis and management of postoperative complications after femoral fractures treated with interlocking intramedullary nails / 中国矫形外科杂志

[Objective]To investigate the causes and treatment methods of postoperative complications of femoral fractures treated with interlocking intramedullary nails.[Method]A total of 243 cases of femoral fractures from Jan 1999 to Dec 2004 were treated with interlocking intramedullary nails.There were 14 cases having complications,delayed union in 1,nonunion in 3,nailing failure in 6(locking scerw loosen in 4,locking scerw folding in 1,locking scerw breakage in 2),nail breakage in 1,re-fracture in 1 and knee ankylosis in 1.Two cases with delayed union to convert the fixation from statictody namicin time;3 cases with nonunion were treated with bone grafting.Breakage nail and re-fractuer cases were treated with enlarging intramedullary tunels,exchanging nails and bone grafting.One of locking scerw loosen were treated with exchanging nails and bone grafting.Knee ankylosis were treated with quadriceps plasty.[Result]Through treatment,the delayed union and the nonunion were all healed and got recovery of knee function.[Conclusion]Though it has certain complications,the interlocking intramedullary nails used for femoral fractures have more advantages than other internal fixations.It needs to take valid measures to reach a satisfying result when complication appears.