Humeral shaft fracture with an intact wedge fragment: mipo vs conventional plating / Fraturas diafisárias de úmero com cunha intacta: mipo x estabilidade absoluta com placa

ABSTRACT Objectives: Evaluate bone healing time, consolidation, and the complication rate between the minimally invasive plate osteosynthesis and open reduction with plate osteosynthesis in humeral diaphyseal fractures with an intact wedge (AO 12B2). Methods: A retrospective study was carried out between 2016 and 2020. The medical records and radiographs of 18 patients were analyzed, and data were collected regarding the time of consolidation, age, sex, plate size, number of screws, complications such as iatrogenic injury damage to the radial nerve, material failure, and postoperative infection. Results: No statistically significant differences were observed in the variables of age, sex, plate size, and number of screws used or in the RUSHU index (Radiographic Union Score for Humeral fractures). There were no postoperative infections, material failure, or need for reoperation, nor cases of secondary radial nerve injury. After one year, all patients had a consolidation index analyzed by RUSHU >11. Conclusion: both techniques showed similar results, with a high consolidation rate and low rates of complications or iatrogenic damage to the radial nerve. Evidence level III; Retrospective comparative study .

RESUMO Objetivos: Comparar o tempo de consolidação e o índice de complicações entre os métodos de osteossíntese com placa minimamente invasiva e estabilidade absoluta através da placa nas fraturas diafisárias do úmero com cunha intacta (AO 12B2). Métodos: Foi realizado um estudo retrospectivo entre os anos de 2016 e 2020. Foram analisados os prontuários e radiografias de 18 pacientes e coletados dados referentes a: tempo de consolidação, idade, sexo, tamanho da placa, número de parafusos, presença de complicações como lesão iatrogênica do nervo radial, falha do material e infecção pós operatória. Resultados: Não foram observadas diferenças estatisticamente significativas nas variáveis de idade, sexo, tamanho da placa e número de parafusos utilizados, ou no índice de RUSHU (Radiographic Union Score for Humeral fractures). Não houve casos de infecção pós-operatória, falha do material ou necessidade de reoperação, nem casos de lesão secundária do nervo radial. Após 1 ano todos os pacientes tiveram índice de consolidação analisado pelo RUSHU >11. Conclusão: Ambas as técnicas se mostraram com resultados similares, com alta taxa de consolidação e baixas taxas de complicações ou lesão iatrogênica do nervo radial. Nível de evidência III; Estudo retrospectivo comparativo .

Comparison of single- and double-plate fixation techniques in the treatment of nonunions of the humeral shaft / Comparação de técnicas de fixação de placa simples e dupla no tratamento de pseudoartrose do corpo do úmero

ABSTRACT Introduction Humerus shaft fractures may be treated conservatively or surgically. In 2.5% to 13% of cases, nonunion is observed, and it leads to severe pain and morbidity. Plate osteosynthesis has become popular in the treatment of nonunion of the humeral shaft. In this study, we compared the clinical outcomes of patients with humerus shaft nonunion whom we treated with single- or double-plate fixation. Materials and Methods Fifty-three patients diagnosed with aseptic humeral shaft nonunion and treated with plate fixation were included in the study. Patients were evaluated according to the number of plates (single vs. double plates). The two groups were subjected to statistical evaluation according to their clinical and radiographical results. Results The average age of the patients was 53 years (range: 1-86); 28 (52.8%) were female and 25 (47.2%) were male. The union rate was 90.32% for single plate and 90.91% for double plate fixation. There was no statistically significant difference between single and double plates in the clinical and radiographical results (union time, union rate, Q-DASH score) (p > 0.05). There was a significant correlation between age and union times / Q-DASH scores according to the Spearman correlation test (p < 0.05). Transient radial nerve neuropraxia developed in 2 patients and 1 patient suffered from an infection that was treated with debridement and antibiotic therapy. Conclusion In our study, similar good results were obtained with single and double plates. In treatment of humeral shaft nonunions, a second plate is not needed if enough stability is provided with single plate fixation. Level of evidence III, Retrospective comparative study.

RESUMO Introdução As fraturas do corpo do úmero podem ser tratadas de modo conservador ou cirúrgico. Em 2,5% a 13% dos casos, observa-se pseudoartrose, que causa dor intensa e morbidade. A osteossíntese com placas tornou-se popular para tratamento da não união da diáfise do úmero. Neste estudo, comparamos os resultados clínicos de pacientes com pseudoartrose do corpo do úmero que tratamos com fixação de placa simples ou dupla. Materiais e Métodos Cinquenta e três pacientes com diagnóstico de pseudoartrose asséptica do corpo do úmero tratados com placa de fixação foram incluídos no estudo. Os pacientes foram avaliados de acordo com o número de placas (placa simples vs. dupla). Os dois grupos foram submetidos à avaliação estatística de acordo com seus resultados clínicos e radiográficos. Resultados A média de idade dos pacientes foi de 53 anos (variação: 1 a 86); 28 (52,8%) eram do sexo feminino e 25 (47,2%) do sexo masculino. A taxa de união foi de 90,32% para placa simples e 90,91% para placa dupla. Não houve diferença estatisticamente significante entre a osteossíntese com placas simples ou duplas nos resultados clínicos e radiográficos (tempo de união, taxa de consolidação e escores do Q-DASH) (p > 0,05). Houve correlação significativa entre idade e tempo de união/escores do Q-DASH, de acordo com o teste de correlação de Spearman (p < 0,05). A neuropraxia transitória do nervo radial desenvolveu-se em dois pacientes e um paciente teve infecção tratada com desbridamento e antibioticoterapia. Conclusões Em nosso estudo, resultados igualmente bons foram obtidos tanto com placas simples quanto duplas. No tratamento de pseudoartroses do corpo do úmero, uma segunda placa não é necessária se houver estabilidade suficiente com a fixação com placa única. Nível de evidência III, Estudo comparativo retrospectivo.

Comparative Study of External Fixator versus Internal Fixation Using Interlocking Nail in Open Diaphyseal Fractures of Tibia: An Hospital Based Prospective Study

Background: External fixation and internal fixation usingintramedullary nails are two well-accepted and effectivemethods, but each has been historically related tocomplications. We therefore performed a prospective study tocompare the early functional recovery and overall results withthese two methods of management.Materials & Methods: This prospective randomized study wascarried out on the patients admitted in the Department ofOrthopaedics, Dr S.N. Medical College, Jodhpur. The studyincluded 30 patients of Open Diaphyseal Fractures of Tibia. Ofthese, 15 patients were treated by intramedullary interlockingnailing and the remaining 15 patients by External Fixator asprimary fixation method. Patient able to walk without supportwithout pain were considered union clinically. Johner AndWruhs Criteria, 1983 were used to evaluate functionaloutcome.Results: Our study showed that the mean age was 32.4 yearsin ILN group and 34 years in external fixation group. The maleto female ratio was approximate 4:1. In present study showedthat the road traffic accident were most of the injury (80%) ingroup A as compared to group B (93.33%). The farmer & laborwas higher incidence of tibial fractures, which are higherdemanding activity and lower incidence of fractures wasoccurred in low demanding activity occupation. The outcome ofour study showed that excellent in 73.33% cases in group A ascompared to 53.33% in group B. Poor outcome maximum ingroup B was 20% cases as compared to 6.66% in group A.Conclusion: We concluded that in open tibial shaft fractureintramedullary interlocked nailing is excellent modalities,leading to accepted union with a mild delay but permissibleearly weight bearing and low patient morbidity

Morphological And Morphometric Study Of Nutrient Foramina Of Femur In South Indian Population

Background: The knowledge of variations in the position of nutrient foramina and hence nutrient arteries isimportant for orthopedicians and radiologists for various procedures.Introduction: The major blood supply to long bones occurs through the nutrient arteries, which enter through theforamina called nutrient foramina. The blood supply from nutrient artery is essential during the growing period,also during the early phases of ossification, and in procedures such as bone grafts, transplant techniques inorthopaedics. The present study analyzed the position and number of nutrient foramina in the diaphysis of fiftyadult femora.Aim: to determine the number, direction, position of nutrient foramen and whether the nutrient foramina obeythe general rule that is, directed away from the growing end of the boneMaterials and Method: The present study has been undertaken in Fifty dry adult femora of South Indian origin inthe Department of Anatomy, M.S Ramaiah Medical College, Bangalore. The number, directions, position of nutrientforamen in femur were measured with a digital Vernier caliper. The data were tabulated as mean + SD andstatistically compared between the right and left sides.Results: A total of 75 foramina were examined in the 50 bones. 40 in Right sided femur and 35 in left sided femur.46% bones had single foramina and 52% bones had double foramina. Foramen was absent in 2% bones. Allnutrient foramina in the femur were directed proximally, away from the growing end. 16% of the foramina werelocated in the proximal third of the bone and the rest 84% were located in the middle third of the bone. There wasno significant difference in location of foramina between right and left sided bones.Conclusion: This study will provide the ethnic data for comparison among various populations. It is also helpfulin interpretation of radiological images and for orthopedic procedures. Precise knowledge of usual and anomalousposition of nutrient foramina and hence the nutrient artery may help the orthopaedician for the internal fixationat appropriate place in the long bone. The location of nutrient foramen is important for bone grafts, tumourresections, in traumas, congenital pseudoarthrosis and more recently in microsurgical vascularised bonetransplantation

A Study On Nutrient Foramen Of Humeri And Its Clinical Significance

Background: A Nutrient Foramen [NF] or vascular channel is a small tunnel in cortex of long bones which is apathway for the entry of nutrient artery. Nutrient artery has pivotal contribution of blood supply to long bonesand plays a major role in Orthopaedic Surgical procedures like bone transplantation, bone grafting thus avoidingavascular necrosis of fractured bonesAims: To determine morphological parameters (variation in number, location, direction) and morphometricparameters (variation in size and foraminal index [FI] ) of nutrient foramina in Humeri.Materials and methods: Present study was conducted on a total of 80 dried human adult Humeri of either sexesor sides which were obtained from fellow students and Department of Anatomy of ESIC medical college &PGIMSR, Bangalore. Infantometer was used to calculate length of humeri, hand held lens was used to detectnutrient foramen under adequate illumination. Hypodermic needles [18G to 26G, where G is gauge], were used tomeasure the size of NF. Foraminal index was also calculated.Results: In our study mean length of humerus was 29.95cm.FI ranged from 39.34 -81.02.Majority (62.50%) ofhumeri have one NF, (28.75%) have two NF,(7.5%) with three nutrient foramina and (1.25%) had no NF. Majority ofNF (43.43%) were present on antero-medial surface, (37.37%) on medial border, (14.14%) on posterior surface,(2.02%) on both anterolateral surface and anterior border, 1.01% in lateral border. (90.09%) of NF were locatedin Zone II (middle third), (8.08%) in Zone III (lower third) and (1.01%) in zone I (Upper third). Majority (41.41%)were of large gauge, (34.34%) of medium gauge and (24.24%) of small gauge. All NF directed towards distal endof humerus.Conclusion: For healing of fractures, blood supply plays a vital role. Awareness about variations in NF isimportant because damage to nutrient artery due to any cause like trauma, road traffic accidents will causeinadequate blood supply .Thus vascular and bone transplant surgeons can reconstruct damaged artery andavoid ischemia of graft during open reduction procedures and transplant surgeries.

Management Of Comminuted Tibial Diaphyseal Fractures By Means Of Interlocking Nails

Introduction:This study assesses the outcome of interlocking tibia nail in comminuted fractures of tibial diaphysis. Objectives: To study the functional outcomes of interlocking tibia nail in comminuted tibial diaphyseal fractures, with respect to time to bony union, mobility achieved, complications of the procedure and secondary procedures. Material and Methods: The present prospective study included 25 patients of comminuted fracture shaft of tibia admitted to the Department of Orthopaedics at MMIMSR, Mullana and at Civil Hospital, Rajpura who were managed with interlocking tibia nail. Results:All 25 cases united with interlocking nailing. 1 case needed additional exchange nailing and bone grafting. 3 cases had a malunion but had an acceptable functional outcome. Conclusions: Due to the simple surgical technique, good healing rate and minimum complications, it is recommended that interlocking tibia nail should be used in comminuted fractures of tibial diaphysis

An Osteological Study On Nutrient Foramina Of Human Dry Adult Ulna Bones

Background: Nutrient artery is the major source of blood supply to long bones. This artery enters the shaft of thelong bone through nutrient foramen. Vascular insults to the Ulna during fracture dislocation or during surgicalcorrection of fracture may result in delayed healing or non-union of fracture.Materials and Methods: The present study was undertaken on 100 dry adult ulna bones of unknown sex (50 eachof right and left sides) from Department of Anatomy, Gadag Institute of Medical Sciences, Gadag, Karnataka. Theulna bones were numbered using a marker pen. Using Hepburn’s osteometric board, length of the bone wasmeasured. The size and direction of the nutrient foramina was assessed using 19, 22 and 25 gauge hypodermicneedles.Results: Among the total 100 ulna studied, 86 had single nutrient foramina, 13 had two nutrient foramina and 1had three nutrient foramina. 59.13% of nutrient foramina were of medium sized and 20% were of large size.85.22% of nutrient foramina were located in upper third of shaft of ulna; 12.17% in middle third and 2.61% inlower third. 1% of NF were directed horizontally, 2% lower oblique and remaining upper oblique. No correlationcould be demonstrated between the length of ulna and number of nutrient foramina in the present study.Conclusion: The present study conducted on nutrient foramina of 100 dry adult ulna arrived at a conclusion thatmajority of nutrient foramina were located in the upper third of the shaft in anterior surface. The results of thepresent study are consistent with most similar studies. The knowledge of location, direction and number ofnutrient foramen on shaft of ulna is of utmost importance to the Orthopaedicians and Oncologists.

Fisioterapia con compresión cíclica en la estrategia de reconstrucción funcional en la no-unión infectada de diáfisis de húmero en un paciente pediátrico: reporte de un caso / Physiotherapy With Cyclic Compression In The Strategy Of Functional Reconstruction In The Infected Non-Union Of Diaphysis Of Humerus In A Child: Report Of A Case

Introducción Las fracturas de humero diafisiarias abarcan del 5% de todas las fracturas del cuerpo humano. La infección asociada a la no-unión de humero en niños es una patología extremadamente rara e incapacitante, que de no ser tratada adecuadamente puede comprometer de manera definitiva la función de toda la extremidad. Reporte de Caso Se reporta el caso de un paciente masculino de 9 años de edad quien consulta a nuestra institución con la no-unión infectada de humero izquierdo, asociado a pérdida de sustancia ósea, muscular y cutánea, con lesión del nervio radial y con una nula funcionalidad de la extremidad. Se plantea una estrategia de reconstrucción en 5 fases y se presenta el uso de terapias de compresión cíclica como factor clave para la consolidación de la fractura. Discusión En este caso complejo y poco común, se cumplieron todos los objetivos propuestos en el tratamiento de una no-unión infectada, la erradicación de la infección con la adecuada consolidación ósea, recuperación funcional y estética en un lapso de 10 meses.

Background Diaphysis humerus fractures constitute 5% of all fractures in the human body. The infection associated with the non-union of humerus in children is an extremely rare and incapacitating condition, which, if not treated properly, can definitively compromise the function of the whole limb. Case Report The case is presented of a 9 year-old male patient who visited this hospital with a left humerus infected non-union, associated with loss of bone, muscular and cutaneous substance, with radial nerve injury, and a lack of limb functionality. A 5-stage reconstruction strategy is presented, and the use of cyclic compression therapies is as a key factor for fracture consolidation. Discussion In this complex and uncommon case, all the proposed objectives in the treatment of an infected non-union: the eradication of the infection with adequate bone consolidation, functional recovery, and aesthetics were fulfilled within a period of 10 months.

Lexema phy-sis en terminologia anatomica / Lexema phy-sis in terminologia anatomica

Múltiples palabras habituales utilizan raíces grecolatinas, como el caso de las estructuras mencionadas en Terminologia Anatomica. Un grupo de términos anatómicos originados en la Antigua Grecia emplean el lexema griego phy-sis o su homólogo ­fisis en español, es por ello que este trabajo tiene por objetivo analizar su significado y etimología en el diccionario de la Universidad de Salamanca, Diccionario de Términos Médicos de la Real Academia Nacional de Medicina y en el Diccionario Etimológico griego-latín del español, para contribuir a la comprensión y aprendizaje de Terminologia Anatomica en el estudio de la Anatomía Humana. Se propone que los estudiantes que cursan la asignatura de Anatomía Humana posean conocimientos básicos de latín y griego, para facilitar su aprendizaje y correcta aplicación de los términos.

Multiple common words use Greek and Latin roots, as is the case of structures mentioned in Terminologia Anatomica. For instance, a number of anatomical terms originating in ancient Greece, use the Greek lexeme ph-sis or its homologue -fisis in Spanish. Therefore, this work aims to analyze meaning and etymology of this term in the Universidad de Salamanca dictionary, the Royal National Academy of Medicine Dictionary of Medical Terms, and in the Spanish etymological Greek-Latin dictionary, to contribute to the understanding and learning of Terminologia Anatomica in the study of Human Anatomy. To facilitate learning and the correct use of Terminologia Anatomica, we propose that students in Human Anatomy course assignments acquire a basic knowledge of Latin and Greek.

Atypical Fracture-Like Insufficiency Fracture of the Tibia with Prolonged Bisphosphonate Drug: A Case Report

Atypical femoral fracture related to a long-term bisphosphonate therapy has commonly been reported; however, a fracture at the site other than the femur has rarely been reported to date. Herein, we report a case of a patient on long-term bisphosphonate therapy who presented atypical tibial insufficiency fracture at the anterolateral aspect of diaphysis, without trauma. We, for the first time in Korea, present this case with a literature review.

Osteosarcoma con presentación atípica en tercio medio de diáfisis de fémur. Reporte de un caso clínico y revisión de la literatura / Atipic osteosarcoma in the femoral shaft case report and review of the literature

Resumen: El osteosarcoma es el tumor maligno primario más frecuente del hueso. Se caracteriza por la formación de osteoide por las células tumorales. Su localización más frecuente es en las metáfisis de los huesos largos; sin embargo, la presentación puramente diafisaria se reporta en 10% de los casos. Se expone el caso de paciente del género femenino de 25 años que inició padecimiento cuatro meses previos a nuestra valoración al presentar dolor y aumento de volumen en tercio medio de muslo derecho, sin causa aparente. Las radiografías del fémur revelaron un tumor en la diáfisis del mismo. La resonancia magnética mostró extensión a partes blandas, sin compromiso del paquete neurovascular. Se tomó biopsia incisional con reporte histopatológico de osteosarcoma osteoblástico y condroblástico. Se clasificó como Enneking IIB, AJCC IIB. Inició tratamiento con tres ciclos de quimioterapia neoadyuvante y posteriormente se le realizó resección intercalar de fémur más reconstrucción con clavo centromedular y espaciador diafisario. El reporte histopatológico evidenció necrosis de 95% (Huvos grado III). Se continuó con tres ciclos de quimioterapia adyuvante. A 18 meses de concluida la quimioterapia adyuvante la paciente se encuentra sin datos de actividad tumoral local o a distancia, tolerando la deambulación sin auxiliares de la marcha. A pesar de que el osteosarcoma no se presenta de forma habitual en el tercio medio de la diáfisis de los huesos largos, debe siempre tomarse en cuenta como un diagnóstico diferencial con otras patologías de localización más frecuente en dicha región. Esta localización nos permite una amplia gama de alternativas quirúrgicas con la preservación de las articulaciones adyacentes.

Abstract: Osteosarcoma is the most frequent primary malignant bone tumor. It is characterized by osteoid production by tumor cells. Its most frequent location is in the metaphyses of long bones, but a purely diaphyseal presentation is reported in 10% of cases. We report the case of a female 25 year-old patient whose symptoms of pain and swelling of the right mid thigh started four months before, without an apparent cause. Femur X-rays showed a tumor in the femoral shaft. The MRI showed extension to soft tissues with no compromise of the neurovascular bundle. The histopathologic report of the incisional biopsy was osteoblastic and chondroblastic osteosarcoma, classified as Enneking IIB, AJCC IIB. Treatment consisted of three cycles of neoadjuvant chemotherapy. Then intercalary femur resection plus reconstruction with centromedullary nailing and a diaphyseal spacer were performed. The histopathologic report was 95% necrosis (Huvos grade III). Three cycles of adjuvant chemotherapy were given and now, 18 months after completing the latter, the patient has no signs of local or distant tumor activity, and she can walk unassisted. Despite the fact that osteosarcoma does not occur usually in the mid shaft of long bones, we should always bear it in mind as part of the differential diagnosis for other conditions that occur more frequently in that region. Such location allows for a broad gamut of surgical approaches that spare the adjacent joints.

Morphological variations of nutrient foramina in lower limb long bones.

Background: The major blood supply to long bone is from the nutrient arteries, which enter through nutrient foramina. Nutrient foramen is an opening into the bone shaft which give passage to the blood vessels of the medullary cavity of a bone The direction of the nutrient foramen of all bones is away from growing end and has a particular position for each bone. Objective: The aim of the present study was to study the topographic anatomy and morphology of the nutrient foramina in human adult lower limb long bones. Material and Method: The study was performed on 150 lower limb long bones which included 50 femora, 50 tibiae and 50 fibulae. The bones were obtained from department of anatomy, Punjab Institute of Medical Sciences, Jalandhar. Results: The variations were found in number and location of nutrient foramen in different lower limb long bones. In femur double and triple foramina were observed. Absence of nutrient foramen was observed in femur and fibula. Conclusion: The topographical knowledge of these foramina is useful in certain operative procedures, in orthopedics as well as in plastic and reconstructive surgery, to avoid damage to the nutrient vessels.

Effect of the Starting Point of Half-Pin Insertion on the Insertional Torque of the Pin at the Tibia

PURPOSE: The authors have observed a failure to achieve secure fixation in elderly patients when inserting a half-pin at the anteromedial surface of the tibia. The purpose of this study was to compare two methods for inserting a half-pin at tibia diaphysis in elderly patients. MATERIALS AND METHODS: Twenty cadaveric tibias were divided into Group C or V. A half-pin was inserted into the tibias of Group C via the conventional method, from the anteromedial surface to the interosseous border of the tibia diaphysis, and into the tibias of Group V via the vertical method, from the anterior border to the posterior surface at the same level. The maximum insertion torque was measured during the bicortical insertion with a torque driver. The thickness of the cortex was measured by micro-computed tomography. The relationship between the thickness of the cortex engaged and the insertion torque was investigated. RESULTS: The maximum insertion torque and the thickness of the cortex were significantly higher in Group V than Group C. Both groups exhibited a statistically significant linear correlation between torque and thickness by Spearman's rank correlation analysis. CONCLUSION: Half-pins inserted by the vertical method achieved purchase of more cortex than those inserted by the conventional method. Considering that cortical thickness and insertion torque in Group V were significantly greater than those in Group C, we suggest that the vertical method of half-pin insertion may be an alternative to the conventional method in elderly patients.

Clear Cell Chondrosarcoma of the Tibia Diaphysis: A Case Report / 대한골관절종양학회지

Clear cell chondrosarcoma is a very rare malignant bone tumor that shows a strong predilection for the epiphysis or metaphysis of long bones. Many studies have reported that the proximal end of the femur is the most commonly affected site, followed by the proximal end of the humerus. Histopathologically, tumor cells of this type have centrally located round nucleoli with clear cytoplasm and a distinct cytoplasmic membrane. Generally, clear cell chondrosarcomas is not confused with conventional chondrosarcomas. However, when it involves the diaphysis in long bones, diagnosis can be hindered, as only three reports of this exist in the literature. We report herein an unusual case of clear cell chondrosarcoma of the tibial diaphysis in a 42-year-old male.

Bisphosphonate Related Atypical Femoral Fracture / 대한고관절학회지

PURPOSE: We attempted to determine the differences in frequency, as well as clinical, radiologic characteristics of atypical femoral fracture between groups of patients who have taken bisphosphonate and those who have not by conduct of a retrospective analysis of patients with low energy subtrochanteric and shaft fractures of the femur. MATERIALS AND METHODS: We conducted a retrospective study of 44 cases of 41 female patients over 60 years old who underwent surgery due to femoral shaft/subtrochanteric fractures from August 2001 to October 2011. The patients were divided into two groups: Group A, 22 cases in 19 patients with a history of bisphosphonate treatment; Group B, 22 cases in 22 patients without a history of bisphosphonate treatment as a control group. We assessed the duration of bisphosphonate treatment, presence of prodromal symptoms, and radiological results, and compared age, BMD results, union period, and nonunion rate between the two groups. RESULTS: Mean medication period was 56.8 months(12-132 months) and prodromal symptoms were observed in one case. Lateral cortical thickening and transverse fracture with a medial cortical bone beak were observed in all patients of Group A, and contralateral cortical hypertrophy of the femur was noted in 15 patients(17 cases) (77.3%). Mean age was 73.2 years in Group A and 78.2 years in Group B, which showed significant difference (P=0.021), while no difference was observed in BMD, union period, and nonunion rate. CONCLUSION: An atypical femoral fracture can occur in the subtrochanteric or shaft of the femur. The typical radiological characteristics of this fracture are lateral cortical thickening and transverse fracture with a medial cortical bone beak and contralateral abnormality of cortical bone. Findings of this study suggest that medical practitioners should be careful of atypical fractures with osteoporosis patients who use prolonged bisphosphonate.

Osteoporosis y osteosíntesis / Osteoporosis and osteosynthesis

Introducción: las manifestaciones clínicas de las osteoporosis incluyen las fracturas debido a pérdida de masa ósea y cambios estructurales en las trabéculas. En estos casos la osteosíntesis se ve afectada por los factores mecánicos inherentes al proceder y los implantes. Objetivo: mostrar las precauciones que el ortopédico necesita tener en mente al seleccionar el tipo de osteosíntesis (interna o externa) y los implantes que vaya a utilizar. Métodos: se realizó una revisión de las distintas precauciones en cirugía ortopédica sobre fracturas vertebrales y de huesos largos, así como su osteosíntesis de acuerdo a instrumental, implante y proceder operatorio. Resultados: se enfatiza en los avances incorporados, en especial, los sistemas mínimo invasivos de estabilización ósea, el uso de implantes con cerrojos"y el recubrimiento de clavos con hidroxiapatita de calcio y alambres para fijación externa. Conclusión: la osteosíntesis precoz, definitiva y eficaz, es el tratamiento de elección en las fracturas poróticas

Introduction: the clinical manifestations of osteoporosis include fractures due to a loss of bone mass and structural changes in trabeculae. In these cases the osteosynthesis is affected by the mechanical factors inherent to procedure and to implants. Objective: to show the cautions that orthopedist must to take into account at selecting the type of osteosynthesis (internal or external) and the implants to be used. Methods: a review of the different cautions in orthopedic surgery on vertebral fractures and long bones was carried out as well as its osteosynthesis according to the instrumental, the implant and operative procedure. Results: it is emphasize on the incorporated advances, specially the minimally invasive systems of bone stabilization, the use of implants with bolts and nails covering or coating with calcium hydroxyapatite and wires for external fixation. Conclusion: the early, definitive and effective osteosynthesis is the choice treatment in porous fractures

Fraturas da diáfise da tíbia / Tibial shaft fractures

A fratura de osso longo mais frequente é a da diáfise da tíbia, e seu tratamento adequado evita o aparecimento de falhas da consolidação, consolidação viciosa e reoperações. Para classificar a fratura ainda se utiliza a classificação AO/OTA, mas vale a pena conhecer a classificação de Ellis, que também inclui a avaliação da lesão das partes moles. A síndrome compartimental é uma associação frequente, e o diagnóstico precoce pode ser feito precocemente com avaliação dos parâmetros clínicos e uma monitorização clínica constante. Feito o diagnóstico, deve-se realizar a fasciotomia. A avaliação da consolidação sempre é difícil, mas o método de RUST pode ajudar nessa avaliação. Avalia-se a radiografia em duas projeções, dando-se pontos para a presença da linha de fratura e a presença de calo ósseo visível. Hoje em dia se discute o dogma das seis horas para a limpeza da fratura exposta. Considera-se de mais importância o início precoce da antibioticoterapia endovenosa e a gravidade da lesão. A questão do fechamento precoce ou tardio da lesão em uma fratura exposta passou por várias fases, com épocas se indicando o fechamento precoce e épocas o tardio. Atualmente se preconiza, sempre que possível, o fechamento precoce da lesão, pois isso diminui o risco de infecção. A fresagem do canal quando da introdução da haste intramedular ainda é um assunto controverso. Apesar de fortes posições pessoais a favor da fresagem, os estudos mostram haver alguma vantagem nas fraturas fechadas, mas não nas expostas.

The long-bone fractures occur most frequently in the tibial shaft. Adequate treatment of such fractures avoids consolidation failure, skewed consolidation and reoperation. To classify these fractures, the AO/OTA classification method is still used, but it is worthwhile getting to know the Ellis classification method, which also includes assessment of soft-tissue injuries. There is often an association with compartmental syndrome, and early diagnosis can be achieved through evaluating clinical parameters and constant clinical monitoring. Once the diagnosis has been made, fasciotomy should be performed. It is always difficult to assess consolidation, but the RUST method may help in this. Radiography is assessed in two projections, and points are scored for the presence of the fracture line and a visible bone callus. Today, the dogma of six hours for cleaning the exposed fracture is under discussion. It is considered that an early start to intravenous antibiotic therapy and the lesion severity are very important. The question of early or late closure of the lesion in an exposed fracture has gone through several phases: sometimes early closure has been indicated and sometimes late closure. Currently, whenever possible, early closure of the lesion is recommended, since this diminishes the risk of infection. Milling of the canal when the intramedullary nail is introduced is still a controversial subject. Despite strong personal positions in favor of milling, studies have shown that there may be some advantage in relation to closed fractures, but not in exposed fractures.

A study of the nutrient foramina of the humeral diaphysis.

Non-union of the humeral shaft remains a difficult clinical problem and it may appear after any method of treatment; closed or open reduction. For this reason the precise location of nutrient foramen of humerus and relevant anatomy should be known. The anatomy of the nutrient foramina of humeral diaphysis has been studied in 200 human humeri. Measurements were taken with the help of osteometric board and observations were noted. In present study 77% foramina were found medially; on ulnar border & anteromedial surface (zone A & B). The mean position of nutrient foramen lies distal to the mid-point of humerus (mean 1.5 cm distal, vertical zone III). Of 200 humeri, 63% had a single nutrient foramen which implies that the major blood supply to humeral shaft will enter at one particular point. Knowledge of the anatomy of nutrient foramina is significantly important for orthopaedic surgeons doing open reduction of fracture mid shaft humerus, in order to avoid injuring nutrient artery & thereby lessens the chances of delayed or non-union of fracture shaft humerus.

Features of long bone diaphysial osteosarcoma on X-ray, CT and MRI / 中华放射学杂志

Objective To explore the findings of diaphysial osteosarcoma in long bone on X-ray,CT and MRI, and discuss their clinical features and manifestations for differential diagnosis. Methods Twenty-eight cases with diaphysial osteosarcoma in long bone proved by surgery and pathology were reviewed retrospectively. Eighteen tumors were located in the femur, 4 in fibula, 4 in humerus and 2 in tibia. All of the patients were examined by X-ray, CT and MRI. The imaging manifestations on X-ray, CT and MRI were analyzed, and the relationship of the imaging features with the pathological types was also observed. The imaging signs were correlated with the pathologic findings with a double blind method. Results Of the 28 cases, there were 16 cases with large bone destruction, 22 cases with periosteal reaction on X-ray and CT. On X-ray, 18 cases showed soft tissue mass and 12 cases with neoplastic bone and tumor calcification.While on CT, 22 cases showed soft tissue mass on plain scan and 2 more cases displayed soft tissue mass after the injection of contrast mediun. Sixteen cases showed neoplastic bone and tumor calcification on CT.On MRI, there were 10 cases with bone destruction and periosteal reaction with iso- and hypo-intense on T1WI and iso- signals on T2WI. Twenty-six cases showed soft tissue edema and bone marrow on MRI. The soft mass were iso-signals on T1 WI and iso-hyperintense signals on T2 WI or STIR. The soft tissue edema was found hyperintense signals on T2WI or STIR. The lesions had heterogeneous enhancement especially in bone marrow with edema and adjcent soft tissue. Conclusion The X-ray, CT and MRI can reflect the pathological changes of diaphysial osteosarcoma in long bone from different aspects. Lower incidence, large bone destruction and no pathological fracture were the features of diaphysial osteosarcoma. The osteogenic type is diagnosed easily, but the osteolytic lesion should be differentiated from Ewing sarcoma, malignant giant cell tumor of bone and so on.

Percutaneous Transphyseal Intramedullary Kirschner Wire Fixation for Pediatric Diaphyseal Forearm Fractures

PURPOSE: Percutaneous pin fixation is commonly applied for pediatric diaphyseal forearm fractures. We analyzed the results of percutaneous transphyseal intramedullary K-wires fixation for pediatric forearm fractures and evaluated the safety of this procedure in terms of growth. MATERIALS AND METHODS: Thirty-six pediatric patients with forearm diaphyseal fractures treated with transphyseal intramedullary K-wire fixation were reviewed retrospectively. Authors analyzed size and number of fixed K-wires and evaluated postoperative complications, bone length discrepancy and any deformity at the last follow-up. We also evaluated range of motion of wrist and forearm as a functional result. RESULTS: The mean age was 9.5 years old and the average period of follow-up was 53 months (range: 23-85 months). Single wire was applied in each bone, and 1.6 mm sized K-wire was most commonly used for radius fractures and 1.1 mm K-wire for ulnar fractures. There was one superficial pin site infection which was healed by conservative treatment. There were no other complications such as premature epiphyseal closure, discrepancy of forearm length or any deformity. All patients showed no significant difference in range of motion compared to opposite side at the last follow-up. CONCLUSION: Percutaneous transphyseal intramedulaary K-wire fixation is one of the effective and safe operative treatment for pediatric forearm fractures without any deleterious effects on subsequent growth of radius and ulna.