Comparison of the Sliding and Femoral Head Rotation among Three Different Femoral Head Fixation Devices for Trochanteric Fractures

BACKGROUND: Recently, various femoral head fixation devices (HFDs) for trochanteric fractures have become available. However, there are some cases in which femoral head rotation with excessive sliding of the HFD is observed and it is often followed by cutout. The purpose of this study is to compare the ability of the three types of HFDs to prevent femoral head rotation. METHODS: Between July 2005 and December 2009, 206 patients aged over 60 years with trochanteric fractures who had undergone surgical treatment using a short femoral nail in our institution were enrolled into the study. We used the gamma 3 nail (GMN) as the screw-type HFD in 66 cases, the gliding nail (GLN) as a non-cylindrical blade in 76 cases, and the proximal femoral nail antirotation (PFNA) as a cylindrical blade in 64 cases. The sliding length of HFDs and the occurrence of femoral head rotation were evaluated by assessing radiographs as the main outcome, and the results were compared among these devices. RESULTS: A comparison of the degree of sliding in the GMN group showed that femoral head rotation was observed significantly more frequently in cases with rotation. Further, it appeared that femoral head rotation occurred more frequently in comminuted fractures. However, no significant differences between the sliding lengths of the different HFDs were observed among three groups. Femoral head rotation was observed in 15 cases of GMN (22.7%), 0 case of GLN, and 5 case of PFNA (7.8%). Significant differences with regard to the occurrence of femoral head rotation were observed among the three groups. Furthermore, significant differences were also observed between GLN and PFNA with respect to the occurrence of femoral head rotation. CONCLUSIONS: The ability to stabilize femoral head appears to be greater with blade-type materials than with screw-type materials. Furthermore, we believe that a non-cylindrical blade is preferable to a cylindrical blade for the surgical treatment of comminuted, unstable trochanteric fractures in order to prevent femoral head rotation and cut-out.

Fixação com parafusos absorvíveis no tratamento da região frontal com videoendoscopia / Biodegradable screw fixation in the treatment of the frontal area with videoendoscopy

São utilizados muitos métodos para obter a fixação dos tecidos moles no tratamento da região frontal com videoendoscopia (EAFL). Porém, nenhum deles pode ser considerado como sendo o melhor. Desde quando iniciamos a fazer EAFL, utilizamos a fixação com parafusos. Depois de notar que a fixação externa temporária com parafuso metálico apresentava alguns efeitos negativos, começamos a usar a fixação interna com parafusos absorvíveis (biodegradáveis). O propósito deste estudo é transmitir nossa experiência e comentar alguns pontos importantes relativos a este método. Nós avaliamos os casos submetidos a cirurgia endoscópica da face nos últimos quatro anos. Foram operados noventa e nove pacientes. Em trinta e oito utilizou-se a fixação externa com parafusos metálicos, e em sessenta e um, a fixação interna com parafusos absorvíveis. Nesse grupo, constatou-se significativa redução nas complicações inerentes ao método, com a mesma qualidade no resultado. Evidencia-se que, mesmo ainda demandando um custo considerável, o emprego de parafusos internos absorvíveis constitui-se numa opção prática, efetiva e segura para a fixação da região frontal na cirurgia endoscópica.

Many methods are used to obtain the fixation of the soft tissues in the treatment of the front area with videoendoscopia (EAFL). However none of them can be considered as the best. From when we began to pratice EAFL, we used the fixation with screws. After noticing that the fixation temporary with metallic screw it presented some negative effects, we start using the fixation interns with absorbable screw (biodegradable). The purpose of this study is to transmit our experience and to comment on some relative important points to this method. We evaluated the submitted cases the surgery endoscopic asssisted frontal lifting in the last four years. Ninety nine patients were operated. In thirty eight the fixation was used with metallic screws and in sixty one a the fixation interns with absorbable screw. In that group, significant reduction was verified in the inherent complications to the method, with the same quality in the result. It is evidenced that, still demanding a considerable cost, the job of internal screws is constituted in a practical option, it executes and it holds for the fixation of the front area after endoscopic surgery.

Estudo comparativo do tratamento dos traumatismos cervicais pelas técnicas de Rogers e Roy-Camille / Comparative study in the treatment of cervical injuries using Rogers and Roy-Camille techniques

Os autores apresentam estudo de 30 pacientes com diagnóstico de fraturas e/ou luxaçoes da coluna cervical inferior, todos tratados cirurgicamente. Quinze pacientes foram operados com a técnica de Rogers e os outros 15 com a de Roy-Camille. Eram 29 (96 por cento) pacientes do sexo masculino e 1 (4 por cento) do feminino, com idade entre 12 e 64 anos (média de 33,9 anos). Compararam-se a estabilidade, poder de reduçao e capacidade de melhorar o quadro neurológico entre as duas técnicas. A técnica de Roy-Camille mostrou-se mais eficaz em relaçao ao poder de reduçao. Quanto aos outros dois critérios, ambas as técnicas foram estatisticamente semelhantes.

Abordagem lateral extracavitária: utilidade no tratamento do traumatismo raquimedular torácico, toracolombar e lombar / Lateral extracavitay approach for the treatment of thoracic, thoracolumbar and lumbar spinal trauma

Entre janeiro de 1996 e maio de 1997, foram tratados 33 pacientes nas Enfermarias do Complexo Hospitalar do Mandaqui e do Hospital do Servidor Público Estadual (HSPE), vítimas de trauma raquimedular torácico, toracolombar e lombar. Vinte e seis pacientes receberam tratamento cirúrgico, em 18 dos quais foi utilizada a abordagem lateral extracavitária. Esta abordagem propiciou a descompressao anterior ao saco dural (9 pacientes), a fusao com enxerto intersomático (7 pacientes), a implantaçao do parafuso cruzado pedículo-corpo vertebral (5 pacientes) e facilitou a colocaçao do parafuso transpedicular em 28 pedículos. Sao discutidas as contribuiçoes desta via.

Leg lengthening with ilizarov method using locally devised, economical Naseer Awis fixator

Lengthening of short lower limbs using Naseer Awais [N.A] fixator. Design: Prospective study comprising 10 cases. Setting: Department of orthopaedics Allama Iqbal Medical College, Lahore. Subjects: Six male and four female patients reporting shortening of femur of tibia due to various causes. The lengthening was achieved in all cases. The consolidation and maturation of newly formed segment was delayed as compared with the pioneer studies. Pin tract infection, osteotomy site infection, bending of schaz screws and contractures were experienced. Ilizarov method is a dependable procedure of leg lengthening. It is independent of the type of fixator. Locally devised Naseer Awais [N.A.] Fixator is a useful economical device for lengthening

Treatment of non-united femoral neck fractures in young adults by internal fixation combined with muscle-pedicle bone graft

Six patients, [16-31 years old], with ununited intracapsular fracture of the femoral neck were treated by internal fixation and quadratus femoris muscle-pedicle bone grafting. Satisfactory union occurred in all, will return of near-normal hip function. One patient developed secondary fracture, treated conservatively, and two patients were left with 1.5, and 2cm shortening. This method is useful in anatomical and functional restoration of the hip and it shortens the time to union

Supracondylar fracture of humerus treated by open reduction and kirschner wire fixation: a prospective study

A prospective study of 46 patients was carried out to assess the role of open reduction and internal fixation in the management of supracondylar fracture of humerus. We found that open reduction and internal fixation with lateral approach is definitely better than other procedures in use at present. Using this method, the fracture is stabilized and a severely swollen elbow can be extended and compression of vessels is avoided. The period of hospitalization is shortened, common complications like cubits varus and stiffness of elbow are negligible. All nerve injuries, if not severe, recover after reduction, myositiossificans and Volkmann's ischaemic contracture are not seen

Surgical treatment of proximal humeral fractures in late adolescence and young adults

Open reduction and internal fixation for 30 cases of displaced proximal humeral fractures and fracture dislocation was done from the period of 1991to 1994. Two cases were lost for follow up and 28 cases were included in the study. We chose certain age group which is late adolescence and young adults because we felt that this is the most active age in which the person needs free mobility and power from his shoulder. Most of the cases were displaced surgical neck freactures [26 cases]. An AO T buttress plate was used in [26 cases] the mean follow up period is one year [range from 6 months and 2 years]. The results were evaluated subjectively using the scorin system of Neer [6]. Overall results were excellent or satisfactory in 85% of cases. The complications encountered was malunion in one case [3.6%], deep infection one case [3.6%], bicipital tendonitis, two cases [7.1%], pain and limitation of movements in various degrees in 20 cases [71.4%] which were included in the satisfactory and the unsatisfactory group. There were no cases of non-union or avascular necrosis

Surgical treatment of fractures of the capitellum

Five cases with fractures of the capitellum [Hahn-Steinthal type] were collected between 1988 and 1993 and treated in Kasr El -Aini Hospital, Cairo and Derriford Hospital, Plymouth. Four cases were treated with open reduction and internal fixation and in one case fracture was comminuted and beyond fixation and the comminuted fragment was excised. During follow-up period [6-24 months], the four cases treated with open reduction and interion regained a good range of movements of the involved elbow and were found to be free of pain and had a stable elbow. The case treated with exision of the comminuted capitellum fragment regained a good range of movementes but was complining of moderate pain during the first 30 degrees of flexion of the involved elbow and some valgus intability. So open reduction and internal fixation of fractures of the capitellum is a better method of treatment than excision if applicable

Tratamiento de las fracturas de Colles grado IV de Sarmiento mediante fijadores externos / Treatment of Sarmientos' IV degree Colles fractures by external fixation

Se revisaron 20 pacientes atendidos en el Servicio de Urgencias del Hospital de Traumatología "Magdalena de las Salinas" del IMSS, con diagnóstico de fractura de Colles grado IV de Sarmiento, en un periodo comprendido de Septiembre de 1987 a Noviembre de 1988, con seguimiento máximo de 12 meses y mínimo de seis meses. Asimismo, se colocó fijador externo AO en la superficie radial a distracción durante cuatro semanas y después se mantuvieron con férula estilo Sarmiento durante cuatro semanas más, para retirar y realizar rehabilitación. Se midió para correlación el ángulo volar, radial y altura estiloides y se valoró movilidad de la muñeca y dolor para su evaluación final, la consolidación se obtuvo en promedio a los 78 días, la desviación radial y cubital así como la flexión estuvieron dentro de rangos normales y la extensión y pronosupinación estuvo limitada en un sólo caso; Hubo dolor en dos casos, resorción simpático refleja en un caso y fractura de metacarpiano en otro caso, el ángulo volar presentó menor índice de restitución anatómica, con íntima relación a los malos resultados concluyendo que las fracturas intra-articulares desplazadas son de difícil tratamiento

Direct repair of spondylolysis or minimal degrees of spondylolisthesis by screw fixation and bone grafting

Twenty patients with chronic low back pain who were not responding to conservative measures for at least six months due to lumbar spondylolysis or grade-1 spondylolisthesis, with no evidence of spinal degeneration or nerve root compression. There ages ranged between 18 to 36 years old, the main age was 22.9 years. There were eleven females and nine males. All patients were treated with repair of the defect by screw fexation and bone grafting. The mean follow up period was 12 months [range, 18 - 40 months]. 80% of the patients obtained good to excellent clinical results, and 90% obtained solid fusion of the defect

Diaphyseal fractures of the humerus treated by open reduction and internal fixation

This paper presents our experience with 57 patients of diaphyseal fractures of the humerus, treated by open reduction and fixation with dynamic compression plate. The indications for surgical treatment included delayed union in 29 patients, soft tissue interposition in 11, multiple injuries in 8, and radial nerve involvement in 9. Seven patients among the 19 who had routine exploration of the radial nerve palsy, took 6 to 12 weeks to recover. We recommend that fractures which do not show evidence of union in 6-8 weeks are unlikely to unite and should be treated by open reduction and internal fixation. Fractures with a gap between the fragments either in anteroposterior or in lateral radiographs and fractures with distraction of the fragments commonly have soft tissue interposition and should have primary open reduction and internal fixation. Exploration of the radial nerve during primary fixation of the fracture should only be done in patients presenting with radial nerve involvement

Cirugía Transpendicular Espinal en Neurocirugía / Transpendicular Surgery of Spine in Neurosurgery

Se realiza una revisión de la técnica de cirugía transpendicular. Se comenta las ventajas y desventajas de este nuevo abordaje. Se presentan casos crónicos de este tipo de cirugía

Estabilización cervical posterior con placas de Roy Camille. Reporte de un caso / Posterior cervical stabilization with Roy Camille plaque: Report of a case

Paciente masculino de 28 años de edad tratado en el Hospital Clínico Universitario de Caracas, quien posterior a traumatismo por caída, presenta cuadraplejia inmediata post-traumática. Los estudios de rayos X simples demostraban lujación C5-C6 de 90 por ciento , la tomografía computada demostró fractura de espinosa y lámina de C5. Fue colocado en tracción en cama de Struker y posteriormente realizada la fijación quirúrgica con placas de Roy-Camille. Se revisa las indicaciones y la técnica quirúrgica

Open reduction and internal fixation of comminuted, intra-articular structures distal radius

Thirty patients with severely displaced intra-articular fractures of the distal end radius were treated by open reduction and internal fixation. All fractures were type C according to the classification of AO system. At mean follow-up of 2.5 years and according to MecBride and Lidstrom system of evaluation the results indicated that patient satisfaction was high 90% Functional and radiographic results were excellent or good in 90% and poor in 10% of the patients