Retrograde Intramedullary Nailing for Distal Femur Fracture with Osteoporosis

BACKGROUND: The incidence of distal femur fracture in the elderly has been increasing recently, and commonly occurs with osteoporosis. Retrograde intramedullary nailing has been considered a good surgical option for distal femur fracture. The purpose of the present study was to present our surgical results with retrograde intramedullary nailing for distal femur fractures with osteoporosis. METHODS: Thirteen patients diagnosed with extra-articular distal femur fracture and osteoporosis and managed with retrograde intramedullary nailing were retrospectively reviewed. Cement augmentation was used in four patients, shape memory alloy was used in eight patients and both were used in one patient. All patients were followed up for more than 2 years. Radiologic alignments. were scored and Tegner and the Lysholm activity score was used for a functional assessment. RESULTS: The average time to clinical union was 13 weeks (range, 10 to 15 weeks). In 12 of our cases, the total alignment scores were excellent. At the last follow-up, the mean range of motion was 116degrees (range, 110degrees to 125degrees). The average functional score at postoperative 1 year was 2.6 (range, 1 to 5). CONCLUSIONS: Retrograde intramedullary nailing is a good surgical option for distal femur fracture with osteoporosis. Cement augmentation and shape memory alloy can also be used for added mechanical stability. This surgical technique is very useful for distal femur fracture with osteoporosis as it promotes fracture healing and early rehabilitation.

Síndrome de compresión longitudinal del miembro inferior: reporte de un caso / Lower limb`s longitudinal compression syndrome: a case report

El Síndrome de Compresión Longitudinal del Miembro Inferior (SCLMI) es la asociación de una fractura diafisiaria de fémur con una fractura de cadera ipsilateral. Es una condición clínica muy rara con una incidencia de 2,5 % al 5 %. La fractura de cadera es considerada de baja energía, ocasionada por la energía residual no disipada de del accidente a alta velocidad, que principalmente originó la fractura diafisiaria, y son fracturas de con mínimo o sin desplazamiento, lo cual dificulta su diagnóstico. Se ha reportado que cerca de un 30 % de las fracturas de cadera en un SCLMI pasa desapercibida. Las lesiones de rodilla ipsilateral se encuentran presentes en 34 % y las de pierna, tobillo y pié en 19 %. Se presenta el caso de un paciente masculino de 24 años, quien ingresa posterior a hecho vial por colisión en moto, presentando fractura diafisiaria del fémur y posterior a la realización de estudios protocolares de pelvis, se diagnóstica la fractura de cadera. Se presenta su tratamiento y evolución

Lower limb’s Longitudinal Compression Syndrome (LLLCS) is the association of a femoral shaft fractures with ipsilateral hip fracture. It’s a very rare clinical condition with an incidence of 2.5% to 5%. Hip fracture is considered low-energy, caused by residual energy dissipated at high speed crash, which originated mainly diaphyseal fracture, and are fractures with minimal or no displacement, which makes hard their diagnosis. It is reported that about 30% of hip fractures in a LLLCS unnoticed. Ipsilateral knee injuries are present in 34% and leg, ankle and foot in 19%. We report of a 24 years male, who is admitted after motorcycle collision presenting femoral diaphyseal fracture. After post-protocol studies of pelvis, hip fracture is diagnosis. We present his treatment and evolution

An injectable cement: synthesis, physical properties and scaffold for bone repair.

Micro-invasive bone grafting is to deliver bone graft materials to the desired site through local puncturation and injection. It has many advantages such as little injury, simple procedures and high efficiency of osteogenesis. Limited sources of graft materials and complicated procedures are the main factors affecting the development of the technique. Therefore, to prepare a stable, economical, efficient and easy-to-use liquid graft material is crucial for the development of the technique. PURPOSE: The potential efficacy of an injectable calcium phosphate cement's handling properties and scaffold for bone repair performance was evaluated in a rabbit femoral condyles model. STUDY DESIGN: A comparative study was conducted between a new cement and a commercially available calcium phosphate cement. MATERIALS AND METHODS: The new cement and commercially available calcium-phosphate cements were compared in terms of the setting time, injection pressure, particle size and compressive strength. Then the cements were delivered to rabbit femoral condyles through local injection and then degradation of cements and bone formation were observed regularly after operation. RESULTS: The new injectable cement was superior to currently used cements in terms of permitted manipulation time, injection pressure, particle size, postoperative degradation and efficacy of scaffold for bone repair; nevertheless, the new cement was slightly inferior to currently used cements in compressive strength and the final setting time. CONCLUSIONS: The new injectable cement is more suitable for the clinical study of micro-invasive bone grafting. It allows a brand new bone grafting procedure and provides a new graft material and thus merits further development and wider application.

Reparação de defeitos ósseos em fêmures de ratos machos e fêmeas espontaneamente hipertensos: estudo histológico e histométrico / Bone healing in drill hole defects in spontaneously hypertensive male and female rats' femurs: a histological and histometric study

OBJETIVO: O objetivo deste estudo foi avaliar a reparação óssea em ratos espontaneamente hipertensos (SHR) e compará-la com a de ratos normotensos, avaliando machos e fêmeas. MÉTODOS: Um defeito ósseo foi criado no fêmur esquerdo de 24 SHR (12 machos e 12 fêmeas) e 24 ratos normotensos (12 machos e 12 fêmeas). Os animais foram divididos em dois grupos com diferentes períodos de sacrifício: sete e 21 dias após o procedimento cirúrgico. Após processamento laboratorial de rotina, as análises histológica e histométrica foram realizadas e os dados submetidos à análise de variância (ANOVA) e ao teste de Tukey (5 por cento). RESULTADOS: Machos e fêmeas do mesmo grupo apresentaram características histológicas similares. Após sete dias, todos os animais apresentaram trabéculas ósseas irregulares, entretanto, os osteoblastos periosteais eram achatados nos SHR, enquanto nos normotensos, essas células apresentavam formato cúbico. Após 21 dias, todos os espécimes mostraram fechamento linear em toda a extensão superficial do defeito ósseo e os SHR apresentaram osteoblastos achatados, enquanto os normotensos apresentaram células cúbicas circundando as trabéculas ósseas. A análise estatística dos dados histométricos indicou médias similares entre machos e fêmeas, exceto para ratos normotensos, aos sete dias. Além disso, aos 21 dias, foi observada maior neoformação óssea nos ratos hipertensos quando comparados aos normotensos, tanto machos quanto fêmeas. CONCLUSÃO: Concluiu-se que os animais SHR apresentaram maior neoformação e maturidade óssea nos defeitos que animais normotensos, no período de 21 dias após a cirurgia.

OBJECTIVE: The aim of this study was to evaluate the bone healing in spontaneously hypertensive rats (SHR) and compare the results with normotensive rats, evaluating male and female animals. METHODS: A bone drill defect was created in the left femur of 24 SHR (12 males and 12 females) and 24 normotensive rats (12 males and 12 females). The animals were divided into two groups and sacrificed 7 and 21 days after the surgical procedure. After the routine laboratory processing, histological and histometric analysis were carried out and data were submitted to ANOVA and TukeyÆs test (5 percent). RESULTS: Males and females from the same group had similar histological characteristics. After seven days, all animals presented irregular bone trabeculae. The periosteal osteoblasts were flattened in SHR, and presented a cuboid shape in normotensive animals. After 21 days, the bone defects of all specimens showed a linear closure in all the superficial extension. In addition, SHR presented flattened osteoblasts surrounding the bone trabeculae, while normotensive ones showed cuboidal cells. Statistical analysis of the histometric data indicated similar means between the male and female groups, except for normotensive rats on day 7. In addition, a larger amount of new bone formation was observed in hypertensive when compared to normotensive rats on day 21, in males as well as females. CONCLUSION: We conclude that bone healing in SHR was more significant than in normotensive ones, as shown by the histological and histometric evaluation 21 days after surgery.

Estudo das alteraçöes da placa epifisária distal do fêmur do rato após fratura ao nível da diáfise / Study of the alterations in the rat's distal growth plate of the femur after fracture at level of the diaphysis

Foi realizado trabalho experimental com ratos machos da raça Wistar, com quatro semanas de vida, nos quais foi executada uma fratura manual, sob anestesia, ao nível da diáfise do fêmur direito, a fim de estudar as alteraçöes da microestrutura da fise distal e as alteraçöes macroscópicas das peças. Após os animais serem sacrificados em grupos iguais ao final de uma, duas, quatro, seis e oito semanas pós-fratura, estudamos os fêmures controles e os fraturados mediante técnicas histológica e histoquímica, avaliaçäo das dismetrias através da mensuraçäo das peças com paquímetro e estudo radiológico. Os resultados demonstraram que do ponto de vista histológico, nos grupos fraturados na 4( e 6( semanas, ocorreu aumento da afinidade pelo alcian blue na placa epifisária, indicativo de maior produçäo de matriz extracelular nesse período. Em relaçäo à macroscopia, observamos hipercrescimento nos fêmures fraturados comparados com o lado contralateral, nos animais em que o periósteo manteve-se íntegro após a fratura.

Estudo experimental da reparaçäo da cartilagem articular em coelhos, após implantaçäo de parafuso em nível subcondral, comparado a uma perfuraçäo controle / Experimental study of articular cartilage repair in rabbits after implantation of screw at the subchondral level, compared to a control perforation

Os autores realizaram estudo experimental em 30 coelhos adultos, tendo o intuito de observar as alteraçöes da superfície articular, após a implantaçäo de um parafuso de 2mm, abaixo da cartilagem articular do côndilo medial em sua zona de carga. Uma perfuraçäo de 1,5mm de diâmetro e 6mm de profundidade foi realizada na área correspondente do côndilo lateral, para fins de controle. Os estudos anatomopatológicos realizaram-se duas, oito e 16 semanas após as cirurgias