Radiological and functional outcome of PFN A2 in treatment of intertrochanteric fractures in elderly patients

Introduction: Intertrochanteric fracture is one of the most common fracture seen in elderly age group. Intramedullary fixation achieves stable fixation. This study was done to find out outcomes with PFNA2, with an objective of finding significance of various radiological parameters. Methods: Forty-three patients were included who underwent closed reduction and PFNA2 fixation. They were followed up at 1month, 3months, 6months and 1 year postoperatively and tip apex distance, Cleveland index, parkers ratio, nail protrusion height, and neck shaft angle were calculated. Statistical correlation of each parameter with complications such as helical blade cut out and back out was derived. Results: Tip apex distance and Cleveland index was found to influence the position of screw and thereby the final outcome. No statistical correlation was derived between Parkers ratio, neck shaft angle and nail protrusion height with the complications. Functional outcome as calculated by Harris hip score was found to be satisfactory in most of the patients. There was only negligible mean loss of functional outcome postoperatively as calculated with parkers mobility score Conclusion: PFNA2 confirms to be stable fixation for both stable and unstable intertrochanteric fracture with fewer complication and good functional outcome in short period of time.

Introducción: La fractura intertrocantérica es una de las fracturas más comunes observadas en el grupo de edad avanzada. La fijación intramedular logra una fijación estable. Este estudio se realizó para conocer los resultados con PFNA2, con el objetivo de encontrar significación de varios parámetros radiológicos. Métodos: Se incluyeron 43 pacientes sometidos a reducción cerrada y fijación PFN A2. Se realizó un seguimiento a 1 mes, 3 meses, 6 meses y 1 año después de la operación y se calculó la distancia del vértice de la punta, el índice de Cleveland, la proporción de Parker, la altura de la protuberancia del clavo y el ángulo del eje del cuello. Se derivó la correlación estadística de cada parámetro con complicaciones como el corte de la hoja helicoidal y el retroceso. Resultados: Se encontró que la distancia del vértice de la punta y el índice de Cleveland influyen en la posición del tornillo y, por lo tanto, en el resultado final. No se obtuvo correlación estadística entre la proporción de Parkers, el ángulo del eje del cuello y la altura de la protuberancia del clavo con las complicaciones. Se encontró que el resultado funcional calculado por el puntaje de cadera de Harris fue satisfactorio en la mayoría de los pacientes. Solo hubo una pérdida media insignificante de resultado funcional después de la operación, según se calcula con la puntuación de movilidad de Parker. Conclusión: PFN A2 confirma ser una fijación estable para las fracturas intertrocantéricas estables e inestables con menos complicaciones y buen resultado funcional en corto período de tiempo.

Enchondroma in the Diaphysis of Tibia - A Case Report and Review of its Characteristics and Differentials in the Diaphysis.

INTRODUCTION: Enchondroma is a solitary, benign, intramedullary cartilaginous tumor commonly noticed in the phalanges of hands and feet with characteristic radiological features. Its occurrence in aberrant sites with atypical features lead to diagnostic dilemma. Enchondromas which are usually managed non-operatively can mimic other benign and malignant lesions, especially chondrosarcoma. CASE REPORT: We report the case of a 31-year-old farmer who presented with long standing inconspicuous pain in his left leg which turned out to be a diaphyseal enchondroma even though it demonstrated aggressive radiological features mimicking a chondrosarcoma. Incisional biopsy was done from the scalloped areas to obtain the correct histological diagnosis. He underwent thorough curettage of the lesion and remains asymptomatic 2 years after the procedure. We attempt to discuss the differentials which the orthopedic surgeon should keep in mind for diaphyseal lesions mimicking enchondroma. CONCLUSION: Though classically found in metaphysis, Enchondromas are not uncommon in diaphysis of long bones. Enchondromas are generally benign, but can cause diagnostic dilemma when they present with aggressive features at rare locations and surgeons should be wary of the differentials. Despite a size of more than 6 cm and evidence of cortical erosion and intramedullary widening, the lesion could still be benign. Early biopsy will help to differentiate Enchondroma from a malignant transformation or malignant tumor.