Do intramedullary implants improve survival in elderly patients with trochanteric fractures? A retrospective study.

BACKGROUND AND HYPOTHESIS: There is currently no consensus regarding superiority of the intramedullary fixation over the sliding hip screw. Regional variation remains high and not backed up by solid evidence. Given these premises we aimed to analyze weather implant preference can influence the postoperative survival. Secondary objectives were determining the trend for implant choice and confounding factors associated with intramedullary nails compared to sliding hip screws. PATIENTS AND METHODS: Retrospective data was obtained from patient charts with the main diagnosis of extracapsular/ trochanteric fractures, corresponding to ICD S72.1 codes. Between 2008-2012, 441 patients underwent osteosynthesis with a dynamic hip screw and 155 with intramedullary nail respectively. The living status was determined by comparing the patient identification number against the national population evidence records. RESULTS: The lifetable shows similar survival for both implants over the 5 year period. The yearly mortality was 19.4% for the dynamic hip screw and 21.8% for the intramedullary implant respectively, even though the later were used predominantly in older patients. This age difference is significant according to both parametric and non-parametric tests whereas duration of hospital stay are similar. We found a clear increase in the proportion of intramedullary implants, for a total of 11.2% over the 5 year period. There is no difference for the one year mortality and overall survival between sliding screw plates and intramedullary constructs. CONCLUSIONS: A clear increase in the use of intramedullary implants for trochanteric fractures was observed. This is even more apparent for older ages, presumably due to an higher surgeon confidence with the biomechanical stability of the intramedullary constructs.

Morphometric analysis of bone vascular channels during the biointegration of autologous bone grafts.

Vascularization of the transplanted bone tissue is a key factor for success and precedes the formation of bone tissue. Vascularized bone grafts have been widely used in bone transplantation for their efficiency. Maturation of the bone tissue at the place of the transplant involves the change in the vascular patterning, from plexiform irregular vascular networks, to regular, polygonal networks following the structure of osteons. Seven dogs were performed bone transplantation and intravenous injection with China ink in order to highlight the network of blood vessels during bone formation at the place of the transplant. The area occupied by blood vessels increased during osteogenesis, and their length decreased in evolution, suggesting a maturation of the vascular pattern.

Microdensity and morphometric analysis of autologous bone grafts cells.

Bone transplantation as a mean to reduce the fracture healing time in large defects was attempted for the first time more than 300 years ago, with nowadays several techniques and methods of assessment of its efficacy. The bone graft was longtime thought as initiating the osteogenesis from the recipient, but new data show that cells from the graft contribute to osteogenesis and to its incorporation into newly formed bone. There is no accurate assessment of the microdensity of bone graft cells in evolution so far, the only studies published recently referring to newly formed bone area. We have performed bone transplantation on seven dogs and have analyzed the microdensity and the morphometric features of bone graft cells. We have found that the cellular microdensity increases both in the graft and in the recipient bone, simultaneously with a decrease of cell size and circularity during maturation.