RESUMEN
INTRODUCTION: Few clinical studies have analyzed the utility of distal interlocking screws in stable and unstable intertrochanteric fractures treated with intramedullary devices. We performed a prospective analysis comparing short unlocked versus short dynamic and short static distal locked intramedullary nails. MATERIALS AND METHODS: Nine level-II trauma centres were involved in the study. 240 patients over the age of 65 with a stable (AO/OTA 31-A1) or unstable intertrochanteric fracture (AO/OTA 31-A2) were prospectively investigated. The same type of nail was used in every patient. Patients were randomly divided into 3 groups according to the type of distal locking used. Intra-operative variables were examined and patients were followed clinically and radiographically at 1, 3, 6, 12 months postoperatively. All complications were recorded. RESULTS: A total of 212 patients completed 1 year of follow-up visits. In the Unlocking Group (UG) the operation time, blood loss, fluoroscopy time, total length of incision were significantly decreased compared to both the Dynamic Group (DG) and the Static Group (SG) (p < 0.05). Conversely, no reliable differences in intraoperative variables were noted between the Dynamic Group and the Static Group (p > 0.05). In terms of time of fracture union we found no differences among the three Groups (p > 0.05). Moreover, no cases of limb shortening >1 cm or varus collapse were detected in any group. The 3 Groups were similar in terms of HHS, SF-12 and Barthel index results at 1-year follow-up (p > 0.05). Finally, no significant differences were demonstrated across the three Groups in terms of major complications. CONCLUSIONS: This clinical study further confirms the hypothesis that short intramedullary nails do not need to be locked for stable and unstable intertrochanteric fractures.
Asunto(s)
Clavos Ortopédicos , Fijación Intramedular de Fracturas , Curación de Fractura/fisiología , Fracturas de Cadera/cirugía , Inestabilidad de la Articulación/cirugía , Anciano , Femenino , Fluoroscopía , Estudios de Seguimiento , Fijación Intramedular de Fracturas/instrumentación , Fijación Intramedular de Fracturas/métodos , Fracturas de Cadera/diagnóstico por imagen , Fracturas de Cadera/fisiopatología , Humanos , Inestabilidad de la Articulación/diagnóstico por imagen , Inestabilidad de la Articulación/fisiopatología , Masculino , Estudios Prospectivos , Rango del Movimiento Articular , Centros Traumatológicos , Resultado del TratamientoRESUMEN
We investigated whether a proximal femoral nail can be implanted without a distal locking screw in AO/OTA 31-A1 and 31-A2 pertrochanteric stable femur fractures. A multicentre, randomised study was conducted in six level-two trauma centres in our area (Puglia, Italy). A total of 333 patients received their allocated intervention (162 in the locking group [LG] and 171 in the unlocking group [UG]) and 266 patients were included in the final analysis at 1year. Our data showed no statistically significant difference between the two groups at 1-year follow-up for ability to walk, SF-36 questionnaire results, residual pain (visual analogue scale [VAS] score) and level of overall satisfaction. There were also no statistically significant differences between groups for mortality and length of hospital stay. Conversely, the UG was associated with shorter operation and fluoroscopy times, shorter surgical incision length, and less blood loss and residual thigh pain. Pertrochanteric stable fractures (31-A1, 31-A2) can be treated successfully with intramedullary nails without distal locking, reducing patient and clinical personnel radiation exposure and sanitary costs (surgery time and screws costs).
Asunto(s)
Clavos Ortopédicos , Fracturas del Fémur/cirugía , Fijación Intramedular de Fracturas , Fracturas Osteoporóticas/cirugía , Complicaciones Posoperatorias/diagnóstico por imagen , Centros Traumatológicos , Anciano , Anciano de 80 o más Años , Tornillos Óseos , Femenino , Fracturas del Fémur/diagnóstico por imagen , Fracturas del Fémur/fisiopatología , Fluoroscopía , Fijación Intramedular de Fracturas/métodos , Curación de Fractura , Humanos , Italia/epidemiología , Masculino , Tempo Operativo , Fracturas Osteoporóticas/diagnóstico por imagen , Fracturas Osteoporóticas/fisiopatología , Satisfacción del Paciente , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/cirugía , Estudios Prospectivos , Resultado del TratamientoRESUMEN
INTRODUCTION: Treatment of displaced heel fractures is controversial; however, ORIF is widely described in the literature to be the gold-standard. Percutaneous reduction and monolateral external fixation is gaining increasing attention because it provides a good and stable reduction, and minimises soft tissue complications due to open surgery, such as deep infections and delays in wound healing. The aim of this study was to show that the new Orthofix Calcaneal Minifixator (six pins) provides a greater stability than the four-pin version to enable a better and more stable reduction, an earlier weight-bearing (30 days) and improved functional outcomes. METHODS: A series of 69 consecutive closed heel intraarticular displaced fractures treated with the new Orthofix Calcaneal Minifixator were evaluated. Patients were assessed clinically with the Maryland Foot Score and radiologically with standard radiographs. RESULTS: The clinical results at follow-up were excellent in 37 cases (53.6%), good in 27 (39.2%), fair in two (2.9%) and poor in three (4.3%). The mean preoperative Böhler's angle was 5.2Ë (range 0-18Ë) and the mean postoperative value was 28.5Ë (range 16-38Ë). CONCLUSION: The excellent functional outcomes were despite some radiological images of imperfect posterior facet anatomical reduction and seemed to correlate with the use of a good and stable minimally-invasive surgical technique. This technique enabled early weight-bearing, minimised complications, respected the delicate biology of this anatomical site and restored the good heel volume and Böhler angle.
Asunto(s)
Calcáneo/lesiones , Fijadores Externos , Fijación de Fractura/métodos , Fracturas Intraarticulares/cirugía , Complicaciones Posoperatorias/cirugía , Tomografía Computarizada por Rayos X , Adulto , Anciano , Anciano de 80 o más Años , Calcáneo/diagnóstico por imagen , Remoción de Dispositivos , Femenino , Estudios de Seguimiento , Fijación de Fractura/instrumentación , Humanos , Fracturas Intraarticulares/diagnóstico por imagen , Fracturas Intraarticulares/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Índices de Gravedad del Trauma , Resultado del Tratamiento , Soporte de PesoAsunto(s)
Retardo del Crecimiento Fetal/diagnóstico , Recién Nacido Pequeño para la Edad Gestacional/sangre , Primer Trimestre del Embarazo/sangre , Proteína Plasmática A Asociada al Embarazo/metabolismo , Adulto , Biomarcadores/metabolismo , Estudios de Cohortes , Bases de Datos Factuales , Diagnóstico Diferencial , Femenino , Retardo del Crecimiento Fetal/sangre , Retardo del Crecimiento Fetal/epidemiología , Humanos , Recién Nacido , Italia/epidemiología , Medida de Translucencia Nucal , Embarazo , Resultado del Embarazo/epidemiología , Embarazo de Alto Riesgo , Nacimiento Prematuro/sangre , Nacimiento Prematuro/epidemiología , Estudios RetrospectivosRESUMEN
Three cases of intracerebral haemorrhage following removal of a chronic subdural haematoma are reported and the literature on this topic reviewed. The possibility of an increase in cerebral blood flow following removal of CSH, makes slow, gradual decompression mandatory in all patients submitted to cranial trapanation.