Demographics and clinical features of humeral shaft fractures: The Latin American multicentre prospective study (HSF-LAMPS).

PURPOSE: To present transversal data (demographic and clinical) on isolated humeral shaft fractures (HSFs) in Latin American countries. METHODS: Patients were enrolled between December 2015 and April 2017 at 11 medical institutions from six Latin America countries. INCLUSION CRITERIA: Age ≥18 years and a closed, isolated 12A, 12B, or 12C fracture (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classification). The patients' demographic, comorbidity, and other baseline data were recorded. The outcome measures included the basal results of the research and the associations among the demographic factors, fracture features, and type of treatment applied. RESULTS: A total of 123 patients were included. There was a preponderance of men (61.8%), whose mean age was significantly lower than that of the women (31.48 vs. 60.55). Overweight or obesity was present in 61.0% of women; 56.1% of patients were sedentary, 75.6% were nonsmokers, and 74.0% had no chronic disease. The type or treatment (operative/nonoperative) was not significantly associated with the patient's or fracture's characteristics. Falls and traffic accidents were the main causes of HSFs. Intramedullary nailing treatment was performed significantly more often in women, elderly patients, patients who did not participate in sports, and patients participating in only home activities. Minimally invasive plate osteosynthesis was performed significantly more frequently in men and in those who were self-employed. Open reduction internal fixation was performed significantly more often when the cause of the fracture was a traffic accident and when radial nerve palsy was present. CONCLUSION: The demographics and etiological differences observed in comparison to the current literature show the importance of regional studies for both preventive measures and educational guidance.

Recommendations for avoiding knee pain after intramedullary nailing of tibial shaft fractures.

BACKGROUND: The objective of this study is to analyze the proximal tibiofibular joint in patients with knee pain after treatment of tibial shaft fractures with locked intramedullary nail. FINDINGS: The proximal tibiofibular joint was analyzed in 30 patients, who reported knee pain after tibial nailing, and standard radiograph and computed tomography were performed to examine the proximal third of the tibia. Twenty patients (68.9%) presented the proximal screw crossing the proximal tibiofibular joint and 13 (44.8%) had already removed the nail and/or screw. Four patients (13.7%) reported complaint of knee pain. However, the screw did not reach the proximal tibiofibular joint. Five patients (17.2%) complained of knee pain although the screw toward the joint did not affect the proximal tibiofibular joint. CONCLUSION: When using nails with oblique proximal lock, surgeons should be careful not to cause injury in the proximal tibiofibular joint, what may be one of the causes of knee pain. Thus, the authors suggest postoperative evaluation performing computed tomography when there is complaint of pain.

CLINICAL AND ANATOMICAL COMPARISON OF THE FIBULAR NERVE IN GERDY's SAFE ZONE.

OBJECTIVE: To clinically and anatomically compare the limits of the fibular nerve in Gerdy's safe zone in cadavers. METHODS: Fifty anatomical knee specimens were clinically measured (before dissection) to determine the distances and angles between Gerdy's tubercle and the posterior region of the fibula (cm); the angle between the line corresponding to the posterior region of the fibula and the tibial crest (degrees); and the angle between Gerdy's tubercle and the tibial crest (degrees). After dissection of the anatomical specimens, the knees were measured again, to determine the distances and angles between Gerdy's tubercle and the fibular nerve (cm); the angle between the fibular nerve, in the posterior region of the fibula, and the tibial crest (degrees); and the angle between Gerdy's tubercle and the tibial crest (degrees). RESULTS: There was a significant increase in the distance between Gerdy's tubercle and the posterior region of fibula (cm), after dissection: an average of 0.26 cm (p = 0.018), corresponding to 8.6% (p = 0.007). There was also a significant reduction in the angle between the posterior region of the fibula and the tibial crest after dissection: an average of 3° (p = 0.047), corresponding to 2.1% (p = 0.06). CONCLUSION: Despite the difference from before to after dissection, Gerdy's safe zone can be considered safe for orthopedic procedures involving the proximal region of the tibia, thereby avoiding damage to the fibular nerve and its branches.

OSTEOSYNTHESIS WITH INTRAMEDULLARY NAILS IN CHILDREN.

The authors present a comprehensive review of the literature emphasizing the use of flexible intramedullary nails in the treatment of fractures in children, focusing the treatment of femoral shaft and forearm fractures and emphasizing the importance of the non-surgical approach. Children's age and weight threshold are not well defined for the use of the method. The removal of implants is a controversial matter in the literature, with a trend towards keeping the implants.