Treatment of intertrochanteric fractures using cephalomedullary nail: One or two cephalic screws?

OBJECTIVES: To determine the incidence of cut-out, cut-in, cut-through, Z-effect, and reverse Z-effect in two cephalomedullary nail (CMN) systems: one with single cephalic screw fixation and the other with dual-screw fixation using a lag screw and an anti-rotation screw. METHODS: A retrospective study from a cohort of patients was conducted between January 2017 and August 2019 in patients with intertrochanteric fractures treated with osteosynthesis using CMN. RESULTS: One hundred ninety-six patients with intertrochanteric fractures who met the inclusion criteria were recruited. The median age was 81 years [interquartile range (IQR) 12]. Seventy-six percent had fractures classified as Orthopaedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen (OTA/AO) 31A2. Twenty-one mechanical complications occurred, 8.7% (17) was cut-out with a single cephalic screw CMN and 2% (4) was Z-effect with a dual-screw CMN non-integrated. The median tip-apex distance (TAD) was 19.4 mm (IQR 10.8) in patients who experienced cut-out and 19 mm (IQR 10) in those who experienced Z-effect. The median time to cut-out occurrence was 39,5 days (IQR 47,5), while the median time to Z-effect was 90 days (IQR 86). CONCLUSIONS: The incidence of osteosynthesis failure using CMN is more frequent in patients treated with a single cephalic screw CMN. LEVEL OF EVIDENCE: Therapeutic, Level III.

Treatment with type-i collagen scaffolds in patients with venous ulcers. case report

ABSTRACT Introduction: Chronic venous insufficiency affects about 5% of the global adult population. Venous leg ulcers are one of the most frequent complications of this pathology, with a global prevalence of 2%. This disease affects both the quality of life of patients and, due to the high cost of the treatment, the health system. Compressive therapy and moist wound healing have been the gold standard treatment. However, when complications occur, they may not be effective. Case report: This is the case of a 66-year-old female patient with venous ulcers on her lower limbs and symptoms of fever and local pain that did not respond to conventional therapies. The patient was treated with a new dermal substitute made of an acellular type-I collagen membrane, which promotes the closure of the ulcer by stimulating the replacement of injured tissue with tissue similar to the healthy one. The condition of the patient improved at 16 weeks, and after 8 months of treatment there was no recurrence of the lesions. Conclusions: Acellular type-I collagen membrane developed by the Tissue Engineering Working Group of the Department of Pharmacy of the Universidad Nacional de Colombia is effective in treating venous ulcers of the lower limbs. Its low cost facilitates the access of the whole population to therapies based on its application.

RESUMEN Introducción. La insuficiencia venosa crónica afecta alrededor del 5% de la población adulta en el mundo; una de sus mayores complicaciones son las úlceras en miembros inferiores, las cuales tienen una prevalencia mundial del 2%. Las úlceras afectan la calidad de vida de los pacientes e impactan al sistema de salud debido a los altos costos de atención que genera. El tratamiento de referencia es la terapia compresiva y la cura húmeda de las heridas, sin embargo estas intervenciones pueden no ser efectivas cuando las lesiones se complican. Presentación del caso. Paciente femenina de 66 años con úlceras venosas en miembros inferiores acompañadas de fiebre y dolor local que no respondían a las terapias convencionales. La paciente fue tratada con un nuevo sustituto dérmico basado en una membrana acelular de colágeno tipo I que contribuye al cierre de la úlcera al estimular el remplazo del tejido lesionado por tejido similar al sano, con lo cual tuvo mejoría a las 16 semanas; después de 8 meses de terminado el tratamiento no se presentó recurrencia de las lesiones. Conclusiones. La membrana acelular de colágeno tipo I desarrollada por el Grupo de Trabajo en Ingeniería de Tejidos del Departamento de Farmacia de la Universidad Nacional de Colombia es efectiva en el tratamiento de úlceras venosas en miembros inferiores y su bajo costo facilita el acceso de toda la población a terapias basadas en su aplicación.