RESUMO
Background: In extra-articular distal femoral fractures (EDFFs), nonunion is a serious complication that occurs rarely. In this study, we examined how longer preservation of initial fracture hematoma by delaying the osteosynthesis (OS) affects the fracture union. Methods: In a retrospective cohort study, 98 EDFF patients were included. The OS was done within 2 days of injury in 50 patients (early OS group) and after 2 days of injury in 48 patients (late OS group). Time to callus formation and fracture union, bleeding amount, surgical duration, pain, knee range of motion, knee function, and postoperative complications, including the nonunion, knee deformity, infection, and revision, were compared between the 2 groups. Statistical analyses were done with SPSS. A comparison of the mean between the 2 groups was made with an independent t test or its nonparametric counterpart. A comparison of categorical variables between the 2 groups was made using a chi-square or the Fisher's exact test. P Ë 0.05 was considered statistically significant. Results: The mean time to callus formation was 47.1 ± 17.3 days in the early OS group and 46.9 ± 19.7 in the late OS group (P = 0.950). The mean time to fracture union was 114.9 ± 21 in the early OS group and 117.4 ± 28.8 days in the late OS group (P = 0.630). The mean operation time and bleeding amount between the 2 groups did not differ significantly (P = 0.230 and P = 0.340, respectively). The knee range of motion, pain, and function were not notably different (P = 0.620, P = 0.790, and P = 0.770, respectively). Nonunion occurred in 3 patients of early OS and 2 patients of the late OS group. Other complications were also comparable in the 2 study groups. Conclusion: Delayed OA in EDFF patients has no significant effect on bone healing and fracture union. Future standard studies are required to confirm these results.
RESUMO
BACKGROUND: Deferoxamine (DFO) angiogenesis induction potential has been demonstrated in earlier studies, but not in the osteonecrosis of the femoral head (ONFH). In this study, we evaluated the outcome of ONFH treated with combined core decompression and local DFO administration loaded on Polylactic Glycolic Acid (PLGA). PATIENTS AND METHODS: In a pilot experimental study, six patients (10 hips) with early-stage non-traumatic ONFH were treated by core decompression, and concurrent injection of local DFO loaded on PLGA scaffold into the subchondral femoral head. Outcome measures were evaluated before the surgery and 12 and 24 months after the surgery and included visual analog scale (VAS) for pain, modified Merle d'Aubigné-Postel (MAP) score for hip function by MRI, and rate of osteonecrosis assessed by the modified. RESULTS: The mean MPA score was 14.7 ± 1.16 before the surgery and 16.7 ± 1.41 one year after the surgery (P = 0.004). The mean VAS for pain was 4.7 ± 1.25 before the surgery and 1.8 ± 1.03 one year after the surgery (P = 0.005). The mean Kerboul angle was 219 ± 58.64 before the operation and 164.6 ± 41.82 one year after the operation (P < 0.001). Osteonecrosis progression or collapse was not seen in any of the patients at the final follow-up. No postoperative side effect attributed to the DFO was noticed, as well. CONCLUSION: In short-term follow-up, combined core decompression and local DFO administration not only prevent the progression of ONFH but also reduces the rate of osteonecrosis significantly. However, future controlled studies are required to confirm the present results. TRIAL REGISTRATION: IRCT20161121031003N3, 16/04/2019.
Assuntos
Glicóis , Osteonecrose , Humanos , Projetos Piloto , Cabeça do Fêmur , DescompressãoRESUMO
Hoffa fractures are rare fractures of the femoral condyle that occur in the coronal plane of the bone. In most cases, high-energy trauma leads to isolated coronal fractures of one of the femoral condyles, medial or lateral. Even with a typical unicondylar Hoffa fracture, our patient sustained a bicondylar Hoffa fracture in his right knee after falling from high and suffering direct trauma as well. The fracture was approached from both the medial and lateral sides of the distal femur. Three-month follow-up showed excellent functional scores, no laxity, and no pain.
