Ipsilateral proximal and shaft femoral fractures: Results of two treatment strategies. / [Artículo traducido] Fracturas ipsilaterales proximales y diafisarias del fémur: resultados de dos estrategias de tratamiento.

INTRODUCTION: Ipsilateral proximal and shaft femoral fractures typically occur in young adults after high-energy trauma. No consensus exists regarding the optimal internal fixation device or surgical strategy for these complex fractures. Our main objective is to identify differences on outcomes and complications between patients treated with one or combined implants. MATERIAL AND METHOD: This is a single-center retrospective cohort study in patients with associated fractures of the proximal (31 AO) and shaft femur (32 AO). We divided the patients into two groups according to the use of single (GroupI) or combined implants (GroupII). Demographic, clinical, radiological, surgical data and development of complications were collected. RESULTS: We identified 28 patients (19 men and 9 women) with an average age of 43years. We used an anterograde femoral nail in GroupI (17 patients) and a retrograde femoral nail or a plate associated with hip lag screws or sliding hip screw in GroupII (11 patients). Patients were followed up for 26.28 (9.12-62.88) months. Osteonecrosis of the femoral head, osteoarthritis, infection or nonunion was found in 9 patients (32%). No significant differences (P=.70) were found in complications between two groups or between definitive surgical fixation before or after the first 24h. CONCLUSIONS: No differences in the development of complications or timing of definitive fixation were found between the use of one or combined implants in ipsilateral proximal femur and shaft fractures. Regardless of the implant chosen, an appropriate osteosynthesis technique is crucial, even so high complication rates are expected.

Does the fracture of the lateral wall affect the degree of collapse and the degree of sliding of the cephalic plate, in pertrochanteric fractures treated by intramedullary interlocking? Radiological study and review of the literature. / ¿Afecta la fractura de la pared lateral al grado de colapso y al grado de deslizamiento de la lámina cefálica, en fracturas pertrocantéreas tratadas mediante enclavado intramedular? Estudio radiológico y revisión de la literatura.

BACKGROUND: Lateral wall fracture has been recognized as an important sign of instability of pertrochanteric fractures. The aim of the present study is to assess the relationship between lateral wall fractures, helical blade telescoping and neck shortening in fractures treated with intramedullary nailing. MATERIAL AND METHOD: A descriptive radiological study was performed at our institution. Patients who suffered a pertrochanteric fracture, treated at Hospital 12 de Octubre by intramedullary nailing were included. All fractures were classified according to Evans and AO systems. Preoperative and postoperative radiological assessment was carried out including a lateral wall fracture classification, helical blade telescoping and femoral neck shortening. RESULTS: 210 patients were included, 48% had a fracture of the femoral lateral wall. Helical blade telescoping was higher in lower lateral wall fractures with respect to higher fractures. Difference was statistically significant (p<0.05). Neck shortening was higher in fractures with femoral lateral wall disruption; despite not have found any significant differences comparing to fractures with intact lateral wall (P=.39). Multivariate analysis showed statistically significant association between helical blade telescoping, neck shortening and lateral wall fracture. CONCLUSIONS: There is evidence of a higher helical blade telescoping and neck shortening in pertrochanteric fractures with lateral wall fracture treated with intramedullary nails, especially in those with most unstable patterns such us fractures of the lateral wall distal to the vastus ridge.

Estudio de la relación de la fractura del maléolo posterior y el desarrollo de artrosis / Study of the relation between the posterior malleolus fracture and the development of osteoarthritis

ANTECEDENTES Y OBJETIVOS: Al menos el 10% de las fracturas de tobillo presentan afectación del maléolo posterior de la tibia, lo cual se ha relacionado con peor pronóstico a largo plazo. Nuestro objetivo ha sido analizar los resultados clínico-funcionales de las fracturas de tobillo con afectación del canto posterior, tratadas de forma quirúrgica sin reducción directa del tercer maléolo. MATERIAL Y MÉTODOS: Realizamos un estudio retrospectivo sobre 45 pacientes menores de 60años que hemos clasificado en tres grupos atendiendo al porcentaje de afectación articular del fragmento posterior (<10%, 10-25% y >25%), valorando los resultados funcionales mediante la escala visual analógica del dolor (EVA), la escala American Orthopaedic Foot and Ankle Society (AOFAS) de tobillo y retropié, y el cuestionario de salud global SF-36; también hemos analizado el grado de artrosis con radiografía en carga, al menos un año tras la lesión. RESULTADOS: La puntuación media del dolor EVA de la muestra fue de 1,1 (0-5) en reposo y de 3 (0-8) en ejercicio; en la escala AOFAS fue de 88,4+/-10,1 y en la de SF-36, de 68,5+/-19,3 puntos. Hasta el 18% de los pacientes desarrollaron artrosis radiográficamente significativa a corto y a medio plazo (entre 12 y 73 meses, con una media de 33 meses). El 55,6% presentaban una afectación entre el 10 y el 25% de la superficie articular. Comprobamos que un mayor tamaño del fragmento posterior se relacionaba con mayor grado de artrosis precoz (p < 0,03) y peores puntuaciones en la escala AOFAS (p < 0,01). CONCLUSIÓN: Las fracturas de tobillo con afectación del maléolo posterior parecen contribuir al desarrollo de artrosis precoz con limitación funcional en adultos jóvenes

Background and aims: At least 10% of ankle fractures involve the posterior malleolus of the tibia, which has been related to poorer long-term prognosis. Our aim was to analyse the clinical and functional outcomes of ankle fractures involving the posterior edge, treated surgically without direct reduction of the third malleolus. MATERIAL AND METHODS: We performed a retrospective study of 45 patients aged under 60, who we classified into three groups in terms of the percentage of joint involvement of the posterior fragment (<10%, 10%-25% and >25%) assessing the functional outcomes using the visual analogue pain scale (VAS), the AOFAS scale (American Orthopedic Foot and Ankle Society) of the ankle and hindfoot and the global health questionnaire SF-36; we also analysed the degree of osteoarthritis with weight-bearing radiography, at least one year following the injury. RESULTS: The mean VAS pain score of the sample was 1.1 (0-5) at rest and 3 (0-8) on exercise; 88.4+/-10.1 on the AOFAS scale, and 68.5+/-19.3 points on the SF-36. Up to 18% of the patients developed radiographically significant osteoarthritis in the short and medium term (between 12 and 73 months, with a mean of 33 months). Of the patients, 55.6% had involvement of between 19% and 25% of the joint surface. We found that a larger posterior fragment size related to a greater degree of early-onset osteoarthritis (P<.03) and poorer AOFAS scores (P<.01). CONCLUSION: Ankle fractures involving the posterior malleolus seem to contribute to the development of early-onset osteoarthritis with functional limitation in young adults

Study of the relation between the posterior malleolus fracture and the development of osteoarthritis. / Estudio de la relación de la fractura del maléolo posterior y el desarrollo de artrosis.

BACKGROUND AND AIMS: At least 10% of ankle fractures involve the posterior malleolus of the tibia, which has been related to poorer long-term prognosis. Our aim was to analyse the clinical and functional outcomes of ankle fractures involving the posterior edge, treated surgically without direct reduction of the third malleolus. MATERIAL AND METHODS: We performed a retrospective study of 45 patients aged under 60, who we classified into three groups in terms of the percentage of joint involvement of the posterior fragment (<10%, 10%-25% and >25%) assessing the functional outcomes using the visual analogue pain scale (VAS), the AOFAS scale (American Orthopedic Foot and Ankle Society) of the ankle and hindfoot and the global health questionnaire SF-36; we also analysed the degree of osteoarthritis with weight-bearing radiography, at least one year following the injury. RESULTS: The mean VAS pain score of the sample was 1.1 (0-5) at rest and 3 (0-8) on exercise; 88.4±10.1 on the AOFAS scale, and 68.5±19.3 points on the SF-36. Up to 18% of the patients developed radiographically significant osteoarthritis in the short and medium term (between 12 and 73months, with a mean of 33months). Of the patients, 55.6% had involvement of between 19% and 25% of the joint surface. We found that a larger posterior fragment size related to a greater degree of early-onset osteoarthritis (P<.03) and poorer AOFAS scores (P<.01). CONCLUSION: Ankle fractures involving the posterior malleolus seem to contribute to the development of early-onset osteoarthritis with functional limitation in young adults.