Effect of Downsized Screw Selection on Bone Healing and Postoperative Complications in Volar Plating of Distal Radius Fractures.

When performing volar plating of distal radius fractures, selecting downsized subchondral screws may prevent dorsal screw penetration (DSP), which is a risk factor for extensor tendon rupture. However, downsizing may cause loss of reduction or poor bone healing. This prospective study investigated the effect of downsized screw selection on bone healing and postoperative complications. A total of 115 patients with postoperative follow-up longer than 6 months comprised the study population. Using a depth gauge, screws that were 2-mm shorter than the measured value were selected. The DSP then was checked using dorsal tangential view (DTV) radiographs during surgery and at final follow-up. Baseline data included bone healing, loss of reduction of radiological parameters, DSP location, and postoperative complications. To assess DSP on DTV radiographs, the dorsal surface of the radius was divided into the radial and ulnar sides at the Lister tubercle, and each was further divided into 2 equal regions. These 4 regions were defined as zones 1 to 4 from the radial side. A total of 114 patients (99%) showed bone healing. Mean loss of reduction was approximately 1° and within 1 mm in radiological parameters. Eleven patients (9.6%) showed DSP during surgery or at final follow-up despite using 2-mm downsized screws. The most common site of DSP was zone 3. Extensor pollicis longus rupture occurred in 2 patients (1.7%) despite no DSP. Downsized screw selection provided a high rate of bone healing with minimum loss of reduction and a low complication rate. The extensor tendon can be torn regardless of DSP. [Orthopedics. 2021;44(2):e259-e265.].

Association of Sarcopenic Dysphagia with Underlying Sarcopenia Following Hip Fracture Surgery in Older Women.

This study aimed to investigate the association between the development of dysphagia in patients with underlying sarcopenia and the prevalence of sarcopenic dysphagia in older patients following surgical treatment for hip fracture. Older female patients with hip fractures (n = 89) were studied. The data of skeletal muscle mass, hand-grip strength, and nutritional status were examined. The development of dysphagia postoperatively was graded using the Food Oral Intake Scale by a certified nurse in dysphagia nursing. The patients' mean age was 85.9 ± 6.5 years. The prevalence of sarcopenia was 76.4% at baseline. Of the 89 patients, 11 (12.3%) and 12 (13.5%) had dysphagia by day 7 of hospitalization and at discharge, respectively. All patients who developed dysphagia had underlying sarcopenia. Lower skeletal muscle mass index (SMI) (<4.7 kg/m2) and grip strength (<8 kg) at baseline indicated a higher incidence of dysphagia on day 7 (p = 0.003 and Phi = 0.391) and at discharge (p = 0.001 and Phi = 0.448). Dysphagia developed after hip fracture surgery could be sarcopenic dysphagia, and worsening sarcopenia was a risk factor for dysphagia following hip fracture surgery. Clinicians and medical coworkers should become more aware of the risks of sarcopenic dysphagia. Early detection and preventive interventions for dysphagia should be emphasized.

Clinical results of surgical treatment for femoral neck fractures with the Targon® FN.

84 cases (male 15 cases, female 69 cases) of intracapsular femoral neck fractures treated with the Targon® FN (TFN) were available for review. Mean patient age was 74.0 years (range 36-100 years). 55 fractures were undisplaced whereas 29 were displaced. Mean follow-up term was 16.4 months. We surveyed patient mobility before injury and after operation as well as postoperative complications. On a four-stage mobility scale we found 3/55 patients with undisplaced fractures loosing mobility by more than one grade (5.5%), whereas 5/29 (17.2%) displayed this kind of functional decline after displaced fractures. Overall postoperative complication rate was 10.7% (9 cases). These complications included nonunion (1 case), avascular necrosis (7 cases) and peri-implant fracture (1case). Internal fixation with the TFN seems to have an acceptable complication rate in both undisplaced and displaced fractures compared to other recent studies.

Complications and fixation techniques of trochanteric fractures with the TARGON(®) PF.

The purpose of this study was to analyse clinical results of elderly patients with trochanteric fractures that were treated with use of TARGON(®) PF nail. Overall, 494 patients (113 males) were available for this study. On the basis of Jensen classification, there were 76 cases in type I, 164 cases in type II, 70 in type III, 129 in type IV and 55 in type V. (1) Sliding amount of lag screw in relation to the Jensen classification, (2) sliding amount of lag screw according to the Ikuta's classification that categorises the reduction in lateral view in three, Subtype A, Subtype N and Subtype P, (3) sliding amount of lag screw in correlation between Jensen classification and Ikuta's classification and (4) postoperative complications (9 cases; 1.7%) were assessed. Cut-out and back-out cases were seen in 6 cases (1.1%), and these severe complications were evaluated in details. In correlation between Jensen classification and Ikuta's classification, the excessive sliding of lag screw was prominent with the Subtype P, which was preoperatively in Jensen type III or V. Cut-out or back-out cases were caused either from (1) Subtype P that were preoperatively Jensen types III or V, or from (2) the fracture where there was bony defect anteriorly. Therefore, special care must be taken for these types.