Does electromagnetic-manual guided distal locking influence rotational alignment in antegrade femoral nailing?

PURPOSE: The aim of this study was to determine whether distal locking using an electromagnetic-manual guided distal locking decreases the malrotation rate in femur fractures treated with intramedullary nailing. METHODS: A total of 113 adult patients having unilateral femoral shaft fractures treated using IM nails were evaluated regarding demographic features, injury mechanism, fracture type, interval between trauma and nailing, operation time and number of image intensifier shots during the operation at least one year after nailing. Patients were divided into two groups according to distal locking technique. All patients had also undergone clinical examination for lower extremity alignment and range of motion and filled out the SF-36 questionnaire and undergone ultrasound measurement of femoral anteversion angles to reveal any rotational femoral malalignment. RESULTS: Group 1 consisted of 47 patients (41.6 %) with electromagnetic-manual targeting guided distal locking and group 2 consisted of 66 patients (58.4 %) with free-hand distal locking. Both groups were statistically similar regarding demographic features, injury mechanism, fracture type, interval between trauma and nailing, clinical examination and SF-36 results. Operation time and number of image intensifier shots were significantly less in group 1. No statistically significant difference was found between the femoral anteversion angles of injured and uninjured sides of the patients in both groups. CONCLUSIONS: Although there is no significant effect on malrotation, previously known advantages lead us to state that electromagnetic-manual guided distal interlocking is an advantageous treatment option in femoral shaft fractures.

Atypical osteoid osteomas.

Osteoid osteoma is a very painful benign bone tumor that affects young adults. It is exceptional before 5 and after 30 years of age. It can be seen in any part of the skeleton. Presentation of the tumor may be intracortical, juxta-cortical or cancellous. In long bones, the tumor is frequently intracortical, and in the spine, it is usually located at the posterior elements. Osteoid osteomas having radiologic and clinical features other than classical presentation of osteoid osteoma are called atypical osteoid osteomas. Atypical osteoid osteomas are important because the diagnosis and treatment are often complicated in these cases. Misdiagnosis with prolonged impairment and sometimes overtreatment appears as a major problem concerning atypical osteoid osteomas. This paper gives brief general information about the classical presentation of osteoid osteoma, discusses the pathogenesis of the lesion and focuses on the clinical presentation, radiologic features and characteristics of atypical osteoid osteomas as well as their treatment modalities.