Expanding indications of the horizontal belt plate: a technical note.

BACKGROUND: Although the standard treatment for articular fractures usually involves open anatomic reduction and internal fixation with the concept of absolute stability, achieving adequate fracture stabilisation in multifragmentary patterns is always challenging. Several anatomical implants were developed to increase stabilisation and improve clinical outcomes in articular fractures. However modern implants, especially in developing countries, are expensive and not always available for routine use. Horizontal rafting plate has recently emerged as an alternative technique to treat complex tibial plateau fractures using simple implants that function as a large washer. OBJECTIVE: This technical note aims to describe horizontal belt plate use for treatment of periarticular fractures including the tibial plateau, thereby expanding its initial indication. CONCLUSION: Horizontal belt plate is an effective, safe, and inexpensive treatment alternative for complex articular fractures. However, the surgeon must carefully analyse the fracture pattern to verify if the horizontal belt plate can be used alone or with traditional techniques.

Interprosthetic femoral fractures: proposed new classification system and treatment algorithm.

Interprosthetic femoral fracture is a rare and challenging fragility fracture issue. Due to aging of the population, the incidence of this type of fracture is gradually and constantly increasing. There is no complete and specific interprosthetic femoral fracture classification system that indicates treatment and prognosis in the literature. The aim of the present study was to describe a new classification system for interprosthetic femoral fractures, and to present a case series and a treatment algorithm derived from the current evidence in the literature.

CLINICAL AND ANATOMICAL COMPARISON OF THE FIBULAR NERVE IN GERDY's SAFE ZONE.

OBJECTIVE: To clinically and anatomically compare the limits of the fibular nerve in Gerdy's safe zone in cadavers. METHODS: Fifty anatomical knee specimens were clinically measured (before dissection) to determine the distances and angles between Gerdy's tubercle and the posterior region of the fibula (cm); the angle between the line corresponding to the posterior region of the fibula and the tibial crest (degrees); and the angle between Gerdy's tubercle and the tibial crest (degrees). After dissection of the anatomical specimens, the knees were measured again, to determine the distances and angles between Gerdy's tubercle and the fibular nerve (cm); the angle between the fibular nerve, in the posterior region of the fibula, and the tibial crest (degrees); and the angle between Gerdy's tubercle and the tibial crest (degrees). RESULTS: There was a significant increase in the distance between Gerdy's tubercle and the posterior region of fibula (cm), after dissection: an average of 0.26 cm (p = 0.018), corresponding to 8.6% (p = 0.007). There was also a significant reduction in the angle between the posterior region of the fibula and the tibial crest after dissection: an average of 3° (p = 0.047), corresponding to 2.1% (p = 0.06). CONCLUSION: Despite the difference from before to after dissection, Gerdy's safe zone can be considered safe for orthopedic procedures involving the proximal region of the tibia, thereby avoiding damage to the fibular nerve and its branches.

FRACTURES OF THE DISTAL EXTREMITY OF THE TIBIA TREATED WITH INTRAMEDULLARY NAIL OR BRIDGE PLATE: COMPARISON OF RADIATION EXPOSURE DURATION BETWEEN THE TWO METHODS.

OBJECTIVE: To compare the duration of exposure to radiation among patients with fractures of the distal third of the tibia treated with an intramedullary nail or with a bridge plate. METHODS: Intramedullary nails were used for 33 fractures, and bridge plates were used for 41 fractures. In the nail group, according to the AO classification, 14 patients had type A fractures, 15 had type B and four had type C. Twelve patients had closed fractures and 21 had open fractures. In the plate group, 10 patients had type A fractures, 22 had type B and nine had type C. Twenty-seven patients had closed fractures and 14 had open fractures. RESULTS: There was a significant difference in the duration of exposure to radiation between the patients treated using a nail and those treated using a plate (p = 0.0001). The group treated using a nail had significantly greater exposure to radiation than did the group treated using a plate. Comparing the type of fracture (A, B or C), it was observed that there was no significant difference in the duration of exposure to radiation between the nail technique (p = 0.19) and the plate technique (p = 0.80). CONCLUSION: Fractures of the distal third of the tibia treated with an intramedullary nail present significantly greater exposure to radiation than do fractures treated with a bridge plate, independent of the fracture type.

LOCALIZATION OF THE TIBIAL ENTRY POINT.

OBJECTIVE: To assess the intramedullary nail entry point in the proximal region of the tibia, through a questionnaire. METHODS: 230 participants undergoing treatment for tibial fractures were interviewed. The questionnaire was created with three sections that could be answered in a "Yes" or "No" format and a fourth section that had two figures representing anteroposterior (AP) and lateral view x-rays that could be answered in an "A, "B" or "C" format. RESULTS: The most frequent reason was "ease of access" (67.8%), followed by "better nail insertion access" (60.9%) and, in third place, "to prevent knee pain" (27.4%). The reasons for choosing the access so as to "prevent knee pain" and "avoid tendinitis" had a significant relationship with points "A" and "C" of the schematic AP x-ray figure, especially "C" (medial tibial crest). There were no significant differences between the types of access to the patellar ligament in the schematic AP and lateral x-ray figures between age groups. CONCLUSION: The greater the age was, the larger the proportion choosing the question "to avoid valgus deformity" was. The reasons from a medical (practical) perspective related to the type of access in the transpatellar ligament, while the reasons from a patient (functional) perspective related to medial parapatellar access. Transpatellar access was chosen by most of the participants (66.5%).

ENTRY POINT FOR THE ANTEGRADE FEMORAL INTRAMEDULLARY NAIL: A CADAVER STUDY.

OBJECTIVE: To analyze the natural exit of the wire guides in major trochanter through retrograde femoral approach, in cadaver specimens. MATERIAL AND METHOD: 100 femurs had been perforated between the femoral condyles, at 1.2 cm of the intercondylar region. A 3-mm straight wire guide was introduced, through retrograde approach, until the proximal extremity of femur was reached. Femurs were assessed for posterosuperior and anterosuperior portions of major trochanter, pear-shaped cavity, and upper median line between the head-neck and the major trochanter. RESULTS: in 62%, the straight wire guides exited at the anterior surface of major trochanter. In the pear-shaped cavity, the median distance found was 1.0 cm and the interquartile range was 0.5 cm, initially expressing, in relation to pear-shaped cavity, better accuracy. CONCLUSION: the central axis of the medullar canal, at coronal plane, projected better accuracy in the region of the pear-shaped cavity.