A six-year retrospective analysis of cut-out risk predictors in cephalomedullary nailing for pertrochanteric fractures: Can the tip-apex distance (TAD) still be considered the best parameter?

OBJECTIVES: Intramedullary fixation is considered the most stable treatment for pertrochanteric fractures of the proximal femur and cut-out is one of the most frequent mechanical complications. In order to determine the role of clinical variables and radiological parameters in predicting the risk of this complication, we analysed the data pertaining to a group of patients recruited over the course of six years. METHODS: A total of 571 patients were included in this study, which analysed the incidence of cut-out in relation to several clinical variables: age; gender; the AO Foundation and Orthopaedic Trauma Association classification system (AO/OTA); type of nail; cervical-diaphyseal angle; surgical wait times; anti-osteoporotic medication; complete post-operative weight bearing; and radiological parameters (namely the lag-screw position with respect to the femoral head, the Cleveland system, the tip-apex distance (TAD), and the calcar-referenced tip-apex distance (CalTAD)). RESULTS: The incidence of cut-out across the sample was 5.6%, with a higher incidence in female patients. A significantly higher risk of this complication was correlated with lag-screw tip positioning in the upper part of the femoral head in the anteroposterior radiological view, posterior in the latero-lateral radiological view, and in the Cleveland peripheral zones. The tip-apex distance and the calcar-referenced tip-apex distance were found to be highly significant predictors of the risk of cut-out at cut-offs of 30.7 mm and 37.3 mm, respectively, but the former appeared more reliable than the latter in predicting the occurrence of this complication. CONCLUSION: The tip-apex distance remains the most accurate predictor of cut-out, which is significantly greater above a cut-off of 30.7 mm.Cite this article: G. Caruso, M. Bonomo, G. Valpiani, G. Salvatori, A. Gildone, V. Lorusso, L. Massari. A six-year retrospective analysis of cut-out risk predictors in cephalomedullary nailing for pertrochanteric fractures: Can the tip-apex distance (TAD) still be considered the best parameter?. Bone Joint Res 2017;6:481-488. DOI: 10.1302/2046-3758.68.BJR-2016-0299.R1.

Static and dynamic baropodometry to evaluate patients treated by total knee replacement with a mobile meniscus.

It was the purpose of this study to use static and dynamic baropodometry pre- and postsurgery in patients submitted to knee replacement with a mobile bearing. Baropodometric analysis was accompanied by clinical and subjective evaluation. Data obtained from the baropodometer revealed considerable oscillations occurring between pre- and postsurgery. Static examination showed a significant increase in the percentage of loading on the side treated that was not observed in the dynamic evaluation. An analysis of the Knee Society score showed a considerable increase in values between pre- and postsurgery similar to how the interpretation of correlations presurgery revealed statistically significant values between function and length of step, between pre- and postsurgery data for scores for function and length of step and Knee Score. The short-term results obtained are encouraging but only a long-term follow-up will be able to confirm the use of evaluating total knee replacement.

Unicondylar femoral fractures: therapeutic strategy and long-term results. A review of 23 patients.

Unicondylar femoral fractures account for 0.65% of all femoral fractures; they have not been studied extensively in the orthopedic literature. Usually occurring following sports trauma or traffic accidents, these fractures involve the lateral condyle three times more frequently than the medial condyle. Conservative or surgical treatment has been advocated, depending on the fracture type. From 1986 to 1999, 19 patients with unicondylar femoral fractures were surgically treated at our institution: there were 15 males and 4 females, aged 36.2 years on average. According to the AO-ASIF classification, there were 7 B1, 6 B2 and 6 B3 fractures. We used Herbert screws in six cases, Barr screws together with cancellous screws in two, cannulated screws in five, cancellous screws alone in four, a compression screw and plate in one and a T-plate in one. In the same period of time, four patients were treated conservatively with a cast. Sixteen patients treated surgically were evaluated with a mean follow-up of 60 months, using Shatzker and Lambert's criteria: six results were rated as excellent, five good, four fair and one poor, while conservative treatment gave three fair and one poor results. In conclusion, we think that open reduction and internal fixation are essential in the treatment of such fractures.

The surgical treatment of intra-articular fractures of the calcaneus using a new multiple-hole Tra.Ma plate. The long-term results in relation to gait analysis.

Intra-articular fractures of the calcaneus have always represented a controversial subject; numerous surgical methods involving synthesis have been proposed, but none of these is without complications. The authors describe the use of new multiple-hole Tra.Ma plate in 25 patients between 1997 and 1999; all of the fractures were classified based on routine CT scan and X-ray evaluation and the Bohler, DeLangre and Preiss preoperative angles were measured 2 and 4 months later. All of the patients were also evaluated clinically and each of them underwent gait analysis using an electronic baropodometer. The Tra.Ma plate allows us to obtain satisfactory results both clinically and radiographically, also reducing the local complications related to the cumbersome nature of previous instrumentation; gait analysis also revealed the distribution of load comparable to that of the contralateral limb.

Unilateral blindness as a complication of intraoperative positioning for cervical spinal surgery.

The authors report a case of unilateral blindness after surgical vertebral stabilization for C5-C6 subluxation. The blindness resulted from ischemia of the retina caused by prolonged compression of the eyeball on the surgical bed. This injury can be serious and irreversible, so it must be prevented by placing the patient in the proper position. The anesthetist must pay particular attention to avoid the consequences of possible intraoperative movement.