Version of femoral neck: a cadaveric dried bone study / Versión del cuello femoral: estudio cadavérico sobre huesos secos

The aim of this study was to measure the version of femoral neck on dried Thai human femora. The version of femoral neck varies widely. It is important to know the version of femoral neck in a particular population to undertake successful femoral neck reconstructive surgery. Paired 216 dried femora of adult Thais from the bone collection maintained in the Department of Anatomy at the Faculty of Medicine, Khon Kaen University, Thailand, were used to measure the version of femoral neck. The mean+SD femoral anteversion (FNA) was 16.21+5.24 degrees. The 95% confidence interval of FNA was from 15.48 to 16.94 degrees. The 95% confidence intervals of male and female average FNA were 14.75 to 16.90 and 15.59 to 17.59 degrees respectively. There was no significance difference of the FNA between males and females in both anteversion and retroversion groups. The average male FNA showed no statistical difference to average female anteversion. The 95% confidence intervals of males and females average retroversion were -8.22 to -4.80 and -7.71 to -4.47 degrees respectively. The average male retroversion showed no statistical difference to average female retroversion. The overall 95% confidence interval of femoral neck anteversion and retroversion were 15.48 to 16.94 degrees and -7.33 to -5.27 with no significant difference between males and females. These degrees of FNA must be considered when the femoral neck reconstructive surgery is planned.

El objetivo fue medir el cuello femoral en fémures humanos de tailandeses adultos. La versión del cuello femoral es muy variable. Es importante conocer la versión de cuello femoral en una población en particular para llevar a cabo con éxito una cirugía reconstructiva. Se utilizaron 216 fémures secos de adultos tailandeses obtenidos de la colección del Departamento de Anatomía de la Facultad de Medicina de la Universidad de Khon Kaen, Tailandia. La anteversión femoral (AFM) media+DE fue de 16,21±5,24. El intervalo de confianza del 95% de la AFM fue entre 15,48 a 16,94. El promedio de intervalos de confianza del 95% en hombres y mujeres fue desde 14,75 a 16,90 y 15,59 a 17,59, respectivamente. No hubo diferencia significativa entre hombres y mujeres en ambos grupos de anteversión y retroversión. La AFM promedio en hombres no mostró diferencia significativa con la anteversión media de las mujeres. Se observó un promedio de -8,22 a -4,80 y -7,71 a -4,47 en el 95% de los intervalos de confianza entre hombres y mujeres, respectivamente. La retroversión promedio en hombres no mostró ninguna diferencia significativa con la retroversión media en las mujeres. Estos grados de AFM deben ser considerados en la planificación de una cirugía reconstructiva del cuello femoral.

Treatment of de Quervain disease with triamcinolone injection with or without nimesulide. A randomized, double-blind, placebo-controlled trial.

BACKGROUND: There is uncertainty as to whether supplemental oral nonsteroidal anti-inflammatory medication improves the effectiveness of steroid injections in the treatment of de Quervain disease. We tested the hypothesis that there are no significant differences in the success rates when this condition is treated with triamcinolone injection with or without supplemental oral nimesulide. METHODS: In a randomized, double-blind trial, 160 patients with de Quervain disease received an injection of 10 mg of triamcinolone acetonide and either 200 mg of oral nimesulide for seven days (eighty patients) or placebo tablets for seven days (eighty patients). An independent, blinded evaluator assessed the primary outcomes (tenderness, pain, and the result on the Finkelstein test) at three weeks after injection. Adverse reactions were assessed, and probabilities of recurrence for both groups were compared. Factors possibly predictive of disease recurrence were also assessed. RESULTS: The success rate after one injection was 67% in the nimesulide group and 68% in the placebo group. The overall success rates after single or multiple injections with a mean follow-up of 13.6 months were 95% for both groups. No significant differences were noted with respect to the success rates (p = 0.69) or pain scores after treatment (p = 0.11). The most common adverse reactions to triamcinolone injection and nimesulide were pain after injection and dyspepsia, respectively. The symptoms of de Quervain disease recurred in 33% of the patients in the nimesulide group and in 37% of those in the placebo group. The median time of recurrence was at the fifth month in the nimesulide group and at the fourth month in the placebo group. The recurrence of symptoms was significantly (p = 0.01) related to the presence of crepitation (relative risk, 2.13; 95% confidence interval, 1.19 to 3.80). CONCLUSIONS: Supplemental oral administration of the nonsteroidal anti-inflammatory drug nimesulide does not improve the effectiveness of a single injection of triamcinolone acetonide in the treatment of de Quervain disease. Patients with crepitation in the first dorsal compartment during thumb extension or abduction are at increased risk for recurrence of this disease. LEVEL OF EVIDENCE: Therapeutic study, Level I-1b (randomized controlled trial [no significant difference but narrow confidence intervals]).