The effectiveness of fixation of hydroxyapatite-coated helical blade in preventing of the cut-out observed in treatment with proximal femoral nail of fractures of the femur intertrochanteric in elderly.

BACKGROUND: This study aimed to retrospectively evaluate the effectiveness of hydroxyapatite-coated (HA-coated) implants and other caput-collum implants in preventing cut-out observed in treatment with proximal femoral nail (PFN) of intertrochanteric femur fractures in elderly patients. METHODS: A total of 98 consecutive patients (56 males and 42 females; mean age: 79.42 (61-115) years) treated with three differ-ent PFNs for intertrochanteric femoral fractures were retrospectively examined. The mean of the follow-up period was 7.87 (4-48) months. It was used a threaded lag screw in 40 patients, an HA-coated helical blade in 28 patients and a non-coated helical blade in 30 patients for PFN. The reduction quality, fracture type, and radiological outcomes among all groups were evaluated. RESULTS: Unstable type was seen in 50 (52.1%) patients according to AO Foundation/Orthopedic Trauma Association fracture classi-fication. An acceptable-good reduction quality was seen in 87 (88.8%) of all patients. The average of tip-apex distance (TAD) value was 27.61 mm, calcar-referenced TAD (CalTAD) value was 28.72 mm, caput-collum diaphyseal angle was 128,° Parker's anteroposterior ratio was 46.36%, and Parker's lateral ratio was 46.82%. The best suitable implant position was observed in 49 (50%) patients. Cut-out was observed in 7 (7.14%) patients, and secondary varus displacement of more than 10° was observed in 12 (12.24%) patients. Correlation analysis and multivariate logistic regression analysis showed a significant difference between HA-coated and other implants in cut-out. Furthermore, implant type was the strongest predictive factor for cut-out complications in the multivariate logistic regression analysis. CONCLUSION: HA-coated implants may reduce the long-term cut-out risk due to increased osteointegration and bone ingrowth in elderly patients with intertrochanteric femoral fractures with poor bone quality. However, this alone is not enough; a suitable screw position, optimal TAD values, and excellent reduction quality are other important factors.

Comparison of Enoxaparin and Rivaroxaban in the Prophylaxis of Deep Venous Thrombosis in Arthroplasty.

BACKGROUND: Pulmonary embolism is a serious early complication of arthroplasty procedures that can develop after deep venous thrombosis. The present study aimed to compare rivaroxaban and enoxaparin in terms of preventing DV and PE, and also in this study, we compared the complications due to these drugs in patients undergoing elective arthroplasty. MATERIALS AND METHODS: 214 patients were divided into three groups based on their treatment regimens. In group I, enoxaparin was used, in group II, rivaroxaban was used, and in group III, enoxaparin was used throughout hospitalization, and after hospital discharge, rivaroxaban was used. These three groups were compared according to the occurrence of deep venous thrombosis, pulmonary embolism, and major and minor complications. RESULTS: Major postoperative complications occurred in 5, 15, and 6 patients in group I, II, and III, respectively. Minor postoperative complications occurred in 10, 24, and 11 patients in group I, II, and III, respectively. No significant difference was found among the three groups. Deep venous thrombosis or pulmonary embolism was not observed in any patient. CONCLUSION: Rivaroxaban was found to be as effective as enoxaparin in the prevention of deep venous thrombosis and other complications after arthroplasty. Moreover, oral rivaroxaban provided greater ease of use compared to subcutaneous enoxaparin. Based on these findings, we consider that rivaroxaban could be an effective alternative to enoxaparin.