RESUMEN
Aim Significant risk factors for femoral nail cutout are well-documented, primarily in the context of single-screw proximal nails. However, it remains uncertain whether those same risk factors are applicable when considering different implant devices. The aim of this retrospective cohort study was to compare cutout risk factors between single- versus double-screw proximal femoral nails. Methods Patients over the age of 75 with intertrochanteric femur fractures (AO Classification 31-A1 or 31-A2) were included in the multicentre study. A study group was treated with a double-screw nail, while a control group received single-screw device. Demographic data, surgical time (min), fracture pattern, distal locking, reduction quality, comorbidities, tip-apex distance (TAD) and 12-month functional scores was collected. Results Two hundred patients were enrolled, 100 for each group. Nine patients experienced a cutout complication, five in the study and four in the control group. The main differences were in distal locking configurations (p<0.05) and in TAD values (p<0.05). The TAD value was higher in the study than in the control group (30.40±0.89 versus 26.79±1.79). No differences at 12-month follow up were reported according to functional scores. Conclusion This study provides insights into the choice of nail systems for intertrochanteric femur fractures, highlighting the importance of distal locking configurations and TAD values. The double screw nail exhibits quite a tolerance by having a higher average TAD value. These findings may guide clinical decisionmaking in the treatment of this challenging fracture type.
RESUMEN
Chondropathy of the knee is one of the most frequent degenerative cartilage pathologies with advancing age. Scientific research has, in recent years, advanced new therapies that target adenosine A2 receptors, which play a significant role in human health against many disease states by activating different protective effects against cell sufferance and damage. Among these, it has been observed that intra-articular injections of polydeoxyribonucleotides (PDRN) and Pulsed Electromagnetic Fields (PEMF) can stimulate the adenosine signal, with significant regenerative and healing effects. This review aims to depict the role and therapeutic modulation of A2A receptors in knee chondropathy. Sixty articles aimed at providing data for our study were included in this review. The present paper highlights how intra-articular injections of PDRN create beneficial effects by reducing pain and improving functional clinical scores, thanks to their anti-inflammatory action and the important healing and regenerating power of the stimulation of cell growth, production of collagen, and the extracellular matrix. PEMF therapy is a valid option in the conservative treatment of different articular pathologies, including early OA, patellofemoral pain syndrome, spontaneous osteonecrosis of the knee (SONK), and in athletes. PEMF could also be used as a supporting therapy after an arthroscopic knee procedure total knee arthroplasty to reduce the post-operative inflammatory state. The proposal of new therapeutic approaches capable of targeting the adenosine signal, such as the intra-articular injection of PDRN and the use of PEMF, has shown excellent beneficial results compared to conventional treatments. These are presented as an extra weapon in the fight against knee chondropathy.
