Distal targeting device for long Gamma nail(®). Monocentric observational study.

INTRODUCTION: Intramedullary nail distal locking screws make it possible to control length and rotation but include an increased risk of radiation exposure. A distal targeting device was recently developed for long Gamma(®) nails (Stryker(®)). The aim of this practical observational study was to evaluate the reliability of this system. Our hypothesis was that the targeting device would be systematically used without conversion or complications. MATERIALS AND METHODS: All of the long Gamma(®) nails implanted between November 2011 and October 2012 were recorded: 91 nails (59W/32M, mean age 73.5years old) for 68 traumatic fractures, 14 preventive nailings and nine pathological fractures. A junior surgeon performed the procedure in 45 cases and a senior in 46 cases. The number of times the device was used, the difficulties and complications encountered, the duration of fluoroscopy and the dose of radiation were noted. Risk factors were looked for. RESULTS: The targeting device was used 79 times (the surgeon chose not to use it 11 times, and it was not available in one case). There was a measurement error in one case, therefore 78 nails could be evaluated. Three wrong positions of the distal locking screw occurred. No statistically significant risk factors were identified. Distal locking screw corresponded to 18% of the entire procedure at a radiation dose of 7.44% (this was higher with titanium nails and pathological fractures). Total fluoroscopy time was longer with junior than with senior surgeons but the dose and duration for distal locking were not different. DISCUSSION: The hypothesis was not confirmed. The device was not systematically used and the risk of complications was not null. No risk factors were identified. The distal locking screw is a difficult step but the use of the targeting device can limit the dose of radiation. This device is effective and allows young surgeons to perform distal locking without increasing the dose of radiation compared to senior surgeons. LEVEL OF EVIDENCE: Level IV, cohort study, observational prospective follow-up.

Minimally invasive fixation of type B and C interprosthetic femoral fractures.

INTRODUCTION: Interprosthetic femoral fractures are rare and raise unresolved treatment issues such as the length of the fixation material that best prevents secondary fractures. Awareness of the advantages of locked-plate fixation via a minimally invasive approach remains limited, despite the potential of this method for improving success rates. HYPOTHESIS: Femur-spanning (from the trochanters to the condyles) locked-plate fixation via a minimally invasive approach provides high healing rates with no secondary fractures. MATERIALS AND METHODS: From January 2004 to May 2011, all eight patients seen for interprosthetic fractures were treated with minimally invasive locked-plate fixation. Mean time since hip arthroplasty was 47.5 months and mean time since knee arthroplasty was 72.6 months. There were 12 standard primary prostheses and four revision prostheses; 11 prostheses were cemented and a single prosthesis showed femoral loosening. Classification about the hip prostheses was Vancouver B in one patient and Vancouver C in seven patients; about the knee prosthesis, the fracture was SoFCOT B in three patients and SOFCOT C in five patients, and a single fracture was SoFCOT D. Minimally invasive locking-plate fixation was performed in all eight patients, with installation on a traction table in seven patients. RESULTS: Healing was obtained in all eight patients, after a mean of 14 weeks (range, 12-16 weeks). One patient had malalignment with more than 5° of varus. There were no general or infectious complications. One patient died, 32 months after surgery. The mean Parker-Palmer mobility score decreased from 6.2 pre-operatively to 2.5 at last follow-up. Early construct failure after 3 weeks in one patient required surgical revision. There was no change in implant fixation at last follow-up. No secondary fractures were recorded. DISCUSSION: In patients with type B or C interprosthetic fractures, femur-spanning fixation not only avoids complications related to altered bone stock and presence of prosthetic material, but also decreases the risk of secondary fractures by eliminating stress riser zones. The minimally invasive option enhances healing by preserving the fracture haematoma. Thus, healing was obtained consistently in our patients, with no secondary fractures, although the construct failed in one patient. LEVEL OF EVIDENCE: Level IV.

Infection control: point prevalence study versus incidence study in Polish long-term care facilities in 2009-2010 in the Malopolska Region.

OBJECTIVE: The objective of this study was to evaluate the epidemiology of infection in Polish long-term care facilities (LTCFs) and to analyse the capabilities and legitimacy of implementing continuous targeted surveillance. METHODS: The study investigated the relationship between the presence of infection and health status, tested using a point prevalence study (PPS) and incidence study. A 1-day PPS was carried out in October 2009, with prospective continuous surveillance between December 2009 and November 2010. Infections were defined according to McGeer's criteria. RESULTS: The surveillance encompassed 193 people. The prevalence was 14.0 % in residential homes (RHs) and 18.7 % in the nursing home (NH). Various types of infections (in the PPS) were observed significantly more frequently in patients with asthma, wounds, atherosclerosis of lower extremities, tracheotomy tubes and conditions in patients hospitalised in intensive care units (ICUs) up to 1 year before the PPS day. The incidence rate was 2.7/1,000 patient days (pds). CONCLUSIONS: The factors determined to be important for the risk of infection (in the continuous study) include the general status of patients, expressed using Barthel, abbreviated mental and Katz scales, as well as limited physical activity, stool incontinence and urinary catheterisation. In the PPS study, only a slight relationship was shown between the general status of residents and the risk of infection. None of the general status scales used clinically were shown to be helpful in estimating that risk, similarly to the five-point physical activity scale. Prospective continuous surveillance shows a possibility of limiting the range of infection control in the LTCFs within targeted surveillance in a population of patients that requires intensive nursing procedures. As a marker, one could point to the low score in the Barthel or Katz scales or low physical activity/bedridden persons.

Determination of gliclazide in pharmaceutical preparations by capillary gas chromatography with cool on-column injection and elimination of the matrix effect.

Conditions were established for the identification and quantitation of gliclazide in pharmaceutical preparations by capillary gas chromatography with flame ionization detection and cool on-column injection. Gliclazide was extracted with methanol and, after filtration, assayed on a (25 m x 0.25 mm id, 0.2 microm film thickness) CP-WAX 58 (FFAP)-CB WCOT fused silica column. Because the available preparations were of various origins and, therefore, could differ in auxiliary substances and their qualitative parameters, the influence of the matrix constituents on the analytical results was taken into account. Good separation conditions were established for the developed method. The retention time of gliclazide is about 36 min and differs from the retention times of the internal standard (approximately 29 min) and additional peaks present in chromatograms (20-26 min), which were assigned to matrix constituents. The recoveries of gliclozide were high and reached 96.5%. The developed method is characterized by selectivity and precision (relative standard deviation 0.38-1.26%), a wide range of linearity (0.1-10.0 mg/mL), and a limit of detection of 30 ng. In addition, the results of chromatographic analyses calculated in 3 ways were compared with those obtained by UV spectrophotometry. The suggested technique of cool on-column injection, in contrast with split-splitless injection (used in preliminary investigations), reduces to a minimum the possibility of thermal decomposition of gliclazide.

Relationship among reduced level of stored iron and dietary iron in trained women.

The aim of the study was to assess the relationship between dietary iron intake (both haeme- and non-haeme-iron) and its status in trained female subjects. Forty female athletes and forty non-trained women of the same age participated in this study. Blood samples were taken to assess haematological (red blood cell count-Er, haemoglobin concentration-Hb, packed cell volume-PCV) and iron related parameters (serum ferritin concentration-SF, serum iron concentration-SI, total iron binding capacity-TIBC). A self questionnaire was used to record food intake for seven days and diets were analyzed on the basis of mean daily nutrient intake, energy values, iron intake and sources of dietary iron. According to established clinical criteria for iron deficiency some athletes and control subjects shown iron depletion (20% and 10%, respectively), iron deficiency erythropoiesis (10% and 7.5%, respectively) and iron-deficient anaemia (10% and 7.5%, respectively). There was no difference in the mean total dietary iron intake between the two female groups, while the mean intake of haeme-iron was significantly lower in the control group. The findings in the present study are: (1) the significant relation exists between serum ferritin level and quantity of haeme-iron intake (but not with total iron intake), and (2) 10% of female athletes have iron deficiency.

[Results of internal-medical examinations of the population from the region of a rural health center in Wielka Wies-BiaLy KoscióL]. / Wyniki internistycznych badan mieszkanców z rejonu wiejskiego osrodka zdrowia we Wielkiej Wsi-Bialym Kosciele.

Among 250 adults (120 male farmers-workers and 130 female farmers) belonging to the population of a village near Krakow, 153 (61%) were recognized sick (67 men--56% and 86 women--66%). Most frequent diseases concerned: the circulation (30% arterial hypertension), digestion (18%, peptic ulcer 14%), respiration (14% mainly bronchial chronic inflammations and asthma), locomotion (11% degenerative joint changes), neuroses (10%) and urogenital system (8.4%). Some cases of neoplasms (3.2%), parasitism (2.8%) and bone fractures caused by professional traumas (2.8%) were registered. The diseases of digestion and respiration were more frequent in men, arterial hypertension, neuroses, urogenital and locomotion diseases more common in women. Arterial hypertension and peptic ulcer afflicted persons over 30, the degenerative joint changes the individuals over 45 years of age.