NEW GENERATION NAIL VS. PLATE IN THE TREATMENT OF UNSTABLE INTERTROCHANTERIC FEMORAL FRACTURE.

OBJECTIVE: To compare antirotator proximal femoral nail (A-PFN) with antirotator dynamic hip screw (A-DHS). METHODS: Fourteen proximal femur models with type 31/A2 fracture, according to the AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification, were separated into two groups. Group 1 bones (n = 7) were fixed with A-PFN and Group 2 (n = 7) with A-DHS. A 5 mm/min axial load was applied to femur heads using a testing device. RESULTS: Two of the seven models in the A-PFN group fractured at the proximal, and the other five at distal locking screw level. All models in the A-DHS group fractured at the tightened distal screw region. The median fracture load for the A-PFN group was 132.1 N (97.1-173.69 N range), and for the A-DHS group it was 81.7 N (75.15-89.12 N range). CONCLUSION: A-PFN-treated unstable intertrochanteric fractured models resisted to higher levels of axial load than the A-DHS-treated group, with statistically significant difference. However, clinical studies are required to support these results. Level of Evidence V, Biomechanical study.

OBJETIVO: O objetivo deste estudo foi comparar a haste do fêmur anti-rotador (A-PFN) com o parafuso dinâmico do quadril anti-rotador (A-DHS). MÉTODOS: Este estudo envolveu dois grupos de quatorze modelos de fêmur proximal, tipo fratura 31/A2, de acordo com a classificação The AO Foundation/Orthopaedic Trauma Association (AO/OTA). Os ossos do grupo 1 (n = 7) foram fixados com A-PFN, enquanto o grupo 2 (n = 7) foi fixado com A-DHS. Um dispositivo de teste foi utilizado para aplicar força axial de 5 mm/min nas cabeças do fêmur. RESULTADOS: Dos sete modelos do grupo A-PFN, dois foram rompidos na proximal e o restante no nível do parafuso de travamento distal. Todos os modelos no grupo A-DHS foram quebrados a partir da região do parafuso distal apertado. Os modelos ósseos no grupo A-PFN foram quebrados a uma força mediana de 132,1 N (variação de 97,1-173,69 N). No grupo A-DHS, a força de fratura dos modelos ósseos foi mediana de 81,7 N (variação de 75,15-89,12 N). CONCLUSÃO: Neste estudo, modelos ósseos fraturados intertrocantéricos instáveis tratados com A-PFN foram resistentes a um nível mais alto de forças de pressão axial, em contraste com o grupo tratado com A-DHS, e a diferença foi estatisticamente significativa. No entanto, há uma necessidade de estudos clínicos para apoiar esses resultados. Nível de Evidência V, Estudo biomecânico.

Does using different entrance points for intramedullary nails affect clinical outcomes for femoral shaft fractures? A retrospective clinical comparative study.

OBJECTIVE: We examined the clinical and radiological outcomes of femoral shaft fractures treated with two different intramedullary nail designs using either greater trochanteric or trochanteric fossa entrance. METHODS: The medical records of patients undergoing operations for a shaft fracture either with a nail with trochanteric entrance or trochanteric fossa entrance were retrospectively reviewed. Inclusion criteria were: having the necessary medical records including radiographic images and follow-up data, at least 12 months of follow-up, skeletal maturity (≥16 years of age) not having osteoporosis (≤60 years of age). Exclusion criteria were: pathological fractures, fragility fractures, fractures that extend to hip or knee joint capsule, lack of enough medical data, less than 12 months of follow up, and patients yet to reach skeletal maturity. RESULTS: A total of 65 patients (67 femur fractures) were treated with intramedullary nails using a trochanteric fossa entrance (TFE) and 21 patients (23 femur fractures) were treated with nails using a greater trochanteric entrance (GTE). No statistically significant differences were evident between groups in terms of union time, blood loss, need for implant removal, implant failure, or revision operation. However, the duration of postoperative hospitalization was significantly shorter in the GTE nail group and the need for open reduction of the fracture was less common in these patients. Although there were no significant differences between groups in terms of complications and union among isthmal and infra-isthmal fractures, malreduction and iatrogenic fractures were more common with the use of GTE nails for treatment of supra-isthmal fractures. CONCLUSION: Use of intramedullary nails via both GTE and TFE were safe and efficient for the treatment of isthmal and infra-isthmal fractures. However, varus malalignments associated with iatrogenic fractures were more common with trochanteric entrance nails. Together, our results show that the use of nails via TFE may represent a safer option for surgical treatment of supra-isthmal fractures.

New generation nail vs. plate in the treatment of unstable intertrochanteric femoral fracture / Pregos de nova geração contra a placa no tratamento de fraturas de fêmur intertrocantéricas instáveis

ABSTRACT Objective: To compare antirotator proximal femoral nail (A-PFN) with antirotator dynamic hip screw (A-DHS). Methods: Fourteen proximal femur models with type 31/A2 fracture, according to the AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification, were separated into two groups. Group 1 bones (n = 7) were fixed with A-PFN and Group 2 (n = 7) with A-DHS. A 5 mm/min axial load was applied to femur heads using a testing device. Results: Two of the seven models in the A-PFN group fractured at the proximal, and the other five at distal locking screw level. All models in the A-DHS group fractured at the tightened distal screw region. The median fracture load for the A-PFN group was 132.1 N (97.1-173.69 N range), and for the A-DHS group it was 81.7 N (75.15-89.12 N range). Conclusion: A-PFN-treated unstable intertrochanteric fractured models resisted to higher levels of axial load than the A-DHS-treated group, with statistically significant difference. However, clinical studies are required to support these results. Level of Evidence V, Biomechanical study.

RESUMO Objetivo: O objetivo deste estudo foi comparar a haste do fêmur anti-rotador (A-PFN) com o parafuso dinâmico do quadril anti-rotador (A-DHS). Métodos: Este estudo envolveu dois grupos de quatorze modelos de fêmur proximal, tipo fratura 31/A2, de acordo com a classificação The AO Foundation/Orthopaedic Trauma Association (AO/OTA). Os ossos do grupo 1 (n = 7) foram fixados com A-PFN, enquanto o grupo 2 (n = 7) foi fixado com A-DHS. Um dispositivo de teste foi utilizado para aplicar força axial de 5 mm/min nas cabeças do fêmur. Resultados: Dos sete modelos do grupo A-PFN, dois foram rompidos na proximal e o restante no nível do parafuso de travamento distal. Todos os modelos no grupo A-DHS foram quebrados a partir da região do parafuso distal apertado. Os modelos ósseos no grupo A-PFN foram quebrados a uma força mediana de 132,1 N (variação de 97,1-173,69 N). No grupo A-DHS, a força de fratura dos modelos ósseos foi mediana de 81,7 N (variação de 75,15-89,12 N). Conclusão: Neste estudo, modelos ósseos fraturados intertrocantéricos instáveis tratados com A-PFN foram resistentes a um nível mais alto de forças de pressão axial, em contraste com o grupo tratado com A-DHS, e a diferença foi estatisticamente significativa. No entanto, há uma necessidade de estudos clínicos para apoiar esses resultados. Nível de Evidência V, Estudo biomecânico.

A Case of Schwannoma of the Common Peroneal Nerve in the Knee.

Schwannomas are benign neurogenic tumors of peripheral nerves that originate from neural sheath. The aim of this case report is to bring to mind the schwannoma in the patient with knee pain. A 39-year-old woman presented with a complaint of knee pain of three months history. After surgical intervention, the patient's complaints completely disappeared in the post-operative period. This should come to mind in the differential diagnosis of knee pain.