Treatment of Trochanteric Hip Fractures with Cephalomedullary Nails: Single Head Screw vs. Dual Integrated Compression Screw Systems.

Extracapsular hip fractures are very common in the elderly. They are mainly treated surgically with an intramedullary nail. Nowadays, both endomedullary hip nails with single cephalic screw systems and interlocking double screw systems are available on the market. The latter are supposed to increase rotational stability and therefore decrease the risk of collapse and cut-out. A retrospective cohort study was carried out, in which 387 patients with extracapsular hip fracture undergoing internal fixation with an intramedullary nail were included to study the occurrence of complications and reoperations. Of the 387 patients, 69% received a single head screw nail and 31% received a dual integrated compression screw nail. The median follow-up was 1.1 years, and in that time, a total of 17 reoperations were performed (4.2%; 2.1% for single head screw nails vs. 8.7% for double head screws). According to the multivariate logistic regression model adjusted for age, sex and basicervical fracture, the adjusted hazard risk of reoperation required was 3.6 times greater when using double interlocking screw systems (p = 0.017). A propensity scores analysis confirmed this finding. In conclusion, despite the potential benefits of using two interlocking head screw systems and the increased risk of reoperation in our single center, we encourage to other researchers to explore this question in a wider multicenter study.

Diabetes Mellitus and Obesity as Prognostic Factors in Arthroscopic Repair of Chronic Rotator Cuff Tears.

Metabolic diseases such as obesity and diabetes mellitus seem to have an influence on reoperation and long-term functional outcomes after arthroscopic repair of chronic rotator cuff tears. High prevalence of these pathologies can be found in the Canary Islands. A retrospective cohort study was carried out, in which 80 patients undergoing shoulder arthroscopic surgery for the repair of chronic rotator cuff tears were included, with a minimum follow up of 5 years, to study the occurrence of complications, reoperation, and functional outcomes. Functionality after surgery improved in 75% of patients with diabetes and remained the same or worsened in 25% (OR = 1.444). In the group of non-diabetic patients, 83.9% had improved function after surgery while it remained the same or worsened in 16.1% (OR = 0.830). Functionality after surgery improved in 76.6% of obese patients and remained the same or worsened in 23.4% (OR = 1.324). In the non-obese group, 87.9% had improved function after surgery, while it remained the same or worsened in 12.1% (OR = 0.598). Despite not obtaining statistically significant differences, the analysis of the results obtained suggests that obesity and diabetes could act by decreasing the subjective improvement in functionality after surgery, and, in the case of obesity, also increase the risk of reoperation.

Modified Dynamic Anterior Stabilization and Labroplasty for Anterior Shoulder Instability With Concomitant SLAP Lesion.

Several arthroscopic techniques to treat anterior shoulder instability have been described. Bankart repair may be insufficient in cases with some degree of bone loss, and arthroscopic Latarjet is technically challenging. It is not rare to find at the time of surgery a more extensive labral tear (SLAP lesion) or an insufficient anterior capsulolabral tissue. We describe for those cases a dynamic anterior stabilization where using the long head of the biceps we are treating the SLAP lesion and at the same time it provides the "sling effect" of a Latarjet procedure for the anterior instability.

Luxación inveterada de base de los metacarpianos 3º, 4º y 5º. Artrodesis carpometacarpiana / Inveterate dislocation of third, fourth and fi fth carpometacarpal joints. Carpometacarpal arthrodesis

Las luxaciones carpometacarpianas (CMC) son raras y de difícil diagnóstico si no se solicitan las proyecciones adecuadas (radiografía lateral a 30º de pronación), es por ello que en muchas ocasiones pasan inadvertidas en la fase aguda. Presentamos un caso extraordinariamente infrecuente como es una luxación inveterada CMC múltiple en un paciente joven tras traumatismo de alta energía. Fue diagnosticado dos meses después del traumatismo por lo que se decide tratamiento quirúrgico mediante artrodesis carpometacarpiana utilizando una forma novedosa de RAFI como son el uso de doble placa circular y bajo perfil, consiguiendo un buen resultado funcional de esa mano

The dislocations carpometacarpal (CMC) are rare and diffi cult to diagnose if proper projections (lateral radiograph at 30 ° of pronation) are not requested, that is why in many cases pass unnoticed in the acute stage. We report an extremely rare case as an inveterate multiple CMC dislocation in a young patient after high-energy trauma. He was diagnosed two months after the trauma so surgical management is chosen by carpometacarpal arthrodesis using a novel way of RAFI such as the use of double circular plate and low profi le, achieving a good functional result of the hand