Effects of the number and the position of transfixation pins in acrylic connecting bars.

Acrylic columns are commonly used in external skeletal fixators, especially for fracture management or trans-articular fixations. To the authors' knowledge, there are no studies demonstrating if the number or position of the transfixation pins influence the ultimate strength and stiffness of the acrylic column. The objective of this study was to evaluate the effects of the number and position of transfixation pins (concentric versus eccentric) on the strength and stiffness of acrylic columns placed in axial compression. We hypothesized that strength and stiffness of acrylic columns under axial compression would not be affected by the number or position of the transfixation pins through the column. Three different groups of 12 acrylic columns were constructed with 4, 6, and 8 pins. In each group, 6 columns were constructed with the pins placed concentrically and the remaining 6 columns with the pins placed eccentrically. Each column was then placed under axial compression using a biomechanical testing machine. No significant differences were observed in ultimate strength regarding the number or position of transfixation pins (P = 0.83 and P = 0.27, respectively). However, stiffness was significantly decreased for columns with 4 eccentric pins compared with columns with 6 and 8 eccentric pins (P < 0.01) and with columns with 4 concentric pins (P < 0.001). Although the effects of transfixation pins on the rigidity of acrylic columns do not appear to be clinically significant, these tests were performed only in compression and results might differ if complete external fixator systems are used with different models of testing. Future studies are recommended.

Les colonnes d'acrylique sont couramment utilisées dans les fixateurs externes, notamment pour la gestion des fractures ou les fixations transarticulaires. Selon les auteurs, aucune étude ne démontre si le nombre ou le positionnement des broches de transfixation influence la résistance ultime et la rigidité de la colonne d'acrylique. Les objectifs de cette étude étaient d'évaluer l'effet du nombre et du positionnement des broches de transfixation (concentriques versus excentriques) sur la résistance et la rigidité des colonnes d'acryliques placées en compression axiale. Nous avons émis l'hypothèse que la résistance et la rigidité des colonnes d'acryliques en compression axiale ne seraient pas affectées par le nombre ou le positionnement des broches de transfixation à travers la colonne. Trois groupes différents de douze colonnes acryliques ont été construits avec quatre, six, et huit broches. Dans chaque groupe, six colonnes ont été construites avec les broches placées concentriquement et les six colonnes restantes avec les broches placées de manière excentrique. Chaque colonne a ensuite été placée sous compression axiale à l'aide d'une machine de tests biomécaniques. Aucune différence significative n'a été observée pour la résistance ultime selon le nombre ou le positionnement des broches de transfixation (P = 0,83 et P = 0,27, respectivement). Cependant, la rigidité a été significativement diminuée pour les colonnes avec quatre broches excentriques par rapport aux colonnes avec six et huit broches excentriques (P < 0,01) et avec les colonnes avec quatre broches concentriques (P < 0,001). Bien que les effets des broches de transfixation sur la rigidité des colonnes acryliques ne semblent pas être cliniquement significatifs, ces tests ont été effectués uniquement en compression et les résultats pourraient différer si des systèmes complets de fixateurs externes sont utilisés avec différents modèles de test. De futures études sont recommandées.(Traduit par les auteurs).

Additional use of anti-rotation U-blade (RC) decreases lag screw sliding and limb length inequality in the treatment of intertrochanteric fractures.

The purpose of this study is to compare the cut-out rate and sliding distance associated with limb length inequality between operations using a standard non-sliding lag screw versus those using a non-sliding lag screw with U-blade (RC) in the Gamma3 nail. This is a retrospective review of two case series involving different lag screws for the Gamma3 nail. Propensity score matching analysis was used to adjust the confounding factors. A comparative analysis of 304 patients who treated with Gamma3 nail with either a standard non-sliding lag screw or a U-Blade (RC) lag screw was performed. Between 2014 and 2018, 152 patients were treated with U-blade (RC) lag screws, and these patients were matched with those treated with standard lag screws. There was no significant difference in cut-out rate between groups. However, additional use of anti-rotation U-blade (RC) could significantly decrease lag screw sliding, with the group treated with U-Blade (RC) lag screws exhibiting shorter sliding, especially in AO/OTA31 A2 and A3 fractures. Also, in A2 and A3 fractures, the mean lag screw sliding distance was greater than that seen in A1 fractures in both groups. These findings can help trauma surgeons choose the proper implant to reduce leg length inequality.

Sagittal plane alignment affects the strength of pin fixation in supracondylar humerus fractures.

ABSTRACT: Closed reduction with percutaneous pin fixation is commonly used to treat pediatric supracondylar humerus fractures. Various pin configurations of varying biomechanical strength have been described. However, to our knowledge, no biomechanical study has focused on pin alignment in the sagittal plane. Our goal was to compare the stability of fixation using 3 different pin constructs: 3 lateral pins diverging in the coronal plane but parallel in the sagittal plane (3LDP), 3 lateral pins diverging in the coronal and sagittal planes (3LDD), and 2 crossed pins (1 medial and 1 lateral).Transverse fractures were made through the olecranon fossa of 48 synthetic humeri, which were then reduced and pinned in the 3LDP, 3LDD, and crossed-pin configurations (16 specimens per group) using 1.6-mm Kirschner wires. The sagittal plane pin spread was significantly greater in the 3LDD group than in the 3LDP group, whereas we found no difference in the coronal plane. Sagittal extension testing was performed from 0° to 20° at 1°/s for 10 cycles using a mechanical torque stand. The torque required to extend the distal fragment 20° from neutral was compared between groups using one-way analysis of variance with multiple comparison post-hoc analysis. P values ≤.05 were considered significant.The 3LDD configuration was more stable than the 3LDP and crossed-pin configurations. The mean torque required to displace the pinned fractures was 5.7 Nm in the 3LDD group versus 4.1 Nm in the 3LDP group and 3.7 Nm in the crossed-pin group (both, P < .01). We found no difference in stability between the 3LDP and crossed-pin groups (P = .45).In a synthetic biomechanical model of supracondylar humerus fracture, sagittal alignment influenced pin construct stability, and greater pin spread in the sagittal plane increased construct stability when using 3 lateral pins. The lateral pin configurations were superior in stability to the crossed-pin configuration.Level of Evidence: Level V.

Use of an Angled Blade Plate for 31A3 Intertrochanteric Fractures.

BACKGROUND: A subgroup of pertrochanteric fractures-namely, the AO/OTA 31A3 fracture-continues to be a difficult problem to treat, even with cephalomedullary nails. We present the results for 26 patients with a 31A3 fracture treated with the angled blade plate. METHODS: The records of 26 consecutive patients with a 31A3 fracture that was treated operatively with the angled blade plate device between 2007 and 2012 at our center were reviewed, and the patients were contacted for follow-up. The functional outcome (traumatic hip rating score) and radiographic outcome (the neck-shaft angle at the time of fixation and final follow-up) were obtained for 20 of the 26 patients at a minimum follow-up of 1 year. RESULTS: All 26 patients had primary surgery. At final review, 2 patients had died and 4 had been lost to follow-up. Of the 4 patients lost to follow-up, 2 had revision of the fixation with the angled blade plate. Of the 20 patients with follow-up, 1 had malreduction and implant failure but eventually had healing after revision of the fixation with the angled blade plate. The mean traumatic hip rating score at the time of follow-up was 50.0 with 4, 14, and 2 patients having excellent, good, and failed outcomes, respectively. The mean neck-shaft angle at the time of final union was 126.16°, which was an average of 4° less than that on the unaffected side. However, this did not correlate with functional outcome. There was no significant difference between the immediate postoperative and final neck-shaft angles. CONCLUSIONS: This study demonstrated that blade plate fixation for 31A3 fractures is associated with low rates of failure (15%), revision surgery (15%), and infection (15%), which are comparable with the results of nail fixation (range, 5% to 12%) and superior to those of sliding hip screw fixation. This large series demonstrates that the angled blade plate can be utilized for these complex fractures and should be part of the armamentarium for these injuries. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Treatment and outcomes of basicervical femoral neck fractures: A systematic review.

PURPOSE: This study aims to systematically review the literature comparing surgical treatments options and respective failure rates for basicervical hip fractures. METHODS: A comprehensive search of databases, including MEDLINE, Embase, Web of Science, and Cochrane Central for studies published in English on or before June 21, 2019 was performed. Selected search terms included "basicervical," "basi cervical," "AO/OTA type 31-B," "femoral neck fracture" AND "bone nails," "bone screws," "fracture fixation," "internal fixation," "arthroplasty," "cephalomedullary," "sliding hip screw," "ORIF," and "treatment outcome." We included studies that assessed outcomes of basicervical fracture fixation using open reduction internal fixation or arthroplasty. Two authors extracted the following data from each paper: study design, country, cohort year, definition of basicervical, intervention type, sample size, patient demographics, follow-up length, percent of fractures that required revision, and the percent of implants that failed. RESULTS: Sixteen articles encompassing 910 patients were included. The main outcome was the percent of implants that required revision. The total revision rates were 8% (8 studies, 157 patients, range 0%-55%) for cephalomedullary nails, 7% (10 studies, 584 patients, range 0%-18%) for sliding hip screws, 23% (3 studies, 40 patients, range 16%-50%) for cannulated screws, 0% (1 study, 6 patients) for total hip arthroplasty, and 8% (2 studies, 13 patients, range 0%-11%) for hemiarthroplasty. CONCLUSION: Management of basicervical fractures with SHS and CMN produces similar failure and re-operation rates. Limited evidence is available on the use of cannulated screws and arthroplasty, but available studies suggest that cannulated screws have an unacceptable revision rate (23%) while arthroplasty may be acceptable. Future studies examining the comparative efficacy of various fixation methods would benefit from strict definition of fracture type as well as consistent reporting of functional outcomes, re-operation rates, and mortality.

Pediatric Lower Limb Lengthening Using the PRECICE Nail: Our Experience With 50 Cases.

BACKGROUND: Limb lengthening using intramedullary externally controlled motorized devices is becoming increasingly popular. There is limited literature regarding their use in the pediatric and adolescent population. This study reviews outcomes on 50 consecutive cases of intramedullary lower limb lengthening surgery in this population. METHODS: A retrospective review of all pediatric and adolescent patients treated in our institution by intramedullary lengthening for lower limb length discrepancy using the PRECICE and STRYDE intramedullary lengthening nails between 2013 and 2019. All patients were operated by a single surgeon. Data were prospectively recorded. We report on nail accuracy and reliability, consolidation index, time to full weight-bearing from completion of lengthening, joint range of movement, ASAMI bone and functional scores, presence of problems, obstacles and complications, and patient reported outcome measures (PROMS). RESULTS: Fifty cases (43 femoral and 7 tibial nails) were performed in 42 patients (20 males, 48% and 22 females, 52%). Six patients had bilateral lengthening and 2 patients had sequential lengthening. There were 28 antegrade femoral, 13 retrograde femoral and 5 tibia PRECICE nails, 2 tibial and 2 femoral PRECICE STRYDE nails. Mean age at surgery was 15 years old (12 to 17). Mean preoperative length discrepancy was 49 mm (20 to 90). Mean achieved lengthening was 46.5 mm (20 to 80). Mean percentage lengthening was 12.6% (5% to 25%). Nail accuracy was 96% and reliability 90%. Average distraction rate was 0.92 mm/d for femur and 0.64 mm/d for tibias. Consolidation index was 28 d/cm (18 to 43) and 39 d/cm (20 to 47), respectively. Time from completion of lengthening to independent full weight-bearing as observed in clinic was 45 days (21 to 70) and 34.2 days (23 to 50), respectively. ASAMI bone and functional scores were favorable and PROMS demonstrated high patient satisfaction levels. No significant complications were observed. CONCLUSIONS: We have demonstrated excellent clinical results and high patient satisfaction with intramedullary lengthening in a pediatric/adolescent population. We highly recommend thorough preoperative preparation, patient education, and a multidisciplinary approach. LEVEL OF EVIDENCE: Level IV.

Locking plate femur fracture repair in a juvenile Western chimpanzee (Pan troglodytes verus) in Sierra Leone.

This case reports the successful management of a traumatic diaphyseal femoral fracture in an infant Western chimpanzee (Pan troglodytes verus) from a rescue centre in Sierra Leone using a 2.4-mm intramedullary pin and two 2.7-mm String of Pearls™ locking plates. Locking plate use has not been previously described in chimpanzees.

Implant wastage in orthopaedic trauma: a UK experience.

INTRODUCTION: Implant wastage is an under-reported issue in orthopaedics, yet it has been shown to have a significant cost burden on healthcare budgets. In a background of a perilous financial climate in the UK health service, our aim was to define the frequency and costs of implant wastage in orthopaedic trauma. MATERIALS AND METHODS: The trauma theatre's implant logbook was retrospectively analysed between April 2017 and April 2018. Wasted implants were identified by the study authors independently. Patient demographics, implant details and costs were among the data collected. Product codes of wasted implants were used to identify implant costs through the manufacturer. RESULTS: Implant wastage occurred in 25.1% of trauma procedures during the study period. Most wasted implants (91%) were screws. The total cost of implant wastage was £8,377.25 during the 12-month period, accounting for 2% of the total implant budget. Wasted intramedullary nails accounted for almost 50% of the total cost. More than 51% of affected procedures involved a trainee as the primary operator. DISCUSSION: We report the first study of implant wastage in orthopaedics from the UK. Total implant wastage was higher than reported in most of the published literature, although it represented a small portion of the budget. Implant wastage is attributable to surgeons or operating theatre staff in most cases and is compounded by surgeons' limited understanding of implant costs. Initiatives to reduce implant wastage should include raising awareness of costs and departmental wastage to surgeons and operating theatre staff as well as employing preoperative planning techniques.

Operative Treatment of Pediatric Pelvic and Acetabulum Fractures.

Pediatric pelvic fractures are rare and differ from adults in etiology, fracture type, and associated injuries. They are observed in multitrauma patients, with severe associated injuries. Treatment of these children in specialized hospitals is likely to provide the best outcome because of the rarity of these fractures. Only a small percentage of the fractures, particularly the displaced ones, need operative treatment with the aim to restore the anatomy of the pelvic ring. In a significant proportion of the operated patients, morbidity and mortality were not linked to the pelvic fractures but to the other associated injuries. Long-term prognosis depends on restoring pelvic symmetry. Nondisplaced fractures of the acetabulum or fractures with minimal displacement with a relatively low roof-arc angle or crush injuries of the triradiate physis are managed nonoperatively. In young patients where continuation of growth is expected, fixation that does not cross the physis anatomically could be used. In some very young children, plate removal may be indicated to allow for continued growth of the acetabulum. One of the major complications in this patient cohort is acetabular dysplasia.

Does an Implant Usage Report Card Impact Orthopaedic Trauma Implant Stewardship?

OBJECTIVES: As hospitals seek to control variable expenses, orthopaedic surgeons have come under scrutiny because of relatively high implant costs. We aimed to determine whether feedback to surgeons regarding implant costs results in changes in implant selection. METHODS: This study was undertaken at a statewide trauma referral center and included 6 fellowship-trained orthopaedic trauma surgeons. A previously implemented implant stewardship program at our institution using a "red-yellow-green" (RYG) implant selection tool classifies 7 commonly used trauma implant constructs based on cost and categorizes each implant as red (used for patient-specific requirements, most expensive), yellow (midrange), and green (preferred vendor, least expensive). The constructs included were femoral intramedullary nail, tibial intramedullary nail, long and short cephalomedullary nails, distal femoral plate, proximal tibial plate, and lower-limb external fixator. Baseline implant usage from the previous year was obtained and provided to each surgeon. Each surgeon received a monthly feedback report containing individual implant utilization and overall ranking. RESULTS: The overall RYG score increased from 68.7 to 79.1 of 100 (P < 0.001). Three of the 7 implants (tibial and femoral nails and lower-limb external fixation) had significant increases in their RYG scores; implant selections for the other 4 implants were not significantly altered. A decrease of 1.8% (95% confidence interval, 0.4-3.2, P = 0.01) was noted in overall implant costs over the study period. CONCLUSION: Our intervention resulted in changes in surgeons' implant selections and cost savings. However, surgeons were unwilling to change certain implants despite their being more expensive.

Pediatric Femoral Shaft Fractures: A Multicenter Review of the AAOS Clinical Practice Guidelines Before and After 2009.

BACKGROUND: To determine if the AAOS clinical practice guidelines (CPG) for the treatment of pediatric femoral shaft fractures (2009) changed treatment, we analyzed pediatric femoral shaft fractures at 4 high-volume, geographically separated, level-1 pediatric trauma centers over a 10-year period (2004 to 2013). METHODS: Consecutive series of pediatric femoral shaft fractures (ages, birth to 18 y) treated at the 4 centers were reviewed. Treatment methods were analyzed by age and treatment method for each center and in aggregate. RESULTS: Of 2646 fractures, 1476 (55.8%) were treated nonoperatively and 1170 fractures operatively. Of the operative group, flexible intramedullary nails (IMN) were used for 568 patients (21.5%), locked intramedullary nails (LIMNs) for 309 (11.7%), and plating for 188 (7.1%). In total, 105 fractures were treated with external fixation or skeletal traction. Analysis before and after the CPG publication revealed a significant increase in the use of interlocked IMNs in patients younger than 11 years (0.5% before, 3.8% after; P<0.001). Over the same time period there was an increase in surgical management, regardless of technique, for patients younger than 5 years (6.4% before, 8.4% after; P=0.206). There were considerable differences in treatment among centers: 74% of fractures treated with plating were from a single center (center A), which also contributed 68% of patients younger than 5 years treated with plating; center B had the highest rate (41%) of flexible IMN in children younger than 5 years; center C had the highest rate (63%) of LIMN in children younger than 11 years; and center D treated the fewest patients outside the CPG guidelines. CONCLUSIONS: Following publication of the AAOS CPG, there was a significant increase in the use of LIMNs in patients younger than 11 years old and a trend toward surgical treatment in patients younger than 5 years. The considerable variability among centers in treatment methods and adherence to the CPG highlights the need for further outcome studies to better define optimal treatment methods and perhaps update the AAOS CPG guidelines. LEVEL OF EVIDENCE: Level III-therapeutic.

The Community Orthopaedic Surgeon Taking Trauma Call: Radial Neck Fracture Pearls and Pitfalls.

Pediatric radial neck fractures will inevitably be encountered by the general orthopaedist, and they carry great potential for poor outcomes. Acceptable displacement varies by age, and unlike adults, most of these injuries can be managed by closed means. If they are taken to the operating room, the mainstays of treatment are percutaneous techniques. Increasing patient age, inadequate reduction, unnecessary open reductions, and prolonged immobilization are all associated with worse outcomes, most commonly manifesting as significant elbow stiffness. Knowledge of the age-specific acceptable displacement criteria, a stepwise approach to closed and percutaneous techniques, and safe strategies for open reduction when needed as a last resort will greatly improve treatment success.

The Community Orthopaedic Surgeon Taking Trauma Call: Pediatric Foot Fracture Pearls and Pitfalls.

Although foot fractures are relatively rare in children, they deserve respect and attention because they may be associated with troublesome long-term consequences. These injuries are more common in adolescents and teenagers. In an epidemiological study in Britain (Cooper et al 2004), the incidence of pediatric foot fractures was 10.5 per 10,000 children occurring equally in boys and girls and peaking around 13 years of age. This article focuses on 5 fracture types which are at higher risk of complications in the pediatric and adolescent age group.

Treatment of Unstable Pediatric Tibial Shaft Fractures with Titanium Elastic Nails.

Background and objectives: Pediatric tibial shaft fractures often have satisfactory outcomes after closed reduction and casting. However, surgical treatment may be required in unstable or open fractures. Titanium elastic nails (TENs) are a good option for the surgical treatment of pediatric tibial fractures due to their advantages such as short hospitalization periods, easy applicability, early weight bearing, and early union. In this study, we evaluated radiological and functional outcomes in pediatric patients with tibial shaft fractures that underwent fixation with TENs. Materials and methods: A total of twenty tibial shaft fractures that were treated with TENs in our clinic between 2013 and 2017 were retrospectively reviewed. The mean age at injury was 8.9 ± 2.78 (range of 3-14) years. Seven (35%) out of 20 fractures were open fractures, of which one fracture was classified as Grade I and six fractures were classified as Grade II. In each patient, antegrade nailing was performed by inserting a TEN in the medial and another TEN in the lateral side of the proximal metaphysis. Clinical outcomes including union, alignment, leg-length inequality, and complications were evaluated using modified Flynn's criteria. Results: The mean time to union was 10.85 ± 3.39 (range of 6-20) weeks. No patient had a sagittal or coronal angulation of over 10°. One patient had a leg-length inequality of 10 mm. Among three patients with open fractures, two of them had superficial wound infections and the other patient had a deep wound infection. All the infections were successfully treated with appropriate antibiotic therapies. Four other patients had pin tract irritation that required no intervention. No significant difference was observed between patients with open and closed fractures with regard to the clinical and radiological findings although patients with open fractures had a significantly higher complication rate compared to patients with closed fractures (p < 0.05). No patient had a restricted range of motion of the ankle and knee joints. Twelve (60%) patients had an excellent outcome, and eight (40%) patients had a satisfactory outcome. Conclusions: Intramedullary fixation with TENs provides favorable outcomes and reduced complication rates in the treatment of unstable pediatric tibial shaft fractures that cannot be reduced with conservative treatment modalities or cannot be casted due to the presence of an edema or open wound.

Comparison of internal fixation with Gamma3 Long nails and INTERTAN nails in the treatment of Seinsheimer type V subtrochanteric femoral fractures in elderly patients.

The aim of this study was to clinically compare the therapeutic effects of internal fixation using a third-generation Gamma Long Nail (TGLN) with that of INTERTAN in the treatment of Seinsheimer Type V subtrochanteric femoral fractures in elderly patients.The therapeutic effect of internal fixation with TGLN, compared with that with INTERTAN, was retrospectively analyzed in elderly patients diagnosed with Seinsheimer Type V subtrochanteric fracture. Twenty-five cases were divided into 2 groups based on the fixation devices: the TGLN group (13 cases; 5 men and 8 women) and the INTERTAN group (12 cases; 5 men and 7 women). Patients were followed up postoperatively, and their clinical history, intraoperative blood loss, fracture healing, Harris Hip Scores, and postoperative complications were recorded and compared.Patients in the TGLN group had shorter operation time and less intraoperative blood loss, compared with those in the INTERTAN group (P < .05). There were no significant between-group differences in postoperative complications, fracture healing time and Harris Hip Scores during the follow-up (P > .05).

Comparison of curettage and bone grafting combined with elastic intramedullary nailing vs curettage and bone grafting in the treatment of long bone cysts in children.

To compare the efficacy of curettage and bone grafting combined with elastic intramedullary nailing (EIN) vs curettage and bone grafting in the treatment of long bone cysts in children and to clarify the necessity of using EIN in the treatment of bone cysts.Sixty-two patients were involved in this study from Jan. 2009 to Sept. 2017 (43 males, 19 females; 27 humeri, 35 femurs); the patients were assigned to an EIN group, comprising 30 patients who underwent curettage and bone grafting combined with EIN, or to a non-elastic intramedullary nailing (NEIN) group, comprising 32 patients who underwent curettage and bone grafting alone. The prognosis of the 2 groups was assessed with reference to the standard of Capanna.No statistically significant differences in sex, age, location, activity, pathological fracture, cyst volume, operative time and intraoperative blood loss were found between the 2 groups (P > .05). The effective rate was 90.0% in the EIN group and 68.8% in the NEIN group, and the difference was statistically significant (P < .05).Compared to simple curettage and bone grafting, curettage and bone grafting combined with EIN treatment can significantly improve the prognosis of children with bone cysts. It is recommended that EIN be added to bone cyst curettage and bone grafting.

Factores asociados al desarrollo de necrosis avascular de cabeza femoral tras fractura del cuello femoral no desplazada tratada con fijación interna / Factors associated with the development of avascular necrosis of the femoral head after non-displaced femoral neck fracture treated with internal fixation

Objetivo: Identificar los factores con influencia sobre la aparición de necrosis avascular de cabeza femoral (NACF) en pacientes con fracturas del cuello femoral no desplazadas tratadas con fijación interna. Material y método: Estudio retrospectivo de casos y controles. Se incluyeron las fracturas de cuello femoral no desplazada, tratadas con fijación interna, y que presentaron NACF tras un seguimiento postoperatorio de al menos 2 años. Se registraron las variables basales, las comorbilidades activas de los pacientes, así como el tiempo para la cirugía y el número de tornillos utilizados para la osteosíntesis. Se realizaron comparaciones entre los grupos, aquellos que presentaron NACF y los que no. Mediante el área bajo la curva se localizaron los puntos de corte de las variables edad y tiempo para la cirugía. Resultados: No encontramos asociación entre el sexo, las comorbilidades activas y el número de tornillos utilizados y el desarrollo de NACF. Los puntos de corte para la edad y el tiempo para la cirugía fueron≤69 años y≤43h, respectivamente. No encontramos asociación estadísticamente significativa para el punto de corte del tiempo para la cirugía. En el análisis multivariante, la edad≤69 años fue un predictor significativo de desarrollo de NACF (OR 4,6; IC 95% 1,1-17,9; p=0,028). Conclusiones: Los pacientes con una edad igual o menor de 69 años presentaban un mayor riesgo de desarrollar NACF tras fractura no desplazada del cuello femoral tratada con fijación percutánea atornillada

Objective: To identify the factors with influence on the development of avascular necrosis of the femoral head (ANFH) in patients with non-displaced femoral neck fractures treated with internal fixation. Material and method: Retrospective study of cases and controls. We included non-displaced femoral neck fractures treated with internal fixation, and that presented ANFH with a postoperative follow-up of at least 2 years. The baseline variables, active comorbidities of the patients, the time for surgery and the number of screws used for osteosynthesis were recorded. Comparisons were made between the groups, those that presented ANFH and those that did not. By area under the curve, the cut-offs of age and time for surgery were located. Results: An association between sex, active comorbidities and number of screws used and the development of ANFH was not observed. The cut-off points for age and time for surgery were≤69 years and≤43hours, respectively. No significant correlation was observed for the cut-off time for surgery. In the multivariate analysis, age≤69 years was a significant predictor of the development of ANFH (OR 4.6; 95% CI 1.1 to 17.9; P=.028). Conclusions: The patients aged 69 years or younger were at increased risk of developing ANFH after undisplaced femoral neck fracture treated with percutaneous screws

Factors associated with the development of avascular necrosis of the femoral head after non-displaced femoral neck fracture treated with internal fixation. / Factores asociados al desarrollo de necrosis avascular de cabeza femoral tras fractura del cuello femoral no desplazada tratada con fijación interna.

OBJECTIVE: To identify the factors with influence on the development of avascular necrosis of the femoral head (ANFH) in patients with non-displaced femoral neck fractures treated with internal fixation. MATERIAL AND METHOD: Retrospective study of cases and controls. We included non-displaced femoral neck fractures treated with internal fixation, and that presented ANFH with a postoperative follow-up of at least 2 years. The baseline variables, active comorbidities of the patients, the time for surgery and the number of screws used for osteosynthesis were recorded. Comparisons were made between the groups, those that presented ANFH and those that did not. By area under the curve, the cut-offs of age and time for surgery were located. RESULTS: An association between sex, active comorbidities and number of screws used and the development of ANFH was not observed. The cut-off points for age and time for surgery were≤69 years and≤43hours, respectively. No significant correlation was observed for the cut-off time for surgery. In the multivariate analysis, age≤69 years was a significant predictor of the development of ANFH (OR 4.6; 95% CI 1.1 to 17.9; P=.028). CONCLUSIONS: The patients aged 69 years or younger were at increased risk of developing ANFH after undisplaced femoral neck fracture treated with percutaneous screws.

Epidemiology, treatment and mortality of trochanteric and subtrochanteric hip fractures: data from the Swedish fracture register.

BACKGROUND: Hip fractures are a major worldwide public health problem and includes two main types of fractures: the intracapsular (cervical) and the extracapsular (trochanteric and subtrochanteric) fractures. The aim of this study on patients with trochanteric and subtrochanteric hip fractures was to describe the epidemiology, treatment and outcome in terms of mortality within the context of a large register study. METHODS: A descriptive epidemiological register study including patients registered in the national Swedish Fracture Register from January 2014 to December 2016. Inclusion criteria were all primary surgically treated traumatic non-pathological trochanteric and subtrochanteric femoral fractures in patients aged 18 years and above. Individual patient data (age, gender, injury location, injury cause, fracture type, treatment and timing of surgery) were retrieved from the register database. Mortality data was obtained via linkage to the Swedish Death Register. RESULTS: A total of 10,548 consecutive patients were identified and included in the study. The mean (±SD) age for all patients was 82 ± 11 years and the majority of the patients were females (69%). Most of the fractures were caused by a fall at the same level (83%) at the patients' accommodation (75%). Fractures were classified using the AO/OTA classification as 31-A1 in 29%, as 31-A2 in 49% and as 31-A3 in 22% of the cases. The most commonly used implant was a short antegrade intramedullary nail (42%), followed by a plate with sliding hip screw (37%). With increasing fracture complexity, the proportion of intramedullary nails was increasing, and also the use of long versus short nails. The majority of the patients were operated within 36 h (90%). There was a higher mortality at 30 days and 1 year for males, and for all those who were delayed to surgery > 36 h. CONCLUSION: Safety measures to prevent fall at elderly patient's accommodation might be a way to reduce the number of trochanteric and subtrochanteric hip fractures. Surgery as soon as possible without delay should be considered to reduce the mortality rate. The selection of surgical methods depends on the fracture complexity.