Do PFNA devices and Intertan nails both have the same effects in the treatment of trochanteric fractures? A prospective clinical study.

OBJECTIVE: To clinically and radiologically compare third-generation intramedullary nails used in the treatment of trochanteric hip fractures and to determine their efficacy. MATERIALS AND METHODS: Seventy-five of 88 patients admitted to our hospital with trochanteric fractures were enrolled in the study; 43 were treated with PFNA devices and 32 with Intertan nails. The amount of compression applied during the procedure, duration of the procedure, amount of subsequent shortening in the proximal femoral area, subsequent backup of proximal screws, and changes in the tip-apex and tip-cortex distances were compared between groups. The postoperative change in the varus angle of the proximal femur and times to mobilization, full weight bearing, and fracture union were also evaluated. RESULTS: On early postoperative radiographs, the tip-apex distance was ≤25 mm in 86 % of patients in the PFNA group and 96.9 % of those in the Intertan group. Twelve months postoperatively, the tip-apex distance did not differ between groups. No cut-out of the screws into the coxofemoral joint was observed. Fracture healing was achieved in all patients. At 12 months postoperatively, the rates of proximal screw backup, proximal femoral shortening, and decrease in the varus angle of the proximal femur were significantly higher in the PFNA group than in the Intertan group. CONCLUSIONS: Trochanteric fractures may be treated effectively with PFNA devices or Intertan nails. During the healing period, the rates of reverse displacement of the proximal screw, shortening of the proximal femur, and decrease in the varus angle of the proximal femur were significantly higher in the PFNA group than in the Intertan group. Surgical technique, implant positioning, and the choice of implant play roles in the successful treatment of trochanteric fractures. LEVEL OF EVIDENCE: Level 1, prospective, prognostic study.

Can the complications of distal locking be prevented with a new nail that offers a novel locking technique in the treatment of humeral shaft fractures?

OBJECTIVES: This study aims to investigate whether complications related to distal locking can be prevented with InSafeLOCK® nail in the treatment of humeral shaft fractures. PATIENTS AND METHODS: Hospital records of 31 patients (15 males, 16 females; mean age 54.4±10.1 years; range, 20 to 86 years) treated with InSafeLOCK® nail for humeral shaft fractures were investigated retrospectively between February 2016 and January 2019. Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification was used to determine the type of fracture. During the implementation, the elapsed time for distal locking was investigated. Complications encountered during both implementation and postoperative follow-up were investigated. RESULTS: Fourteen of the fractures were type A, 12 were type B, and five were type C. The mean follow-up time was 18.2 (range, 6 to 30.5) months. The mean duration for distal locking was 2.1 (range, 1.2 to 3.1) minutes. In one (3.2%) patient, cortical penetration occurred at the anterior cortex of the humerus at distal to the nail. In one patient, nail breakage occurred at the distal part of the nail. In one patient, rotational instability occurred due to screw loosening. CONCLUSION: InSafeLOCK® humeral nail is safe when applied with the recommended technique. It can easily be applied without damaging the veins, nerves or other soft tissues around the elbow due to the internal distal locking feature; furthermore, there is no need to use fluoroscopy or targeting guide. Thus, it is possible to avoid complications that may occur during and after distal locking in conventional intramedullary nail implementations.

Effect of Repeated Sterilization by Different Methods on Strength of Carbon Fiber Rods Used in External Fixator Systems.

OBJECTIVES: We aimed to study the effects of repeated sterilization, using different methods, on the carbon fiber rods of external fixator systems. METHODS: We used a randomized set of 44 unused, unsterilized, and identical carbon fiber rods (11 × 200 mm), randomly assigned to 2 groups: unsterilized (4 rods) and sterilized (40 rods). The sterilized rods were divided into 2 groups, those sterilized in an autoclave and those sterilized using hydrogen peroxide. These were further divided into 5 subgroups based on the number of sterilization repetition to which the fibers were subjected (25, 50, 75, 100, and 200). A bending test was conducted to measure the maximum bending force, maximum deflection, flexural strength, maximum bending moment and bending rigidity. We also measured the surface roughness of the rods. RESULTS: An increase in the number of sterilization repetition led to a decrease in maximum bending force, maximum bending moment, flexural strength, and bending rigidity, but increased maximum deflection and surface roughness (P < 0.01). The effect of the number of sterilization repetition was more prominent in the hydrogen peroxide group. CONCLUSIONS: This study revealed that the sterilization method and number of sterilization repetition influence the strength of the carbon fiber rods. Increasing the number of sterilization repetition degrades the strength and roughness of the rods.

[The effect of risedronate treatment on bone turnover markers in patients with hip fracture]. / Kalça kiriklarinda risedronat tedavisinin kemik yikim ürünlerine etkisi.

OBJECTIVES: The effect of risedronate treatment on bone resorption was investigated quantitatively by measuring N-telopeptide levels in urine of patients with hip fracture. METHODS: Forty-six women (mean age 75 years) who underwent surgical treatment for intertrochanteric or femoral neck fractures due to minor trauma were divided into two groups according to the order of presentation. One group (26 patients; mean age 77+/-5 years) received oral risedronate 5 mg/day after the fifth postoperative day, while the other group (20 patients; mean age 73+/-6 years) received no drug treatment. Patients who had been on treatment for Paget's disease or osteoporosis or those with renal failure were excluded. Urine samples were collected from all the patients on the second day of hospitalization and at the end of three months to measure N-telopeptide levels, one of the bone turnover markers, with the use of the Osteomark NTx ELISA laboratory kit. RESULTS: The mean urine N-telopeptide level decreased by 49.7% at the end of three months of treatment with risedronate (p<0.0001), whereas there was a 5.8% increase in the N-telopeptide level of the control group. The two groups differed significantly with respect to the levels of bone resorption at the end of three months (p<0.0001). CONCLUSION: Risedronate treatment was found effective in decreasing bone resorption and thus in reducing the risk for refractures in patients with hip fractures due to minor trauma.

Mid-term radiological and clinical results of incomplete triple pelvic osteotomy.

OBJECTIVE: The aim of this study was to assess clinical and radiological results of incomplete triple pelvic osteotomy in acetabular dysplasia. PATIENTS AND METHODS: Twenty-six hips of 24 patients (5 males, 19 females) treated with incomplete triple pelvic osteotomy by a single surgeon from February 1995 to October 2001 were retrospectively reviewed at an average follow-up time of 12 years. The mean age at the time of surgery was 21.6 years (range: 14-41). Radiological evaluation was based on the central edge angle, acetabular angle, acetabular index, acetabular head index and lateralisation. Clinical and radiological scoring was performed using the Harris scoring system, Ömeroglu scoring system and the Tönnis criteria for osteoarthritis. RESULTS: There was significant improvements in all of the radiological parameters with 88.5% good radiological results, 96.2% excellent clinical results, no significant progression to osteoarthritis and no need for conversion to total hip arthroplasty. The rate of major complication was 11%. Retroversion was seen in 15.4% of the hips. CONCLUSION: Our results support the use of incomplete triple pelvic osteotomy as a safe choice in the treatment of acetabular dysplasia as it offers clinical and radiological benefits and contributes to the prevention of osteoarthritis. LEVEL OF EVIDENCE: Level IV, therapeutic study.

Deep venous thrombosis and pulmonary embolism as rare complications after hallux valgus surgery: case report and literature review.

The incidence and life-threatening complications of thromboembolic disease after major orthopedic surgical procedures have been extensively defined in the medical literature. However, there are few studies concerning the incidence of thromboembolic disease after foot and ankle surgery. We describe a 57-year-old female patient who underwent surgery for bilateral hallux valgus deformities and was diagnosed as having deep venous thrombosis and pulmonary embolism after the surgery despite early mobilization and mechanical prohylaxis. Her preoperative physical examination revealed varicose veins in both cruris. She was treated for pulmonary embolism with low-molecular-weight heparin and an oral anticoagulant in the postoperative period. Although venous thromboembolism is more commonly described after proximal lower-extremity procedures, it can occur after foot and ankle surgery, particularly if the patient has certain risk factors. Therefore, in addition to mechanical prophylaxis, pharmacologic prophylaxis should be kept in mind in such patients.