Hip hemiarthroplasty for femur neck fractures: minimally invasive direct anterior approach versus postero-lateral approach.

BACKGROUND: The minimally invasive direct anterior approach (MDAA) has been reported to be useful in total hip arthroplasty. The benefits of this approach may be useful for the treatment of femoral neck fractures. Aim of this study is to compare MDAA and postero-lateral approach (PLA) in patients treated with hip hemiarthroplasty for femoral neck fractures. MATERIALS AND METHODS: Between 2013 and 2014, 109 patients underwent bipolar hip hemiarthroplasty for femoral neck fracture: 88 female and 21 male with a mean age of 88 years old. PLA was performed in 54 cases and MDAA in 55 cases. RESULTS: The mean surgery time was significantly lower in MDAA group (P = 0.001). The hemoglobin loss was significantly lower in MDAA group (P = 0.02). The mean postoperative pain was significantly lower in the MDAA group (P = 0.001). The mean hospitalization period was 2 days lower in the MDAA group but with no significant difference between the two groups (P = 0.09). Hip dislocation was higher in PLA cases (7.4 %) than in MDAA cases (1.8 %). Periprosthetic fracture occurred only in one case of PLA. Great trochanter fracture occurred in 1 MDAA cases, while no cases were observed in the PLA group. CONCLUSIONS: Minimally invasive direct anterior approach for hip hemiarthroplasty in elderly people with femoral neck fracture provided significant benefit in the early postoperative period when compared to the postero-lateral approach in terms of surgery time, hemoglobin loss, postoperative pain, time of recovery and dislocation rate. LEVEL OF EVIDENCE: Therapeutic study, level IV (case series).

Operational conditions influencing the proficiency of AFB microscopy services in the Philippines.

SETTING: The microscopy services of the Philippine National Tuberculosis Programme (NTP). OBJECTIVE: To investigate how operational conditions in field microscopy centres (MC) affect proficiency. DESIGN: In 2004, a newly developed external quality assessment system (blinded rechecking) for acid-fast bacilli (AFB) microscopy employing lot quality assurance sampling (LQAS) was introduced into the NTP by the Philippine government. Performance reported by the quality assurance centres (QACs) of the four provinces and four cities was analysed. RESULT: There was no significant difference in rechecking results between small MCs examining fewer than 166 slides (500 slides/3 sputum samples per suspect) and larger MCs in the provinces. City MCs recorded better performance than those of the provinces. A city QAC covers only five MCs in average, whereas a provincial QAC covers 38. The average distance between city QACs and MCs is much shorter (3.2 km) than in the provinces (60.5 km). CONCLUSION: The number of MCs to be covered by each QAC and the distances between QAC and MCs are the dominant factors influencing the quality of AFB microscopy. Combining a few neighbouring MCs to reduce the number of MCs and/or provision of sufficient travel funds and timely use of vehicles, particularly in the provinces, are recommended.

Peroneus quartus muscle: a case report and review of the literature.

The peroneus quartus is a supernumerary muscle of the lateral compartment of the lower leg. There are several variations of this accessory muscle, and its terminology is very confusing. The peroneus quartus is found with a frequency varying from 10 to 21.7% of observed individuals. It is rarely involved in pathologic processes of the foot and ankle. Only a few reports exist in the literature involving peroneus quartus in a "retromalleolar conflict" (lateral ankle stenosis), sometimes in association with longitudinal attrition and tears of the peroneus brevis. We present a novel case, together with a review of the clinical, anatomic, and radiologic references about this muscle, and we try to make order in classification and terminology of its different forms.

Acetabular fractures.

Over the last few years an increased percentage of work-related and car accidents has led to a higher percentage of acetabular fractures. These injuries are among the most difficult to treat in orthopaedic surgery because of their anatomy and because of the consequent difficulty in surgical exposure. It was the purpose of this study to reveal the diagnostic and the therapeutic paths related to the treatment of these kinds of fractures, based on our experience. A total of 517 acetabular fractures were treated over 16 years; at present, better results are obtained with surgical treatment than with non-surgical treatment.

Intramedullary reaming in the treatment of chronic osteomyelitis of the femur and tibia.

The authors comment on the experience acquired in the treatment of chronic osteomyelitis of the long bones with intramedullary reaming. The procedure is reserved for the femur and tibia with stage I chronic osteomedullary infection according to the Cierny-Mader classification. 2 A total of 36 patients were treated. Surgical treatment consists in reaming of the medullary canal and in its contra-opening with antiseptic solutions. Mean time for lavage is 6 days. Criteria for healing involves the absence of clinical, humoral, and radiologic signs of active medullary sites of infection. The percentage of healing was 83.2%, mean long-term follow-up was 2.9 years.

Fractures of the humerus treated by elastic nailing.

The Marchetti-Vicenzi elastic nail was used in the osteosynthesis of 15 diaphyseal or metadiaphyseal fractures of the humerus, 14 cases achieved consolidation, 1 resulted in nonunion. Surgical approach was always distal, transtricipital and the nail was always locked distally. In the cases that healed, the mean radiographic consolidation time was 90 days. There were no immediate postoperative complications.

Synthesis of a small library of bivalent α-D-mannopyranosides for lectin cross-linking.

A small library of bivalent α-D-mannopyranosides having rigid linkers was constructed in order to evaluate the effects of inter-saccharide distances upon multivalent binding interactions with plant and bacterial lectins. To this end, iodoaryl and propargyl α-D-mannopyranosides were synthesized and the former treated with TMS-acetylene under palladium chemistry to provide their corresponding ethynylaryl derivatives. A library of 15 dimeric members was then obtained using Lewis acid catalyzed glycosidation, aryl-aryl homocoupling, transition metal catalyzed Sonogashira cross-coupling reactions, and oxidative Glaser homocoupling.

A bizarre giant leiomyoma.

We report the clinical and imaging features of a huge deep leiomyoma of the rectus abdominis treated surgically in an 84-year-old man. Hypotheses are put forward to elucidate the etiology of this enigmatic localization, apparently the first described in the literature.