Proximal screws placement in intertrochanteric fractures treated with external fixation: comparison of two different techniques

<p>Abstract</p> <p>Background</p> <p>To compare two different techniques of proximal pin placement for the treatment of intertrochanteric fractures in elderly patients utilizing the Orthofix Pertrochanteric Fixator.</p> <p>Methods</p> <p>Seventy elderly high-risk patients with an average age of 81 years were treated surgically for intertrochanteric fracture, resulting from a low energy trauma. Patients were randomly divided in two groups regarding to the proximal pin placement technique. In Group A the proximal pins were inserted in a convergent way, while in Group B were inserted in parallel.</p> <p>Results</p> <p>All fractures healed uneventfully after a mean time of 98 days. The fixator was well accepted and no patient had significant difficulties while sitting or lying. The mean VAS score was 5.4 in group A and 5.7 in group B. At 12 months after surgery, in group A the average Harris Hip Score and the Palmer and Parker mobility score was 67 and 5.8, respectively. In group B, the average Harris Hip Score and the Palmer and Parker mobility score was 62 and 5.6, respectively. No statistically significant difference was found regarding the functional outcome. The mean radiographic exposure during pin insertion in Group A and Group B was 15 and 6 seconds, respectively. The difference between the two groups, regarding the radiographic exposure, was found to be significant.</p> <p>Conclusion</p> <p>Proximal screw placement in a parallel way is simple, with significant less radiation exposure and shorter intraoperative duration. In addition, fixation stability is equal compared to convergent pin placement.</p

Optimal time for distraction osteogenesis in limbs with nerve repairs: experimental study in the rat

The optimal period of time between peripheral-nerve repair and initiation of limb lengthening procedures has never been precisely determined. In the clinical setting, the surgeon must decide how long the repaired nerves should be allowed to heal before subjecting them to the forces created by the limb-lengthening process. The authors designed a study to quantify and qualify the effects of different recovery periods between initial nerve repair and subsequent limb-lengthening via distraction osteogenesis. Forty-two Sprague-Dawley male rats were randomized in two different categories of nerve repair: end-to-end and nerve grafts. At 4, 8 and 12 weeks after nerve reconstruction, the femur was submitted to limb- lengthening at a rate of 1 mm/day (0.25 mm every 6 hr). Sciatic Function Index (SFI) evaluation indicated that the impact of distraction was detrimental in the grafted nerves, although they maintained their electrical and morphologic properties at comparable levels to the non-distracted nerves. Nerves with direct coaptation presented an overall superior regeneration pattern. The findings in end-to-end repairs distracted at 8 weeks and those of grafted nerves at 12 weeks were comparable to those in distracted normal nerves. The morphology of the distracted nerves appeared to be more organized than that observed in the non-distracted nerves

Index Finger Pollicization in the Treatment of Congenitally Deficient Thumb

Congenital deficiency of the thumb greatly compromises hand function, because the normal thumb contributes at least 40% of its usefulness. The method of choice in the treatment of this functional liability is the pollicization of the index finger. This study presents the long term outcome of 21 index finger pollicizations in 18 patients, with a mean follow-up time of 9 years. The thumb deficiency was bilateral in 3 patients, whereas in 7 it was associated with radial club hand. The result was considered excellent in 75%, good in 19%, and poor in 6% of the 21 pollicizations, according to Percival’s scoring system. The less rewarding function was obtained in the presence of associated radial club hand in combination with late reconstruction. Index finger pollicization is the method of choice in the treatment of thumb aplasia or severe hypoplasia. The younger patients adapt easier and use the new thumb in a more natural way