RESUMEN
INTRODUCTION: The purpose of this study was to demonstrate the effectiveness of controlled telescoping system for lateral hip pain caused by sliding of the blade following intramedullary nailing of trochanteric fractures. MATERIALS AND METHODS: A retrospective cohort study was performed to compare the controlled telescoping system (Compression Hip Nail; CHN) with the conventional sliding system (Proximal Femoral Nail Antirotation; PFNA) for trochanteric fractures. 74 cases in the PFNA group and 77 cases in the CHN group were included from two university hospitals in this study. All patients had a minimum of 12-month follow up period. Lateral hip pain was evaluated and operation time and blood loss during the surgery were measured. The fracture classification was evaluated. The quality of postoperative reduction and other complications after surgery were also evaluated and tip-apex distance (TAD), telescoping and lateral protrusion of the blade and lag screw were measured. RESULTS: The mean age was 78.5 years in the PFNA group and 74.7 years in the CHN group (p=0.25). The mean telescoping was 19.2mm in the PFNA group and 10.7mm in the CHN group (p<0.001). The mean length of lateral protrusion was 10.5mm in the PFNA group and 2.5mm in the CHN group (p<0.001). Twenty-eight patients in the PFNA group complained of lateral hip pain, whereas 12 patients in the CHN group did (p=0.002). These four variables showed statistically significant differences between the PFNA and CHN groups (p<0.05). The length of lateral protrusion was the only variable significantly related to lateral hip pain through multivariate logistic regression analysis (p=0.045). CONCLUSIONS: The degree of lateral protrusion was mainly related to lateral hip pain. Therefore, controlled telescoping would help to decrease lateral hip pain by decreasing the lateral protrusion beyond the lateral femoral cortex.
Asunto(s)
Clavos Ortopédicos , Fijación Intramedular de Fracturas , Fracturas de Cadera/cirugía , Dolor Postoperatorio/complicaciones , Dolor Postoperatorio/diagnóstico , Ajuste de Prótesis/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Fijación Intramedular de Fracturas/efectos adversos , Fracturas de Cadera/diagnóstico por imagen , Fracturas de Cadera/fisiopatología , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/diagnóstico por imagen , Dolor Postoperatorio/fisiopatología , Diseño de Prótesis , Falla de Prótesis , Ajuste de Prótesis/efectos adversos , Radiografía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
The purpose of the present retrospective study was to describe the single oblique posterolateral approach for open reduction and internal fixation of large, displaced, posterior malleolar fractures with an associated lateral malleolar fracture. A single oblique posterolateral approach was used for osteosynthesis of the posterior and lateral malleolus in 50 consecutive patients (23 females [46%], 27 males [54%]; mean age, 47.44 ± 16.13 years; mean follow-up duration, 26.32 ± 5.15 months). The mean interval to surgery was 4.3 ± 1.9 days after the inciting trauma. During the follow-up period, the surgery was complicated by skin necrosis around the incision in 2 (4%) patients and sural nerve damage in 2 (4%) patients. We found that the single oblique posterolateral approach to large, displaced, posterior malleolar fractures with an associated lateral malleolar fracture provided easy exposure of the posterior and lateral malleoli and had the potential to decrease the incidence of sural nerve injury because of the smaller incision size.
Asunto(s)
Fracturas de Tobillo/cirugía , Fijación Interna de Fracturas/métodos , Adulto , Anciano , Femenino , Estudios de Seguimiento , Curación de Fractura , Humanos , Masculino , Persona de Mediana Edad , Necrosis , Tempo Operativo , Complicaciones Posoperatorias , Estudios Retrospectivos , Piel/patología , Nervio Sural/lesionesRESUMEN
Fractures of ossified tibialis anterior tendon have been successfully managed by the excision of the ossified tendon and transfer of the extensor hallucis longus tendon. A 64-year-old man sustained an injury during mountain hiking 2 weeks prior to presentation, falling down on his heels with his ankle fully plantarflexed. Two tender and bony hard masses were palpable along the course of the tibialis anterior tendon, one at the anteromedial aspect of the ankle and another at the dorsum of the talonavicular joint. Radiographs of the ankle demonstrated an approximately 2x1-cm ovoid-shaped bony mass at the anterior aspect of the ankle joint and another bony mass of similar size and shape at the dorsal aspect of the talonavicular joint. He underwent operative exploration, and complete rupture of the tendon through a bony mass was observed. The gap between the torn ends of the tendon after excision of the mass was too long to be repaired directly. Extensor hallucis longus tendon was retrieved 1 cm proximal to the metatarsophalangeal joint and was passed through the insertion of the anterior tibial tendon and pulled proximally and sutured to itself with the ankle in neutral. At 1 year after surgery, plain radiographs and ultrasonography showed no recurrence of calcification or ossification in the tendon and good mobility of the tibialis anterior muscle was observed.