Guanglin Wang

The new proximal femoral nail antirotation-Asia: early results.

The proximal femoral nail antirotation system was introduced by the Arbeitsgemeinschaft fur Osteosynthesfragen/Association for the Study of Internal Fixation (AO/ASIF) in 2003 and is suitable for treating unstable trochanteric fractures. However, proximal femoral nail antirotation was designed according to the geometric proportions of the White population, and it is known that important differences exist between Asians and Americans with regard to femoral geometry. Reports of serious postoperative complications also exist when used for the elderly Asian population. Therefore, geometrical mismatch between proximal femoral nail antirotation and the femora of Asians has led the AO/ASIF to design a new proximal femoral nail antirotation for Asia with adapted sizes and geometry. This article reports early clinical results of using proximal femoral nail antirotation for Asians in 84 consecutive patients to stabilize unstable trochanteric fractures (AO classification, 31.A2 and A3). Patients were followed up for an average 8 months (range, 4-11 months). Intraoperative and postoperative complications, surgical details, and outcome measurements were evaluated. Fractures were treated by closed reduction and intramedullary fixation. The proximal femoral nail antirotation Asia position was ideal in 80 cases (95%). No patients showed complication related to the mismatch between the nail and femora. The mean time to bone healing was 14 weeks. Functionally, 90% of the patients regained pretrauma mobility. According to the Harris hip scoring system, 63 patients (78%) had an excellent or good outcome. The new proximal femoral nail antirotation Asia yields better results in the treatment of unstable trochanteric fractures in elderly patients by closely matching Asian femoral anatomy and thereby reducing complications related to the implants.

Ipsilateral basicervical femoral neck and shaft fractures treated with long proximal femoral nail antirotation or various plate combinations: comparative study

BackgroundAlthough many treatment methods have been developed, controversy exists regarding the optimal management of ipsilateral femoral neck and shaft fractures. The purpose of this retrospective study was to compare the results of long proximal femoral nail antirotation (PFNA-long) and various plate combinations in the treatment of ipsilateral basicervical femoral neck and shaft fractures.MethodsBetween January 2004 and May 2008, a total of 21 patients with ipsilateral basicervical femoral neck and shaft fractures were treated with PFNA-long or various plate combinations. We divided patients into two groups. Group I included 11 patients who underwent surgery with cancellous lag screws or dynamic hip screws (DHS) combined with compression plate fixation. Group II included 10 patients who underwent surgery with PFNA-long.ResultsThe average follow-up periods were 22.2 and 20.8 months for groups I and II, respectively. The average union times for femoral neck fractures in groups I and II were 15.6 and 16.0 weeks, respectively; and the average union times for shaft fractures were 21.1 and 20.3 weeks, respectively. There were eight good, two fair, and one poor functional result in group I and eight good, one fair, and one poor in group II. One case of implant failure and nonunion of the femoral shaft fracture occurred in group I. There were no significant differences in the functional outcomes or major complications between the two groups.ConclusionsBoth treatment methods achieved satisfactory functional outcomes in patients with ipsilateral basicervical femoral neck and shaft fractures. PFNA-long was a good option for the treatment of complex fractures, with the advantages of closed antegrade nailing with minimal exposure, reduced perioperative blood loss, and biological fixation of both fractures with a single implant.

Oestrogen Receptor-α Polymorphism and Risk of Fracture: a Meta-analysis of 13 Studies Including 1279 Cases and 6069 Controls

A meta-analysis was performed to evaluate the effect of oestrogen receptor-α (ESR1) gene PvuII polymorphism on fracture risk. It included published data from relevant studies (up to May 2010) identified from Medline™, Embase™ and Current Contents™. The 13 included studies contained 1279 fracture cases and 6069 controls. The combined results based on these studies showed no relationship between ESR1 gene PvuII polymorphism and fracture risk. No significant difference in genotype distribution was found when stratifying by race. When stratifying by fracture type, it was found that vertebral fracture cases had a significantly higher frequency of the PvuII pp genotype than controls in five studies (552 cases and 2350 controls). This meta-analysis suggests a modest but statistically significant association between the ESR1 PvuII pp genotype and vertebral fracture.

Sanders II-III calcaneal fractures fixed with locking plate in elderly patients.

Purpose To evaluate the clinical outcomes of locking calcaneal plate in treating calcaneal fracture (Sanders II–III) in elderly patients. Methods From October 2012 to December 2013, 23 elderly patients suffering from calcaneal fracture (Sanders II–III) were treated and followed up. There were 15 males and 8 females with the mean age of 68.5 years (range: 65–79 years). According to Sanders classification, 16 cases (16 feet) were type II fractures and 7 cases (7 feet) were type III fractures. Anteroposterior, lateral and axial views of X-ray were taken to detect the calcaneum. CT scan was done to assess the amount of comminution and articular depression. Radiological assessment was performed using Bohlers angle and Gissanes angle. Functional outcome was assessed using the Maryland foot score. Results All the patients were followed up for 13.7 months on average (10–20 months). The mean time of bone union was 3.2 months (3–4 months). The mean time of complete weight bearing was 3.2 months (3.1–4.0 months). The soft tissue necrosis was found in 1 case. The mean Bohlers angle and Gissanes angle were 25.31° and 117.5° respectively. The overall excellent to good rate was 82.6%. Conclusion Open reduction and internal fixation with locking calcaneal plate can obtain good functional outcome for Sanders II–III calcaneal fractures in elderly patients.