Marcelo Teodoro Ezequiel Guerra

Functional recovery of elderly patients with surgically-treated intertrochanteric fractures: preliminary results of a randomised trial comparing the dynamic hip screw and proximal femoral nail techniques.

INTRODUCTION Intertrochanteric fractures of the femur are prevalent in the elderly, and leave patients with functional restrictions after surgical treatment. The aim of this study was to compare the functional recovery at 1-year follow-up of elderly patients with intertrochanteric fractures treated surgically with the dynamic hip screw (DHS) or proximal femoral nail (PFN) fixation techniques. MATERIAL AND METHODS This prospective, randomised, blinded trial included patients aged over 65 years with intertrochanteric fractures classified as AO group 31.A1 or 31.A2. The patients were allocated into one of two treatment groups: one treated with DHS and the other with PFN. Data on functional recovery were obtained using the Functional Recovery Score developed by Zuckerman for elderly patients with hip fracture. Variables were described as means and standard deviations, and the non-parametric Kolmogorov-Smirnov test was used to verify the normality of data distribution. Non-normally distributed variables were compared using the non-parametric Friedman and Mann-Whitney U tests. Data processing and analysis were carried out in SPSS 10.0. Results were deemed significant at the 5% level (p ≤ 0.05). RESULTS There were no significant between-group differences in age (p=0.152), sex (p=0.363), or American Society of Anaesthesiologists (ASA) score (p=0.579). Functional recovery scores in the DHS group at 3 and 6 months after surgery were significantly reduced from preoperative baseline scores (p=0.007) compared with in the PFN group. However, there were no statistically significant differences between the two groups in functional recovery scores at baseline (p=0.346) or at 3 months (p=0.880), 6 months (p=0.699), and 12 months (p=0.468) after surgery. There was no between-group difference in mortality (p=0.140). CONCLUSION At 1-year follow-up, functional recovery scores were similar in elderly patients treated with the DHS and PFN techniques. However, DHS-treated patients exhibited significant loss of function in the first 6 months after surgery, which did not occur in the PFN-treated group.

One-year mortality of elderly patients with hip fracture surgically treated at a hospital in Southern Brazil

Objective To analyze the mortality rate at one-year follow-up of patients with hip fracture who underwent surgery at the university hospital of this institution. Method The authors reviewed 213 medical records of hospitalized patients aged 65 years or older, following to the order they were admitted to the orthopedics and traumatology service from January 2012 to August 2013. Results One-year mortality rate was 23.6%. Mortality was higher among women, with a 3:1 ratio. Anemia (p = 0.000) and dementia (p = 0.041) were significantly associated with the death group. Patients who remained hospitalized for less than 15 days and who were discharged within seven days after surgery showed increased survival. Conclusion In the present sample of patients with hip fracture who underwent surgery, one-year mortality rate was 23.6%, and the main comorbidities associated with this outcome were anemia and dementia.

Elderly with proximal hip fracture present significantly lower levels of 25-hydroxyvitamin D

Objective To compare serum 25-hydroxyvitamin D (25[OH]D) levels, a serum marker of vitamin D3, between patients with and without proximal hip fracture. Methods This was a case–control study in which serum samples of 25(OH)D were obtained from 110 proximal hip fracture inpatients and 231 control patients without fractures, all over 60 years of age. Levels of 25(OH)D lower than or equal to 20 ng/mL were considered deficient; from 21 ng/mL to 29 ng/mL, insufficient; and above 30 ng/mL, sufficient. Sex, age, and ethnicity were considered for association with the study groups and 25(OH)D levels. Results Patients with proximal hip fracture had significantly lower serum 25(OH)D levels (21.07 ng/mL) than controls (28.59 ng/mL; p = 0.000). Among patients with proximal hip fracture, 54.5% had deficient 25(OH)D levels, 27.2% had insufficient levels, and only 18.2% had sufficient levels. In the control group, 30.3% of patients had deficient 25(OH)D levels, 30.7% had insufficient levels, and 38.9% had sufficient levels. Female patients had decreased serum 25(OH)D levels both in the fracture group and in the control group (19.50 ng/mL vs. 26.94 ng/mL; p = 0.000) when compared with male patients with and without fracture (25.67 ng/mL vs. 33.74 ng/mL; p = 0.017). Regarding age, there was a significant association between 25(OH)D levels and risk of fracture only for the age groups 71–75 years and above 80 years. Conclusion Patients with proximal hip fracture had significantly decreased serum 25(OH)D levels when compared with the control group. Female patients had significantly lower serum 25(OH)D levels in both groups.

Densitometric study of the clavicle: bone mineral density explains the laterality of the fractures,

Introduction Epidemiological studies have shown laterality in clavicle fractures, such that the left side is more frequently fractured. The present study had the aim of evaluating whether the clavicle on the dominant side is denser and thus explaining the greater incidence of fractures on the non-dominant side. Materials and methods This was a descriptive study on 52 healthy patients, who were classified according to age, sex and whether the dominant or non-dominant side was affected. Results The participants comprised 28 women (53.8%) and 24 men (46.2%). Regarding the dominant side, 30 were right-handed (57.7%) and 22 were left-handed (42.3%). The mean age was 25 years. In this study, it could be seen that the non-dominant side had greater bone mass than the dominant side. It was also observed that the bone density was greater in the middle and distal thirds on the non-dominant side, with a statistically significant difference. In the women, the density was also greater on the non-dominant side; this difference was not significant in relation to the dominant side, but there were significant differences between the middle thirds (p < 0.001) and the distal thirds (p < 0.006). Conclusion Variations in bone density, toward higher and lower bone mass, may have been responsible for the fractures. According to the findings from this study, fractures occur more in the middle third of the non-dominant clavicle, as a result of greater bone mineral mass, which gives rise to lower flexibility and fractures in the region.

Fratura pantrocantérica: incidência da complicação em pacientes com fratura trocantérica tratados com parafuso dinâmico de quadril em um hospital do Sul do Brasil

Objective The aim of the present study was to investigate the incidence of pantrochanteric fractures in cases of trochanteric fractures treated with dynamic hip screw in our service. Methods A sample of 54 patients with trochanteric fractures treated with dynamic hip screws was included in this retrospective study. Preoperative radiographs were evaluated for fracture classification using the Arbeitsgemeinschaft für Osteosynthesefragen (Association for the Study of Internal Fixation, in German)/Orthopedic Trauma Association (AO/OTA) system for the identification of radiographic osteoporosis and for the measurement of the lateral femoral wall thickness. In the immediate postoperative images, the presence of pantrochanteric fracture was evaluated. Results The final sample presented an incidence of 16.7% of pantrochanteric fractures. The thickness of the lateral wall was significantly lower in the group with the complication ( p  < 0.001). Although fractures classified as 31-A2 were more numerous in the group with pantrochanteric fracture, the difference was not statistically significant ( p  = 0.456). Conclusion The percentage of pantrochanteric fractures in this service is in accordance with previous studies. There was an association between lateral femoral wall thickness and the occurrence of iatrogenic fracture of the lateral cortex. There was no significant difference between fracture classification and pantrochanteric fracture, possibly due to sample size.

Evaluation of the effectiveness of a care program for elderly patients with hip fractures: a network strategy

Objective: Evaluate the effectiveness of a care program for elderly persons with hip fractures due to a fall, based on a public network in Canoas, Rio Grande do Sul, Brazil. Methods: a prospective cohort study of quantitative character was carried out. A total of 182 elderly person above 60 years diagnosed with hip fractures were included. The sample was divided into two groups, one who underwent their usual treatment (n=91) and another who were included in a care program for elderly persons with hip fractures Palavras-chave: Idoso. Fraturas do quadril. Serviços de Saúde para Idosos. Queda. http://dx.doi.org/10.1590/1981-22562017020.170008

Infection rate in adult patients with open fractures treated at the emergency hospital and at the ULBRA university hospital in Canoas, Rio Grande do Sul, Brazil

Objective To identify the infection rate in adult patients with open fractures treated at two tertiary hospitals in the city of Canoas, Rio Grande do Sul, Brazil. Methods This quantitative descriptive study was conducted at Hospital de Pronto Socorro de Canoas. Eligible participants were adults aged 18–60 years with open fractures who were admitted to the orthopedic trauma service from January to May 2014 and followed-up for one year. Results A total of 133 patients with open fractures were included; most were men (92.48%), with a mean age of 36 years. There was a predominance of Gustilo-Anderson type III fractures. The infection rate was 18.80%, being more frequent in Gustilo-Anderson type III fractures (72.00%). The most commonly observed bacteria were Staphylococcus aureus and Enterobacter aerogenes. Conclusion The infection rate in open fractures of patients initially treated at the emergency department of HPSC was 18.8%. The infections occurred predominantly in Gustilo-Anderson type III fractures. The bacteria with the highest incidence in infections were Staphylococcus aureus and Enterobacter aerogenes.

Surgical treatment of intraarticular fractures of the calcaneus: comparison between flat plate and calcaneal plate

Objective To evaluate the clinical results of surgical treatment of intraarticular fractures of the calcaneus, comparing the use of calcaneal plate and flat plate. Methods This was a retrospective study assessing the postoperative results of 25 patients between 2013 and 2015. Patients undergoing surgical treatment of intraarticular fractures of the calcaneus without concomitant surgical lesions were included. Patients who did not complete appropriate follow-up after surgery were excluded from the study. Results The unavailability of calcaneal plates at resource-limited settings, associated with the availability and lower cost of flat plates, may have been a confounding factor in the present study. However, there was no statistical difference between the outcomes of fractures treated with calcaneal plates or flat plates. Conclusion Statistical inference shows that, when calcaneal plates are not available, it is possible to use flat plates with similar clinical outcomes.

Hematoma de ligamento amarelo: relato de caso e revisão da literatura

El objetivo es presentar un caso raro de un hematoma ligamento flavum en la region lumbar, discutir su fisiopatologia y el tratamiento y revision de la literatura. Una mujer de 68 anos presento claudicacion neurogenica debido a la espondilolistesis lumbar degenerativa y que se convirtio en un repentino empeoramiento con el sindrome de cauda equina. Una imagen de resonancia magnetica (RM) mostro signos de degeneracion de la columna lumbar, con canal espinal estrecho de L2 a S1, anterolistesis L4 L5 y en la L1-L2, un proceso expansivo redondeado e hiperintenso en T1 y hipointenso en los bordes en T2, compatible con hematoma en la topografia del ligamento amarillo. La paciente fue sometida a laminectomia y fijacion lumbar. Su evolucion fue buena en el postoperatorio y, a los 18 meses de seguimiento caminaba sola, a pesar del dolor que se controla con medicamentos simples. Aunque raro, parece que el hematoma del ligamento amarillo tiene relacion con la degeneracion y la ruptura de pequenos vasos asociadas a micro-traumas en la columna vertebral. Su fisiopatologia no esta bien definida y el tratamiento es similar a otros procesos de compresion de la columna vertebral.O objetivo e apresentar um caso raro de hematoma do ligamento amarelo na regiao lombar, discutir sua fisiopatologia e tratamento e revisar a literatura. Uma mulher de 68 anos apresentou-se com claudicacao neurogenica devido a doenca degenerativa lombar e espondilolistese que evoluiu para uma piora subita com a sindrome da cauda equina. A imagem por ressonância magnetica (IRM) mostrou sinais de degeneracao da coluna lombar, com um canal vertebral estreito de L2 a S1, ântero-listese de L4 L5 e, posteriormente no nivel da L1-L2, um processo expansivo arredondado e hiperintenso em T1 e com bordas hipointensas em T2 ponderada, compativel com hematoma na topografia do ligamento amarelo. A paciente foi submetida a laminectomia e fixacao lombar. Sua evolucao foi boa no periodo pos-operatorio e, aos 18 meses de follow-up andou sozinha, apesar da dor que e controlada com medicamentos simples. Mesmo sendo raro, parece que o hematoma do ligamento amarelo tem uma relacao com a degeneracao e ruptura de pequenos vasos associadas a microtraumas na coluna vertebral. Sua fisiopatologia ainda nao e bem definida e o tratamento e semelhante ao de outros processos de compressao da coluna vertebral.

Hematoma del ligamento amarillo: caso clínico y revisión de la literatura

El objetivo es presentar un caso raro de un hematoma ligamento flavum en la region lumbar, discutir su fisiopatologia y el tratamiento y revision de la literatura. Una mujer de 68 anos presento claudicacion neurogenica debido a la espondilolistesis lumbar degenerativa y que se convirtio en un repentino empeoramiento con el sindrome de cauda equina. Una imagen de resonancia magnetica (RM) mostro signos de degeneracion de la columna lumbar, con canal espinal estrecho de L2 a S1, anterolistesis L4 L5 y en la L1-L2, un proceso expansivo redondeado e hiperintenso en T1 y hipointenso en los bordes en T2, compatible con hematoma en la topografia del ligamento amarillo. La paciente fue sometida a laminectomia y fijacion lumbar. Su evolucion fue buena en el postoperatorio y, a los 18 meses de seguimiento caminaba sola, a pesar del dolor que se controla con medicamentos simples. Aunque raro, parece que el hematoma del ligamento amarillo tiene relacion con la degeneracion y la ruptura de pequenos vasos asociadas a micro-traumas en la columna vertebral. Su fisiopatologia no esta bien definida y el tratamiento es similar a otros procesos de compresion de la columna vertebral.O objetivo e apresentar um caso raro de hematoma do ligamento amarelo na regiao lombar, discutir sua fisiopatologia e tratamento e revisar a literatura. Uma mulher de 68 anos apresentou-se com claudicacao neurogenica devido a doenca degenerativa lombar e espondilolistese que evoluiu para uma piora subita com a sindrome da cauda equina. A imagem por ressonância magnetica (IRM) mostrou sinais de degeneracao da coluna lombar, com um canal vertebral estreito de L2 a S1, ântero-listese de L4 L5 e, posteriormente no nivel da L1-L2, um processo expansivo arredondado e hiperintenso em T1 e com bordas hipointensas em T2 ponderada, compativel com hematoma na topografia do ligamento amarelo. A paciente foi submetida a laminectomia e fixacao lombar. Sua evolucao foi boa no periodo pos-operatorio e, aos 18 meses de follow-up andou sozinha, apesar da dor que e controlada com medicamentos simples. Mesmo sendo raro, parece que o hematoma do ligamento amarelo tem uma relacao com a degeneracao e ruptura de pequenos vasos associadas a microtraumas na coluna vertebral. Sua fisiopatologia ainda nao e bem definida e o tratamento e semelhante ao de outros processos de compressao da coluna vertebral.