Cut Out Complications and Anisomelia of the Lower Limbs In Surgery With Valgus Reduction for Intertrochanteric Fractures

Background: The proximal fractures of the femur are counted among the group of orthopedic and traumatic pathologies which consume most of the financial resources set aside for health worldwide. Surgical treatment continues to be the treatment of choice for intertrochanteric fractures of the femur. However, although the surgical treatment of the proximal fracture of the femur is widely known and accepted in the orthopedic field, it is not without risk with the cut out being the most feared complication. Objective: This paper describes the complications of cut out or the anisomelia of the lower limbs of patients with intertrochanteric fractures who underwent valgus reduction surgery. Method: Sixty-one patients with 3rd and 4th degree, according to Tronzo classification, intertrochanteric fractures underwent surgery with the use of Dynamic hip screw type sliding screw and valgus reduction. The data were analyzed one year after surgery, when a functional assessment was made by scanometry, Tip-Apex Distance index diaphyseal cervical angle and the modified Merle d'Aubigné & Postel questionnaire. Kruskal-Wallis and Mann-Whitney tests were used for the statistical analysis, Spearman’s correlation test for the quantitative variables and the chi-squared test for the qualitative variables. Results: The correlation between the Tip-Apex Distance index and the diaphyseal cervical angle was statistically significant (rho=0.391, p=0.002), while the correlations between the Tip-Apex Distance index and the scanometry and the diaphyseal cervical angle and the scanometry were not significantly correlated. In accordance with the modified Merle d’Aubigné & Postel questionnaire, 23 patients (37.7%) achieved a very good result, 29 patients (47.5%) had a good result, five patients (8.2%) obtained a moderately good result, one patient (1.6%) presented a reasonable result and three patients (4.9%) obtained a poor result. Conclusion: No cut out complications occurred in the 3rd and 4th degree intertrochanteric fractures with a Baumgaertner index ≥ 25 mm, when the reduction and valgus fixation of the intertrochanteric fracture was performed with the Dynamic hip screw type sliding pin, as there was also, in the majority of patients, no anisomelia of the lower limbs

Randomized clinical trial between proximal row carpectomy and the four-corner fusion for patients with stage II SNAC

AbstractObjectiveTo compare the outcomes of patients with stage II SNAC submitted to surgical treatment by proximal row carpectomy (PRC) or four-corner fusion (FCF).MethodTwenty-seven patients aged 18–59 years (mean 37.52 years) were included. Thirteen patients underwent PRC in Group A, and 14 underwent FCF of the wrist in Group B. Evaluations were made before and after surgery with follow-up between 45 and 73 months. Range of motion (ROM); pain assessment with a visual analog scale (VAS); grip strength; disability of the arm, shoulder, and hand (DASH); and return to work were evaluated.ResultsGroup A patients had 68.5% and Group B patients, 58.01% of the ROM of the contralateral side. The VAS score was 2.3 in Group A and 2.9 in Group B. Grip strength was 78.67% and 65.42%, respectively, relative to the side not affected. The DASH score was 11 for PRC and 13 for FCF. In Group A, 9/13 (69.23%) and in Group B, 8/14 (57.14%) patients are currently working. Complications were symptomatic osteoarthritis in the mid-carpal joint in Group A and loosening of a screw in Group B.ConclusionThe clinical and functional results do not present statistically significant differences for both analyzed methods

Randomized clinical trial between proximal row carpectomy and the four-corner fusion for patients with stage II SNAC

ABSTRACT OBJECTIVE: To compare the outcomes of patients with stage II SNAC submitted to surgical treatment by proximal row carpectomy (PRC) or four-corner fusion (FCF). METHOD: Twenty-seven patients aged 18-59 years (mean 37.52 years) were included. Thirteen patients underwent PRC in Group A, and 14 underwent FCF of the wrist in Group B. Evaluations were made before and after surgery with follow-up between 45 and 73 months. Range of motion (ROM); pain assessment with a visual analog scale (VAS); grip strength; disability of the arm, shoulder, and hand (DASH); and return to work were evaluated. RESULTS: Group A patients had 68.5% and Group B patients, 58.01% of the ROM of the contralateral side. The VAS score was 2.3 in Group A and 2.9 in Group B. Grip strength was 78.67% and 65.42%, respectively, relative to the side not affected. The DASH score was 11 for PRC and 13 for FCF. In Group A, 9/13 (69.23%) and in Group B, 8/14 (57.14%) patients are currently working. Complications were symptomatic osteoarthritis in the mid-carpal joint in Group A and loosening of a screw in Group B. CONCLUSION: The clinical and functional results do not present statistically significant differences for both analyzed methods

Avaliação da qualidade de vida dos pacientes idosos com fratura do colo do fêmur tratados cirurgicamente pela artroplastia parcial do quadril

Foram analisados 30 pacientes, cuja idade variou de 70 a 95 anos, sendo 24 (80%) do sexo feminino e seis (20%) do masculino, que sofreram fratura do colo do fêmur e foram operados de artroplastia parcial do quadril entre 2001 e 2003, nos seguintes hospitais: Hospital Ipiranga SUS-SP e Hospital Estadual Mário Covas de Santo André-SP. A artroplastia parcial foi realizada nas fraturas do colo de fêmur instáveis Garden III e Garden IV, sendo utilizada a prótese parcial de Thompson cimentada. Foi aplicado o questionário de qualidade de vida SF-36. Os pacientes foram entrevistados no décimo primeiro mês de pós- operatório, com o objetivo de avaliar a qualidade de vida de pacientes idosos que sofreram fratura do colo do fêmur, tratados cirurgicamente com prótese parcial do quadril. Com relação à saúde física, os pacientes apresentaram baixa pontuação na capacidade funcional e alta nos quesitos referentes aos aspectos físicos, dor e estado geral de saúde. A saúde mental foi moderada quanto à vitalidade e alta nos aspectos sociais, emocionais e na saúde mental propriamente dita. Podemos concluir que a artroplastia parcial de Thompson, pós-fratura do colo do fêmur, em pacientes acima de 80 anos, analisados no período pós-operatório de 11 meses, permite uma boa qualidade de vida