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The purpose of this study is to present our experience with the technique, the problems and the potential pitfalls of arthroscopically assisted retrograde femoral nailing for supracondylar femoral fractures. In a 2-year period, nine patients (seven women, two men, average age 72 years) with supracondylar femoral fractures were treated in our department with a retrograde nailing under arthroscopic control. The mean operative time was 63.8 min (42-84 min) and the mean follow up period was 34.5 months (ranged 12-52). Solid union of the fracture was achieved in all patients without additional intervention, in 14 weeks (range 12-18). There was no malalignment (more than 5 degrees in any plane) or implant failure. In conclusion we believe that the arthroscopically assisted technique is a very good method to treat supracondylar fractures of the femur. It has very low morbidity since the knee is not opened through the operation, and the surgeon has the ability to inspect the joint for any additional damage. It is very helpful in multitrauma patients and in young patients, where the precision of the entry point is critical. However, we do not recommend the technique in intraarticular fractures because the reduction is difficult and the fixation is performed with safety only under direct vision. [ABSTRACT FROM AUTHOR]

Increased mortality after a hip fracture has been associated with age, sex, and comorbidity. In order to estimate the long-term mortality with reference to hip fracture type, we followed 499 patients older than 60 years who had been treated surgically for a unilateral hip fracture for 10 years. At admission, patients with femoral neck fractures ( n = 172) were 2 years younger than intertrochanteric patients (77.6 ± 7.7 [SD] vs. 79.9 ± 7.4 [SD], P = 0.001) and had a greater prevalence of heart failure (57% vs. 40.3%, P = 0.03). Similar mortality rates were observed at 1 year in both types of fracture (17.9% vs. 11.3%, log rank test P = 0.112). Mortality rates were significantly higher for intertrochanteric fractures at 5 years (48.8% vs. 34.7%, P = 0.01) and 10 years (76% vs. 58%, P = 0.001). Patients 60–69 years old with intertrochanteric fractures had significantly higher 10-year mortality than patients of similar age with femoral neck fractures ( P = 0.008), while there was no difference between the groups aged 70–79 ( P > 0.3) and 80–89 ( P = 0.07). Women were less likely to die in 5 years (relative risk [RR] = 0.57, 95% confidence interval [CI] 0.41–0.79, P = 0.0007) and 10 years (RR = 0.65, 95% CI 0.49–0.85, P = 0.002). Age, sex, the type of fracture, and the presence of heart failure were independent predictors of 10-year mortality (Cox regression model P < 0.0001). The intertrochanteric type was independently associated with 1.37 (95% CI 1.03–1.83) times higher probability of death at 10 years ( P = 0.002). In conclusion, the type of fracture is an independent predictor of long-term mortality in patients with hip fractures, and the intertrochanteric type yields worse prognosis. [ABSTRACT FROM AUTHOR]

Introduction: In this study, we initiated a prospective, randomised, clinical trial comparing the AMBI, TGN and PFN operations used for treatment of unstable fractures, for differences in intra-operative use, consolidation, complications and functional outcome. Materials and Methods: We have compared the pre-, intra- and post-operating variables of AMBI, TGN and PFN operations that were used for treatment of unstable trochanteric fractures, of 120 patients all above 60 years old diagnosed with extracapsular hip fractures classified as AO Type 31-A2 or Type 31-A3. Results: According to our results the three methods are comparable in the treatment of unstable trochanteric fractures of patients above 60 years old. Conclusion: The AMBI remains the gold standard for the fractures of trochanteric region. TGN has an easier and faster procedure, facilitates early weight bearing and had minor late complications. An improper use of the PFN system was the reason for the most complications and the longer operation time of the device. PFN is also an accepted minimally invasive implant for unstable proximal femoral fractures but future modification of the implant to avoid Z-effect phenomenon, careful surgical technique and selection of the patients should reduce its high complication rate. [ABSTRACT FROM AUTHOR]

The evaluation of blood supply of the humeral head in displaced 4-part "valgus impacted" fractures of the proximal humerus. Digital angiographic image processing, using the segmentation technique, showed no statistical difference in the supply of the humeral head before and after the operation. Conclusions: Although the small number of cases, transosseous suturing fixation of 4-part valgus impacted fractures seems to no further harm the remaining blood supply of the humeral head. The incidence of a vascular necrosis is higher in cases with severe lateral displacement.

A prospective clinical study is presented, in order to evaluate the midterm results of short posterior instrumentation in the treatment of thoracolumbar burst fractures. Surgical technique included insertion of transpedicular screws in the fractured vertebra and fixation of one level above and below, followed by facetectomy, posterior indirect reduction of the fracture and arthrodesis with the use of autografts. The use of transpedicular screws in the fractured vertebra at a compression burst fracture of the thoracolumbar region, although technically demanding, allows short fusion and succeeds satisfying correction and midterm preservation of reduction, leading to uneventful healing of the fracture.

Summary: The present study investigates the correlation between radiological parameters of wrist fractures and the clinical outcome expressed by objective clinical parameters and the level of patient-rated wrist dysfunction. Thirty consecutive cases of unstable distal radial fractures treated with closed reduction and percutaneous fixation were prospectively studied for a period of one year. The outcome parameters included objective clinical and radiological parameters and the previously described and validated patient-rated wrist evaluation (PRWE) score. Analysis showed that for unstable (AO classification types 23-A2, -A3, -C1 and -C2) fractures the fracture type affects the range of wrist palmarflexion (p =0.04) and that the presence of postoperative articular ‘step-off’ affects the range of wrist dorsiflexion and the patient-rated wrist function at the final time of the study (p <0.01 and p =0.02, respectively). It is also shown that permanent radial shortening and loss of the palmar angle were associated with prolonged wrist pain (p <0.01 and p =0.03, respectively). Our finding that residual articular incongruity correlates with persisting loss of wrist dorsiflexion and wrist dysfunction contradicts the view that loss of articular congruity is associated with late development of articular degeneration but not with early wrist dysfunction. Additionally, this study failed to show any association between the fracture type and the functional outcome as rated by the patients. [Copyright &y& Elsevier]