PURPOSE OF THE STUDY: Intertrochanteric hip fractures in elderly patients are a significant cause of morbidity and mortality, with increasing incidence due to the aging population. Despite advancements in intramedullary nailing (IMN) technology, fixation failure remains a concern. This study aims to evaluate pre-and postoperative radiographic risk factors for varus collapse in geriatric intertrochanteric fractures treated with twin interlocking derotation and compression screw cephalomedullary nail (InterTAN, Smith & Nephew). MATERIAL AND METHODS: This retrospective study included patients over 60 years with AO 31A1 and 31A2 intertrochanteric femur fractures treated with InterTAN at a tertiary referral center from August 2012 to August 2017. Patients with high-energy fractures, AO 31A3 fractures, or those requiring open reduction were excluded. Data on demographics, fracture classification, implant sizes, imaging studies, and follow-up were collected. Radiographic assessments included Chang's medial cortical support concept, tip-apex distance (TAD), calcar-referenced TAD (CalTAD), neck-shaft angles (NSA), and screw placement according to Cleveland zones. Varus collapse was defined as a >5° change in NSA within three months postoperatively. Multivariate logistic regression analysis was used to identify risk factors for varus collapse. RESULTS: The study included 136 patients with a mean age of 79.8 years, of whom 38.2% were male. The early postoperative tipapex distance (TAD) averaged 21.9mm, with 30.1% of patients experiencing varus collapse greater than 5°. Positive medial cortical support (PMCS) or neutral position (NP) type reduction was highly protective against varus collapse (p < 0.001), as well as TAD less than 25mm (p < 0.001). Additionally, the placement of screws in the central-central or central-inferior zones provided a protective effect against varus collapse (p = 0.031). Conversely, having an OTA/AO type A2.2 or A2.3 fracture significantly increased the risk of varus collapse (p = 0.030). Other factors, such as CalTAD and the nail width to medullary canal ratio, did not significantly predict varus collapse (p = 0.831 and p = 0.952, respectively). DISCUSSION: Our findings align with previous studies highlighting TAD and screw placement as critical factors in preventing fixation failure. The protective effect of PMCS or NP reduction and the increased risk associated with OTA/AO type A2.2 and A2.3 fractures are noteworthy. Unlike previous studies, CalTAD was not significantly associated with varus collapse in our cohort. The study underscores the importance of surgical technique and radiographic parameters in optimizing outcomes for elderly patients with intertrochanteric fractures. CONCLUSIONS: In elderly patients treated with InterTAN nails, varus collapse is influenced by fracture type, TAD, reduction quality, and screw placement. Ensuring a TAD <25mm, achieving PMCS or NP reduction, and placing screws in central-central or central-inferior zones are crucial for minimizing varus collapse. These findings highlight the importance of meticulous surgical technique and radiographic assessment in managing intertrochanteric fractures in the elderly. KEY WORDS: hip fractures, intertrochanteric fractures, internal Fixation, geriatrics, cephalomedullary nail.

• MeSH
• Hip Fractures * surgery   MeSH
• Fracture Fixation, Intramedullary * methods   instrumentation   adverse effects   MeSH
• Bone Nails * MeSH
• Bone Screws * adverse effects   MeSH
• Middle Aged MeSH
• Humans MeSH
• Postoperative Complications etiology   epidemiology   MeSH
• Retrospective Studies MeSH
• Risk Factors MeSH
• Prosthesis Failure MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

PURPOSE OF THE STUDY: The purpose of this study was to assess the clinical outcomes and complications associated with intramedullary and transverse K-wire fixations of 5th metacarpal neck fractures. MATERIAL AND METHODS: Patients who were operated for 5th metacarpal neck fractures between 2019 and 2022 were evaluated retrospectively. Regarding the surgical treatment methods, patients were assessed by dividing them into two groups. The first group comprised patients who underwent treatment with an intramedullary K-wire. The second group comprises patients who underwent transverse K-wire fixation. RESULTS: The average quick DASH score of all patients was 5.6±4.7 in the intramedullary K-wire fixation group and 5.9±5.1 in the transverse K-wire fixation group. An average 5th finger metacarpophalangeal joint extension limitation was 6.2±5.7° in the intramedullary fixation group and 6.1±5.8° in the transverse K-wire group. The mean radiological union time was 4.9±0.7 weeks in the intramedullary fixation group and 5.1±0.7 weeks in the transverse K-wire group. No statistically significant difference was found between the quick DASH scores and degrees of the MCP joint extension limitation ( p=0.785). Intramedullary fixation and transverse K-wire fixations are effective surgical treatment methods for metacarpal neck fractures. DISCUSSION: It has been reported that the intramedullary fixation method in metacarpal bone fractures is more effective than the fixation methods with cross and transverse K-wire. But our results revealed no difference in clinical outcomes between the two surgical fixation methods. CONCLUSIONS: We observed no statistically significant difference between the two fixation techniques with regard to union, clinical outcomes, or complications. KEY WORDS: intramedullary fixation; metacarpal neck fracture; transverse K-wire fixation.

• MeSH
• Adult MeSH
• Fractures, Bone * surgery   MeSH
• Fracture Fixation, Intramedullary * methods   instrumentation   MeSH
• Bone Wires * MeSH
• Middle Aged MeSH
• Humans MeSH
• Metacarpal Bones * injuries   surgery   MeSH
• Retrospective Studies MeSH
• Fracture Fixation, Internal methods   instrumentation   MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Comparative Study MeSH

PURPOSE OF THE STUDY: Intraarticular fractures of the distal femur rank among the most severe musculoskeletal injuries. Various treatment options, such as plate osteosynthesis or retrograde nailing, can be employed. This study aims to evaluate the clinical outcomes and complications of intraarticular distal femoral fractures treated with retrograde femoral nail, with particular emphasis on C3 fractures. MATERIAL AND METHODS: Between January 2016 and January 2023, 18 AO/33.C3 fractures were treated with a retrograde femoral nail. Of these, two were classified as 33.C1, eight as 33.C2 and eight as 33.C3. Twelve of the fractures were open. After the initial treatment and stabilizing the patient's overall condition, we proceeded with the definitive osteosynthesis. The first phase involved open reduction and fixation using individual screws to reconstruct the articular surface. The second phase consisted in retrograde nailing with correction of the length, axis and rotation of the femur. The evaluation criteria included: complication rate, number of revisions, knee range of motion, mechanical axis and length of the lower extremity, progression of gonarthrosis, pain level, need of walking support, Lysholm and Tegner Activity Score for functional outcome. RESULTS: Overall, we evaluated the complications and the outcomes of 12 patients (13 fractures). Of these, 8 patients experienced some kind of postoperative complications, primarily insufficient healing or nonunion, which were managed through revision surgery. Plate reosteosynthesis was used in 2 patients who were then excluded from the final clinical evaluation. No cases of deep infection or deep vein thrombosis were reported and no patient required total knee replacement. Seven AO/33.C3 fractures were individually evaluated. The average knee range of motion was nearly 0-93°, maximum flexion was 120°. On average, the lower extremity was 1.6 cm shorter and 7.3° varus to the mechanical axis. Only little progression of gonarthrosis was observed along with low levels of pain. The Lysholm Score ranged between 52 and 84 points (averaging 73.1). The mean Tegner Activity Score was 3.4. All results showed adequate improvement in 33.C2 and 33.C1 groups. DISCUSSION: The retrograde femoral nail demonstrates several advantages over the locking compression plate, particularly in biomechanical aspects. Various clinical studies have reported superior outcomes in terms of healing, complication rate, blood loss and functional outcome. Our study findings align with some of those international studies, particularly in the rate of infectious complications (0%), mean Lysholm Score (79.3 p.) and Tegner Activity Score (4.1). On the other hand, we observed a higher rate of revision surgery (53.8 %), mainly due to evaluating 33.C fractures only. The main advantage of this method lies in complete visualization, leading to better reconstruction of the articular surface coupled with excellent biomechanical properties of the intramedullary nail. CONCLUSIONS: Intraarticular distal femoral fractures pose significant challenges to treatment and frequently lead to permanent damage. The primary treatment goals involve achieving anatomical reposition of the articular surface, stable osteosynthesis, correction of the femoral length and axis and early rehabilitation. Our study demonstrates good clinical outcomes with a relatively low rate of complications. Patients are capable of walking without pain, achieving a good range of motion, returning to their occupations and becoming self-sufficient. Moreover, there were no infectious complications and no significant progression of gonarthrosis. KEY WORDS: retrograde femoral nail, intraarticular distal femoral fracture, functional outcome, complication rate.

• MeSH
• Femoral Fractures * surgery   MeSH
• Intra-Articular Fractures surgery   MeSH
• Fracture Fixation, Intramedullary methods   instrumentation   MeSH
• Bone Nails * MeSH
• Middle Aged MeSH
• Humans MeSH
• Postoperative Complications etiology   MeSH
• Reoperation methods   MeSH
• Range of Motion, Articular MeSH
• Fracture Fixation, Internal methods   MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• English Abstract MeSH
• Journal Article MeSH

• Keywords
• Masqueletova technika,
• MeSH
• Splints MeSH
• External Fixators classification   MeSH
• Fractures, Bone * surgery   history   diagnostic imaging   therapy   MeSH
• Ilizarov Technique MeSH
• Fracture Fixation, Intramedullary methods   instrumentation   MeSH
• Bone and Bones surgery   diagnostic imaging   MeSH
• Humans MeSH
• Orthopedic Procedures * history   methods   MeSH
• Fracture Fixation, Internal classification   MeSH
• Plastic Surgery Procedures classification   MeSH
• Check Tag
• Humans MeSH

• MeSH
• Acetabulum * surgery   injuries   MeSH
• Splints utilization   MeSH
• Fracture Fixation, Intramedullary methods   instrumentation   MeSH
• Middle Aged MeSH
• Humans MeSH
• Hip Injuries complications   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Case Reports MeSH

PURPOSE OF THE STUDY The locked nailing of diaphyseal fractures of the tibia currently represents a method of choice for treating the closed diaphyseal fractures, some of the tibial metaphyseal fractures and open tibial diaphyseal fractures classified as grade I and II according to Gustilo-Anderson (GA) classification. The suprapatellar (SP) approach is an alternative technique of insertion of the nail in semi-extension of the lower extremity with easier reduction, namely of multiple fractures and proximal diaphyseal fractures of the tibia in particular. This study aims to evaluate the group of patients in whom the suprapatellar approach was used and who were followed up for the period of at least 12 months. MATERIAL AND METHODS The prospective study included 55 cases of osteosynthesis of diaphyseal fractures of the tibia with the surgery performed in the period from January 2013 to June 2015, of which in 53 patients (17 women and 36 men) with the mean age of 49.6± 16.7 years the ETN nail by DePuy Synthes ® was inserted through a suprapatellar approach. In 38 cases (70.1%) an isolated trauma was involved, 15 patients (29.9%) were treated for multiple injuries or polytrauma. In nine cases (17%) it was an open fracture (2times - GA grade I, 7times - GA grade II). A multiple fracture or a fracture of the proximal third was recorded in 19 cases (34.5%). The functional and radiological results of the treatment were assessed prospectively at 12 months after the surgery using the Lysholm (LS) score. RESULTS The final functional results were successfully assessed in 49 performed osteosyntheses (89.1%). The mean duration of surgery was 72.7± 19.57 min (40-140 min, median 65 min). A total of 48 (98%) fractures healed by primary intention. In five cases (10.2%) a delayed healing occurred and in one case (2 %) non-union was reported, requiring a revision surgery. In three cases (6.1%) complete implant was removed (twice by SP and once by IP approach). The mean Lysholm score was 93.4 ± 8.39 points (59-100 points, median score of 95 points). An excellent or a good result was observed in 45 patients (91.8%), a satisfactory result in three patients (6.2%), and a poor result in one patient (2%). A statistically significant correlation (p = 0.006) between the LS score values and the age of the patients was confirmed. In patients up to 60 years of age the LS score was 96.2 ± 4.51 points (89-100, median 96), at the age of more than 60 years it was 86.9 ± 11.46 (59-100, median 89). CONCLUSIONS The suprapatellar approach in treating the tibial diaphyseal fractures represents a safe alternative nail insertion technique. If an appropriate surgical technique is applied, the risks inherent in this approach are negligible. The approach allows for an easy reduction of challenging fractures of the proximal third diaphyseal fracture of the tibia and multiple fractures of the tibia and facilitates an easy check of the axial position of the extremity. The functional results of the knee joint are comparable to those achieved with the infrapatellar nailing technique. The final LS score correlates with the age of the patients. Key words:tibial fractures, suprapatellar approach, intramedullary nailing, knee pain.

• MeSH
• Diaphyses diagnostic imaging   injuries   surgery   MeSH
• Adult MeSH
• Tibial Fractures classification   diagnostic imaging   surgery   MeSH
• Fracture Fixation, Intramedullary instrumentation   methods   MeSH
• Bone Nails * MeSH
• Middle Aged MeSH
• Humans MeSH
• Lysholm Knee Score MeSH
• Fractures, Open diagnostic imaging   surgery   MeSH
• Prospective Studies MeSH
• Radiography MeSH
• Aged MeSH
• Fractures, Closed diagnostic imaging   surgery   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

PURPOSE OF THE STUDY The presented study was construed as a retrospective multicentric clinical study focused on paediatric skeletal injuries of the proximal radius. As a general rule, the Type I displaced fractures (Judet classification) are treated conservatively, with no reduction. In the case of Type II-IV displacement, the fracture necessitates reduction or is also transfixed by a Kirschner wire (K-wire) or a Prevot nail (P-nail) where subsequent fragment instability occurs. The comparison aimed to ascertain whether there is a statistically significant difference between the two methods. No difference was expected by the authors, therefore a null hypothesis was set. MATERIAL AND METHODS The patients were treated at the Clinic of Paediatric Surgery, Orthopaedics and Traumatology (CPSOT) of the Faculty of Medicine of the Masaryk University and at the Clinic of Orthopaedics and Traumatology of the Musculoskeletal System of the University Hospital in Pilsen in the period from 2006 to 2015. Two methods of closed reduction and minimally- invasive osteosynthesis were evaluated. The first method was the elastic stable intramedullary nailing (ESIN) with a P-nail, the second method was an osteosynthesis using a K-wire. In the clinical part of the study, comparisons were made based on the monitoring of the same parameters - final restriction of movement, time to full weight bearing of the extremity and incidence of serious complications. RESULTS The final group comprised a total of 31 patients, of whom 7 boys and 24 girls aged 3-16 years with the median of 9-10 years. Some restriction of movement following the treatment occurred in a total of seven patients (44%) with the K-wire and in four patients (27%) with the P-nail. When comparing the movement at 5% level of significance using the Chi-Square tests, no significant difference was found (p = 0.446). When evaluating the serious complications at 5% level of significance using the Chi-Square tests, the difference between the two methods of treatment was again insignificant (p = 0.365). When the full weight bearing was compared (median K-wire 8 weeks, median P-nail 10 weeks), a statistically significant difference was obtained at 5% level of significance using the Fischer exact test (p = 0.003). DISCUSSION In these fractures, usually the metaphysis or the physis are involved in the injury, in which case the fractures are classified according to Salter and Harris, with the most frequent occurrence of SHII epiphyseal separation and rare SHIII and SHIV epiphyseal fractures. The radial head fractures are mostly caused by valgus force. Therefore, the individuals with a higher elbow valgosity are more prone to injuries. The girls strongly prevail (77%) also in our study. In general, our results as well as the literature have proven that as the displacement increases, the necessity of closed reduction and osteosynthesis grows. The post-treatment complications in our group were observed in 35.5% of patients, namely most often in the form of limited movement. The literature refers to complications in 26.5-53% of patients. CONCLUSIONS The clinical results clearly show that when comparing the complications after the radial head fracture in children there is no statistically significant difference between the methods of osteosynthesis. This study shall serve as a starting point for the currently ongoing prospective multicentric study evaluating the modified ESIN technique using a pre-bent Kirschner wire. Key words:children, fracture, radius, proximal, osteosynthesis.

• MeSH
• Child MeSH
• Radius Fractures * diagnosis   surgery   MeSH
• Fracture Fixation, Intramedullary * adverse effects   instrumentation   methods   MeSH
• Conservative Treatment * adverse effects   methods   MeSH
• Bone Wires MeSH
• Bone Nails * MeSH
• Humans MeSH
• Minimally Invasive Surgical Procedures methods   MeSH
• Adolescent MeSH
• Postoperative Complications * diagnosis   etiology   MeSH
• Child, Preschool MeSH
• Radius * diagnostic imaging   injuries   surgery   MeSH
• Range of Motion, Articular MeSH
• Treatment Outcome MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Child, Preschool MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Clinical Trial MeSH
• Multicenter Study MeSH

Intramedullary nailing is a worldwide accepted technique for stabilization of fractures of long bones. Technique, instruments and implants primarily have been developed for the fixation of short (transverse and oblique) diaphyseal fractures. First generation nails were hollow and slotted, which gave them some elasticity. When the tip of the nail passed the fracture gap, picked up the opposite fracture fragment and was driven further down, the longitudinal axis of the bone was restored and the extremity realigned. Bone length was restored by closure of the fracture gap. The tight connection between the deformable hollow nail and the inner cortex at the isthmus realized a press-fit, which achieved a very stable bone-implant construct. The nail had the function of a weight-shearing implant. Interlocked nails represent the second-generation nails. They changed the spectrum of indications for nailing considerably. Not only short middle-third shaft fractures, but shaft fractures of all types (from transverse to comminuted) and all localizations can be stabilized with an interlocked nail. Due to interlocking, length and rotation are controlled. The nail bridges the area of instability, being a weight-bearing implant. Small diameter, solid nails formed the next generation of nail implants. They were conceived for the provisional treatment of fractures with an enhanced risk of postoperative infection such as open fractures or closed fractures with severe soft tissue damage. They were increasingly used for minimal invasive treatment of closed fractures without soft tissue damage as well, as reaming was not necessary and endosteal blood supply less damaged. Nevertheless, it became clear that they were connected with a higher incidence of implant failure and revision surgery. Another development was the creation of nails with multiple and angular stable interlocking options. Major advantage is that high stability is obtained in the fracture fragment, in which multiple interlocking is used. This property gives the possibility of nailing fractures close to a joint with a short fracture segment (24). Nevertheless, intramedullary nailing of metaphyseal fractures remains controversial. Major complications to be avoided are malalignment, delayed union, nonunion and implant failure due to suboptimal fracture reduction (23).

• MeSH
• Lower Extremity injuries   surgery   MeSH
• Fractures, Bone surgery   MeSH
• Fracture Healing MeSH
• Fracture Fixation, Intramedullary adverse effects   instrumentation   methods   MeSH
• Bone Nails * MeSH
• Humans MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

PURPOSE: Proximal femoral fractures are among the most commonly sustained fractures. The current treatment of stable proximal femoral fractures located in trochanteric region primarily involves the use of two systems: extramedullary dynamic hip screws and intramedullary hip nails. Given that these fractures are mainly found in the elderly population, the necessity of a repeat, due to failure of the first, may jeopardize the patient's life. Decisive factors contributing to the healing of a fracture (or the failure thereof) include fracture pattern, technical implementation of the operation (i.e., position of the implant), implant's properties and its changes in relation to the surrounding bone tissue during loading. Each screw insertion variant results in damage to various load-bearing bone structures, which can be expected to influence healing quality and stability of newly formed bone. METHOD: With the aid of a numerical model and finite element methods, the authors analyzed several different positions of IMHN/PFH-nails in the proximal femur, with the objective of determining positions with an increased risk of failure. RESULTS AND CONCLUSION: In model situations, it has been shown that in stable fractures results do not depend on absolutely precise positioning and small deflections in the nails and neck screws positions do not significantly increase the risk of failure for the entire fixation. Damage to load-bearing structures relative to various implant placements does not impact the resultant overall fixation stability. Therefore, it is not necessary to re-introduce implants in the ideal position, which can lead to reduced patient radiation doses during surgery.

• MeSH
• Finite Element Analysis MeSH
• Biomechanical Phenomena MeSH
• Femur injuries   surgery   MeSH
• Hip Fractures surgery   MeSH
• Fracture Fixation, Intramedullary instrumentation   methods   MeSH
• Bone Nails * MeSH
• Humans MeSH
• Treatment Failure MeSH
• Risk Factors MeSH
• Aged MeSH
• Models, Theoretical MeSH
• Weight-Bearing MeSH
• Check Tag
• Humans MeSH
• Aged MeSH
• Publication type
• Journal Article MeSH

We report a case of 68-year-old female patient who suffered two Gamma 3 nail breakages following trochanteric fixation failure revision surgery. A patient was primarily treated with sliding hip screw. Revision surgeries of reverse trochanteric nonunion were performed with short Gamma 3 nails and bone grafting. The nail failures occurred 11 and 7 months after implantation. This undesired series of events were caused by inappropriate implant selection, thus replacing the nail to a modular total hip arthroplasty was more effective as salvage surgery. Key words: salvage total hip arthroplasty, gamma nail, sliding hip screw, fixation failure, reverse trochanteric fracture, nonunion.

• MeSH
• Hip Fractures radiography   surgery   MeSH
• Fracture Fixation, Intramedullary adverse effects   instrumentation   MeSH
• Bone Nails * MeSH
• Bone Screws MeSH
• Humans MeSH
• Arthroplasty, Replacement, Hip methods   MeSH
• Treatment Failure MeSH
• Reoperation MeSH
• Aged MeSH
• Salvage Therapy methods   MeSH
• Check Tag
• Humans MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH