ObjectiveThe purpose of this study is to evaluate the performance of dynamic hip screw for the treatment of dislocated femoral neck fractures in young patients, focusing on osteonecrosis.MethodsA series of 53 patients with less than 55 years of age were retrospectively evaluated. All patients had dislocated femoral neck fractures (Garden III or IV) and were treated with DHS. Ficat's staging system was used to evaluate avascular necrosis.ResultsThere were 38 (71.7%) males and 15 (28.3%) females, with an overall mean age at the onset of fracture of 41.9 years (±12.8). According to Garden's classification, 21 (39.6%) fractures were classified as type III and 32 (60.4%) were considered totally dislocated, Garden IV. Fracture healing was achieved in 39 patients (73.6%). Thirteen cases of avascular necrosis were observed (24.6%).ConclusionsThe incidence of avascular necrosis in young patients with a displaced femoral neck fractures treated with DHS was 24.6%. No statistically significant association was found between times elapsed to surgery, fracture displacement, and presence of derotation screw with osteonecrosis. Level of evidence IV.

Objectives. To study the correlation between avascular necrosis and the demographics, time elapsed from fracture to surgery, quality of reduction, Garden classification, and the position of the screw following use of the dynamic hip screw (DHS) in the treatment of subcapital neck fractures. Methods. A prospective study of 96 patients with subcapital neck fractures was carried out in a faculty hospital. Patients underwent surgery with closed reduction and internal fixation with DHS. Results. There were 58% male and 42% female patients, with a mean age of 53 years (+/−14). In terms of Garden classification, 60% were Garden IV, 26% were Garden III, and 14% were Garden II. Nonunion was observed in three cases (3%) and was treated with valgus intertrochanteric osteotomy, in all cases leading to successful healing. Avascular necrosis was observed in 16% of patients. The positioning of the screw into the femoral head showed a significant correlation with necrosis. Conclusions. The incidence of necrosis in patients under the age of 50 years is twice as high as that in older patients. Displacement is a predictive factor regarding osteonecrosis and is associated with a high and anterior position of the screw in the femoral head. Level II of evidence. Study Type: therapeutic study.

Estudo comparativo entre rivaroxaban e enoxaparina na profilaxia de tromboembolismo venoso profundo em pacientes submetidos à artroplastia total do quadril selecionados 67 pacientes, todos submetidos à artroplastia total de quadril (ATQ). Desses, foram excluídos dois pacientes por falta de adesão à profilaxia proposta após a alta hospitalar. Para um dos grupos foi administrada enoxaparina 40mg, subcutânea seis a oito horas antes da cirurgia e, depois desta, foi adicionado um comprimido de placebo, via oral, durante os primeiros 32 a 36 dias, uma vez ao dia. O outro grupo recebeu rivaroxaban 10mg, via oral, uma vez ao dia, durante os primeiros 32 a 36 dias pós-operatórios. Para fazer o cegamento dos grupos foi administrada uma injeção de placebo subcutâneo seis a oito horas antes da cirurgia e nos 32 a 36 dias subseqüentes. O desfecho principal estudado foi a eficácia na prevenção de TVP, que foi avaliada através de venografia bilateral realizada entre os dias 32 e 36 de pós-operatório e/ou através de sintomas documentados de trombose venosa profunda ou tromboembolismo pulmonar (TEP). O desfecho secundário estudado foi segurança na posologia, avaliada através de sangramento importante e/ou hepatotoxicidade. Resultados: Rivaroxaban e enoxaparina tiveram resultados semelhantes (as diferenças não foram estatisticamente significativas), quando comparados quanto à redução da incidên-cia de TVP INTRODUÇÃOA artroplastia total de quadril (ATQ) é considerada um dos procedimentos cirúrgicos mais bem sucedidos da ortopedia. Proporciona alívio da dor e recuperação da mobilidade da articulação do quadril, melhorando sensivelmente a qualidade de vida do paciente.Apesar dos benefícios indiscutíveis do procedimento, complicações locais e sistêmicas podem ocorrer. As complicações locais mais citadas são: lesões vasculonervosas, luxações da prótese, fraturas do fêmur e infecção (1) .Fenômenos tromboembólicos representam a principal complicação sistêmica de ATQ (2)(3) . Trombose venosa profunda (TVP) ocorre em aproximadamente 40-70% dos pacientes submetidos à artroplastia dos membros inferiores que não fazem uso de medidas profiláticas (2)(3)(4)(5)(6)(7) . Pequeno número de pacientes, entre 1 e 3%, que desenvolve TVP irá evoluir para tromboembolia pulmonar (TEP), que é a maior causa de morte nos três primeiros meses após a operação, representando mais de 50% da mortalidade pós-operatória (5,(7)(8) .Inúmeros estudos têm sido feitos na busca de um método eficaz e seguro na profilaxia de eventos tromboembólicos nas cirurgias de grande porte, como é o caso da ATQ. O surgimento de métodos cientificamente eficazes para esse propósito propiciou diminuição significativa do risco cirúrgico e dos custos hospitalares e, conseqüentemente, maior segurança para o paciente e para o cirurgião. No entanto, ainda não há consenso na literatura sobre qual o mais eficiente fár-maco a ser indicado para a profilaxia dos fenômenos tromboembólicos associados à ATQ.Estudo comparativo entre rivaroxaban e enoxaparina na profilaxia de tromboembolismo venoso...

OBJECTIVE: The purpose of this study was to evaluate the performance of valgus intertrochanteric osteotomy in femoral neck non-union.METHODS: Forty-two patients with femoral neck fractures with non-union treated using Pauwels' intertrochanteric osteotomy were reviewed. Demographics, time elapsed between fracture and surgery, follow--up, osteosynthesis used, Garden's classification, limb shortening, and x-rays were evaluated. RESULTS: Twenty-two men and 20 women were reviewed. The youngest patient was 18 years old and the oldest 65 years old, with a mean age of 42.4 years (±11.2). The minimum follow-up was 2 years, with a mean of 10.2 years. The average time elapsed between initial fracture and osteotomy was 6.5 months. Twel-ve cases were neglected femoral neck fractures. Nineteen patients were classified as Garden III, and 23 patients as Garden IV. After valgus osteotomy, non-union healing was observed in 38 patients (38/42; 90.4%). Healing of thirty-seven cases of pseudoarthrosis were obtained after the first-attempt osteotomy, and one case required two operations for healing. The osteotomy failed in four cases. Conside-ring the healed osteotomies, good to excellent functional results were achieved in 80.9% (34/42) of the patients. Total hip replacement was subsequently performed in 14.2% (6/42) of the patients for unfavoura-ble outcomes (two for cutting out, two for osteonecrosis, and two for osteoarthritis).CONCLUSIONS: Valgus intertrochanteric osteotomy has a high success rate in archiving healing in femoral neck non-union with good functional results. It is a biological and effective method. Level of Evidence IV, Therapeutic Study.