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Background This work aimed to compare two mini-invasive palmar approaches (longitudinal and transverse) to osteosynthesize fractures of the distal radius. The main hypothesis was that the longitudinal technique gave smaller incisions. The secondary hypothesis was that the longitudinal technique would be better for the recovery of pain, functional scores, strength, and mobility. Materials and Methods The series included 30 extra-articular distal radius fractures in 30 patients (average age: 74 years) fixed with volar locking plate using a mini-invasive technique. Fifteen of these patients had a single longitudinal surgical approach (Group I), and 15 had a transverse approach that was completed with a longitudinal incision for the proximal screws (Group II). Results The combined average incision size was 14.73 mm in Group I and 19.8 mm in Group II. After 6 months, the pain was on average 1.4/10 (Group I) and 0.46/10 (Group II), the quick Disability of the Arm, Shoulder, and Hand was 13.63/100 (Group I) and 2.8/100 (Group II), Patient-Related Wrist Evaluation was 11.8/100 (Group I) and 5.97/100 (Group II), grip strength was 81.06% (Group I) and 72.13% (Group II), flexion was 88.13% (Group I) and 75% (Group II), extension was 86% (Group I) and 64.6% (Group II), ulnar inclination was 89% (Group I) and 78.67% (Group II), radial inclination was 89.73% (Group I) and 79.93% (Group II), pronation was 96.67% (Group I) and 81.46% (Group II), and supination was 91.93% (Group I) and 79.87% (Group II). Clinical Relevance The longitudinal technique gave smaller incisions than the transverse technique. Among the secondary hypotheses, all the variables were better with the longitudinal technique, except the pain, although without any significant difference.

Objectives: The purpose of this study is to describe a technique of volar locking plate for distal radius fractures with pronator quadratus (PQ) preservation, determining whether, with a less invasive approach, we can achieve good clinical, radiographic, and functional outcomes. Methods: The study period extended from July 2012 to January 2015. This study comprised 72 patients with distal radius fracture who were followed up for a minimum period of 12 months. All of them underwent a minimally invasive approach (54 women, 18 men), with a mean age of 65 years. All fractures were classified according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, finding 35 fractures type A (13 A2 and 22 A3), 14 type B (9 B1, 2 B2, and 3 B3), and the remaining 23 fractures type C (12 C1, 8 C2, and 3 C3). In all cases, surgery was indicated based on (1) dorsal deviation greater than 10°, (2) radial inclination less than 15°, (3) ulnar variance greater than 3 mm, and (4) articular step greater than 2 mm. The surgical technique begins with a closed reduction and fixation with temporary K-wires under an image intensifier. A 25-mm transverse skin incision is then performed and deepened between the flexor carpi radialis tendon and radial artery to expose the PQ. Afterward, we continued with a distal edge dissection of the PQ to introduce the volar locking plate under the muscle. Distal screws are placed under direct vision and proximal screws percutaneously. Postoperative evaluation was determined by clinical and functional assessment by Visual Analog Scale, range of motion, grip strength, time to return to work activity, and Disability of the Arm, Shoulder and Hand (DASH) score. Radiographic evaluation was performed by measuring the volar tilt, radial inclination, ulnar variance, joint congruity of the distal radius, and plate alignment regarding the shaft of the radius. Results: At the time of the last control, all patients had clinical and radiographic signs of bone healing. Of the 72 patients, 47 were handworkers prior to suffering the fracture, and they were able to return to their jobs at an average of 8 weeks. The average score on the DASH scale during the last control was 4.2 points. Regarding postoperative radiographic evaluation, there was an average volar tilt of 14.3° and an average radial inclination of 26.3°. We observed no complications related to the fracture, implant, or surgical wound in none of the postoperative controls. Conclusion: Although we did not obtain better results with this technique than those published with the conventional one, and that there is no literature available which demonstrate that the minimally invasive technique is superior, we believe that the fact of getting similar results with both approaches justifies using this technique with PQ preservation, especially in patients concerned about the cosmetic appearance of the scar. However, we could see that the indication of this technique depends on certain limitations, such as the need to use a dorsal plate in certain fractures or the inability to reduce the fracture before skin incision.

Re su menIn tro duc ción: El objetivo de este reporte fue caracterizar los factores predisponentes de la fractura periprotésica intraoperatoria de fémur durante una artroplastia primaria de cadera. Materiales y Métodos: Entre 1999 y 2010, se analizaron 1943 reemplazos de cadera, en 28 casos, se produjo una fractura de fémur durante una artroplastia total de cadera primaria, lo que arroja una incidencia del 1,4%. Se utilizó la clasificación de Vancouver y se estudiaron la presencia de factores predisponentes, el tratamiento realizado, la evolución clínica y radiográfica. Resultados: Del total de la muestra, 23 (82,1%) fracturas eran de tipo A y 5 (17,9%), de tipo B. El promedio obtenido del ángulo cervicodiafisario del fémur de 140° (rango 120°-160°). El 71,4% de la muestra eran mujeres. El 7,1% presentaba osteosíntesis previa. La incidencia de fracturas fue del 3,54% para los implantes no cementados (16/452) y del 0,8% para los tallos cementados (12/1491). Se realizó lazada de alambre en 18 pacientes (64,3%), malla metálica más lazada de alambre en un paciente (3,6%) y en 9 (32,1%) tratamiento conservador. En 27 (96,4%) casos, la evolución fue buena y el puntaje promedio posoperatorio del Harris Hip Score fue de 93 puntos (rango 89-95). Conclusiones: El sexo femenino, el aumento del ángu-lo cervicodiafisario, la presencia de caderas displásicas, implantes no cementados y zonas de debilidad luego de retirar una osteosíntesis son factores predisponentes para sufrir este tipo de complicación, por lo que es recomendable realizar una lazada de alambre profiláctica cuando se conjuguen varios de los factores de riesgo mencionados.Palabras clave: Fractura periprotésica. Lazada de alambre. Artroplastia de cadera. Factores predisponentes.Predisposing factors for intraoperative femur fracture in primary total hip arthroplasty Abstract Background: The objective of this study was to characterize the predisposing factors for intraoperative femur fracture during primary total hip arthroplasty. Methods: From 1999 to 2010, 28 fractures occurring during 1943 primary total hip arthroplasties were analyzed, an incidence of 1.4%. Vancouver classification was used. The presence of predisposing factors, their treatment and clinical and radiological outcomes were evaluated. Results: Twenty three (82.1%) fractures were type A and 5 (17.9%) were type B. The average of the cervical-shaft angle was 140° (120°-160°). 71.4% were women and 7.1% had previous osteosynthesis. The incidence was 3.54% (16/452) in cementless femoral stems and 0.8% in cemented femoral stems (12/1491). Intraoperative treatments were: cerclage wire in 18 cases (64.3%), metal mesh plus cerclage wire in one patient (3.6%) and conservative treatment in 9 patients. Twenty seven (96.4%) patients obtained good results and the average Harris Hip Score was 93 points (89-95). Conclusions: Female patients, high cervical-shaft angle, hip dysplasia, cementless femoral stems and femur weakness after removing the osteosynthesis, are predisposing factors for this type of complicatio...