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Background: Regarding trochanteric hip fractures, one type of posterior coronal fragments was described as the "banana-shaped fragment", while the impact of the banana-shaped fragment on mechanical stability has not been further studied. The current study investigated the association between the banana-shaped fragment and mechanical complications after surgery. Methods: This retrospective cohort study included 273 patients treated by proximal femoral nail antirotation (PFNA) in the full analysis. The age, the sex, the fracture side, the follow-up time, the American Society of Anesthesiologists classification, the operators, the fracture classification, the tip-apex distance, the blade positions, the reduction quality and the bone mineral density were analyzed in relation to mechanical complications, through univariate and multivariate approaches. Results: Mechanical complications happened in 33 patients. The banana-shaped fragment (adjusted odds ratio 5.240, 95% CI 2.172 to 12.641; p < 0.001), the tip-apex distance and the reduction quality showed significant association with mechanical complications in both univariate and multivariate analysis. Moreover, for 118 patients with the banana-shaped fragment, we found that the use of wire cerclage couldn't significantly lower the rates of mechanical complications (p = 0.648). Conclusions: The banana-shaped fragment had a negative impact on mechanical stability of trochanteric hip fractures treated by PFNA. In the perioperative period, the BSF should be carefully evaluated, and its specific handling deserves further study. [ABSTRACT FROM AUTHOR]

Background: The treatment of proximal femoral fractures in geriatric osteoporotic patients continues to be a challenge in orthopaedic trauma. Various kinds of cephalomedullary nails, such as gamma nail, InterTan and PFNA were used clinically. The latest generation PFNA II, specially designed for Asian population, is commonly used for geriatric per-/intertrochanteric fractures. The aim of this study was to determine whether the current PFNA-II proximal segment length is suitable for the greater trochanter height, as assessed by postoperative radiograph measurements. Materials and Methods: 51 consecutive patients with per-/intertrochanteric fractures treated with the PFNA-II between July 2012 and December 2012 were enrolled in this study. There were 19 males and 32 females, with an average age of 78.6 years (range 66-92 years). According to AO/OTA classification system, there were 4 cases of 31A1 fractures, 35 cases of 31A2 fractures, and 12 cases of 31A3 fractures. The nail protrusion height over the lateral greater trochanter and the Parker ratio of the helical blade tip in the femoral head were measured and compared using pelvic digital anteroposterior radiographs taken within 2 weeks postoperatively. Patients were followed up for a minimum period of 1 year to check whether they had lateral trochanter pain. Results: Postoperative digital anteroposterior (AP) films were used for assessment and any prominence was recorded as positive. Overall, nail protrusion over the greater trochanter occurred in 87.8% of cases. In 60.8% of the cases, protrusion height was >5 mm. The average protrusion height was 6.25 ± 4.27 mm (male average 4.84 ± 4.38 mm, and female average 7.09 ± 4.70 mm). The average Parker ratio of all cases was 51.0 ± 6.9% (male average 49.8 ± 7.5% and female average 51.7 ± 6.5%). Protrusion height was positively correlated (r = 0.394, P = 0.004) with the helical blade position in the femoral head (Parker ratio). Clinically, a total of 42 patients were followed up at an average of 15.0 ± 2.6 months (range 12--24 months) they were able to walk independently or with a stick. There were 13 patients with lateral trochanter pain on the injured side. Protrusion height of these patients was 11.13 ± 3.75 mm, whereas the protrusion height of the remaining 29 patients was 3.87 ± 3.39 mm. Conclusions: There was a morphologic mismatch between the proximal segment length of the PFNA-II and the greater trochanter in the Asian population, which may be the cause of postoperative lateral trochanter pain. A modification to shorten the proximal part of the nail is proposed to avoid protrusion over the greater trochanter. [ABSTRACT FROM AUTHOR]

Median nerve injury is rarely associated with the humeral shaft fracture. Sixty two year old woman with a displaced humeral shaft fracture, developed a symptomatic carpal tunnel syndrome after plating with a screw protruding medially. 16 months later, the implants were removed and the symptoms gradually improved without carpal tunnel release surgery. A double crush syndrome resulted due to the proximal compression by the medially protruding screw and the distal compression by carpal tunnel. The proximal decompression produced by removal of the screw led to relief of the symptoms. [ABSTRACT FROM AUTHOR]

Background: The treatment of proximal femoral fractures in geriatric osteoporotic patients continues to be a challenge in orthopaedic trauma. Various kinds of cephalomedullary nails, such as gamma nail, InterTan and PFNA were used clinically. The latest generation PFNA II, specially designed for Asian population, is commonly used for geriatric per-/intertrochanteric fractures. The aim of this study was to determine whether the current PFNA-II proximal segment length is suitable for the greater trochanter height, as assessed by postoperative radiograph measurements., Materials and Methods: 51 consecutive patients with per-/intertrochanteric fractures treated with the PFNA-II between July 2012 and December 2012 were enrolled in this study. There were 19 males and 32 females, with an average age of 78.6 years (range 66-92 years). According to AO/OTA classification system, there were 4 cases of 31A1 fractures, 35 cases of 31A2 fractures, and 12 cases of 31A3 fractures. The nail protrusion height over the lateral greater trochanter and the Parker ratio of the helical blade tip in the femoral head were measured and compared using pelvic digital anteroposterior radiographs taken within 2 weeks postoperatively. Patients were followed up for a minimum period of 1 year to check whether they had lateral trochanter pain., Results: Postoperative digital anteroposterior (AP) films were used for assessment and any prominence was recorded as positive. Overall, nail protrusion over the greater trochanter occurred in 87.8% of cases. In 60.8% of the cases, protrusion height was >5 mm. The average protrusion height was 6.25 ± 4.27 mm (male average 4.84 ± 4.38 mm, and female average 7.09 ± 4.70 mm). The average Parker ratio of all cases was 51.0 ± 6.9% (male average 49.8 ± 7.5% and female average 51.7 ± 6.5%). Protrusion height was positively correlated ( r = 0.394, P = 0.004) with the helical blade position in the femoral head (Parker ratio). Clinically, a total of 42 patients were followed up at an average of 15.0 ± 2.6 months (range 12-24 months) they were able to walk independently or with a stick. There were 13 patients with lateral trochanter pain on the injured side. Protrusion height of these patients was 11.13 ± 3.75 mm, whereas the protrusion height of the remaining 29 patients was 3.87 ± 3.39 mm., Conclusions: There was a morphologic mismatch between the proximal segment length of the PFNA-II and the greater trochanter in the Asian population, which may be the cause of postoperative lateral trochanter pain. A modification to shorten the proximal part of the nail is proposed to avoid protrusion over the greater trochanter., Competing Interests: There are no conflicts of interest.

Median nerve injury is rarely associated with the humeral shaft fracture. A Sixty two year old woman with a displaced humeral shaft fracture, developed a symptomatic carpal tunnel syndrome after plating with a screw protruding medially. 16 months later, the implants were removed and the symptoms gradually improved without carpal tunnel release surgery. A double crush syndrome resulted due to the proximal compression by the medially protruding screw and the distal compression by carpal tunnel. The proximal decompression produced by removal of the screw led to relief of the symptoms.