The correlation between lateral bowing angle of the femur and the location of atypical femur fractures

This study is the first to report the use of data on incomplete atypical femur fracture (AFF) to evaluate the curvature of femur and explore the relationship between lateral femoral bowing angle (FBA) and AAF location. In this study, we obtained 17 cases of incomplete AFF and calculated the accurate lateral FBA and location ratio of the incomplete fracture. Incomplete fracture location was defined as a percentage (length from lesion to greater trochanter tip/entire femur length %; greater trochanter tip: 0 %; femoral condyles: 100 %). A lateral FBA of 7° was set as the point of demarcation. Eleven femurs had a lateral FBA ≤ 7° (group 1), with a median lateral FBA of 4.75° (IQR 2.5-5.9°) and a median of incomplete AFF location at 25.2 % (IQR 23.4-30.1 %). Another six femurs had a FBA > 7° (group 2) with a median of 1.8° (IQR 10.2-14.3°) and a median location at 47.7 % (IQR 38.6-54.5 %). There was a significant statistical difference in location (p < 0.05) between the two groups. The rate of BP use was 87.5 % in group 1 which was higher than 60 % in group 2. There was some degree of positive correlation between the bowing angle and location in simple linear regression (r (2) = 0.549, p < 0.001, ß = 1.789). AAFs located in diaphysis were associated with large lateral FBA. On the other hand, AAFs located in subtrochanteric region were more commonly found in femurs with smaller lateral FBA. In conclusion, the degree of the FBA was associated with AFF location.

Endoscopic carpal tunnel release using a new median nerve protector

PURPOSE

We designed a reusable median nerve protector for endoscopic carpal tunnel release (ECTR) and prospectively evaluated its safety and efficacy.

TYPE OF STUDY

Therapeutic study--Investigating the results of treatment.

METHODS

Seventy-two patients (97 palms) with carpal tunnel syndrome were operated on endoscopically with the new median nerve protector. Patients were followed-up at 1, 3, 6, 12, and 24 weeks postoperatively. Evaluation included the symptom severity scale, functional status scale, wound pain and scar tenderness, monofilament sensory mapping, grip strength measurement, and pin strength gauge.

RESULTS

No patients sustained iatrogenic neurovascular injury or hematoma, but 3 developed superficial wound infections postoperatively. The symptom severity score decreased from 3.8 points preoperatively to 2.3 at 1 week, 1.9 at 3 weeks, and 1.3 at 6 weeks, and remained at 1 point at 12 and 24 weeks postoperatively. The functional status score dropped from 3.8 points to 2.8 at 1 week, 2 at 3 weeks, 1.5 at 6 weeks, and 1 at 12 weeks and thereafter. Semmes Weinstein monofilament mapping improved in all operated hands (59) of the 44 patients not lost to follow-up by 24 weeks. Tip pinch testing and grip strength showed gradual improvement as early as 3 weeks postoperatively. The mean value of the postoperative scar tenderness score dropped from 2.4 points at 1 week to 1.7 points at 3 weeks, 1.3 at 6 weeks, 1.2 at 12 weeks, and 1 point after 12 weeks.

CONCLUSIONS

This new median nerve protector provides clear visualization of neurovascular structures and is a safe and reliable tool for single-portal ECTR.

LEVEL OF EVIDENCE

Level IV.