Therapeutic studies, Level I.

Objectives: To determine whether a time delay greater than 6h from injury to surgical debridement influences the infection rate in open fractures. Methods: During a period of 18 months, from October 2010 to March 2012, 151 open fractures were available for study in 142 patients in our hospital. The data were collected prospectively and the patients were followed up for 6 weeks. The patients were divided into two groups regarding the time delay from injury to surgical debridement (more or less than 6 hours). Results: Surgical debridement was carried out in less than 6h from injury in 90 (59.6%) fractures and after 6 hours from injury in 61 (40.4%) fractures. Infection rates were 12.22% and 13.24%, respectively. The global infection rate was 13.24%. Conclusion: A significantly increased infection rate was not observed in patients whose surgical debridement occurred more than 6h after injury. However, in the fractures of high-energy trauma, a statistically significant increase of the rate of infection was observed in those operated 6 hours after trauma. Level of Evidence II, Study Type Comparative and Prospective.

ObjectiveTo evaluate the inclination and the length of the femoral tunnel in patients submitted to anterior cruciate ligament reconstruction (ACL) surgery by transtibial and anatomical techniques.MethodsThis is an analytical observational study in patients with ACL injury that underwent arthroscopic reconstruction through transtibial and anatomical surgical techniques. In the immediate postoperative period, computed tomography (CT) and anteroposterior (AP) view digital radiographs (X-rays) were performed to evaluate the inclination and length of the femoral tunnel.ResultsForty-two patients were analyzed: 27 underwent anatomical reconstruction and 15, transtibial reconstruction. The inclination angle and tunnel length by the transtibial technique are always greater than by the anatomical technique. The mean inclination angles were 59.75° (53.9–66.1°) in the X-rays and 54.17° (43.5–62.3°) in CT for the transtibial technique, and 42.91° (29.3–57.4°) in the X-rays and 39.10° (23.8–50.6°) in CT for the anatomical technique. Regarding the length of the femoral tunnel, the transtibial technique promotes longer tunnels: mean 55.7 mm (40.0–70.2 mm) in the transtibial and 35.5 mm (24.5–47 mm) in the anatomical technique. No statistically significant correlation was observed between the length and the inclination of the tunnel, regardless of the technique used. Thus, these variables can be considered as independent.ConclusionThe anatomical reconstruction technique presented shorter femoral tunnels and lower angle of inclination than the transtibial technique. The CT showed smaller inclination angle than the X-rays, regardless of the surgical technique.

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