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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Avulsion fractures of the apophysis of the iliac crest have rare incidence and are little known. In this article, we report the case of an 11-year-old female patient who presented this injury after indirect trauma. From careful radiographic analysis, an avulsion fracture of the iliac crest was identified. It was decided to use nonsurgical treatment comprising analgesia and load restriction. This case report emphasizes the importance of suspecting avulsion fractures in cases of low-energy trauma, and also guides the treatment, so as to prevent functional deficit and deformities.

Objective: Evaluate the influence in the position of the anti-rotational device in cephalomedullary nails and its influences on the consolidation of trochanteric fractures. Methods:Retrospective case series comprising 58 patients with unstable trochanteric fractures that underwent osteosynthesis with cephalomedullary nail and anti-rotational device. Were analyzed the radiographs of the pelvis and ipsilateral hip osteosynthesis with 6 months postoperatively and compared to initial. The radiographic parameters used were tip-apex index (TAD), the positioning of the sliding screw in relation to the central axis of the femoral neck, the angle of reduction and fracture healing.Results: From the 58 patients selected for initial postoperative examination, 15 (26%) died, 6 (10%) lost the thread of the treatment and 37 (64%) were reassessed. Most of them were female patients, beteween the ninth and tenth decade of life. It was observed that 31 (84%) fractures were consolidated, while 6 (16%) patients had their fractures not yet consolidated. The reduction angle in healed fractures was 129o and in non-healed were 136o. In these, the position of the sliding screw was far from the central axis of femoral neck. Conclusion:The fixation of trochanteric fractures with cephalomedullary nail with anti-rotational device is safe. The reduced fractures with valgus above 135 ° showed higher rates of nonunion. In these cases the position of the sliding screw was lower than ideal to fit the anti-rotational device, which may have affected negatively the fracture healing.

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