To assess the clinical, radiological and functional evolution of osteosynthesis using a cephalomedullary nail, in unstable trochanteric fractures of the femur, over a one-year postoperative follow-up. Methods: Fourteen men and 23 women of mean age 77.7 years were evaluated. Twenty-seven of them had fractures classified as AO/ASIF 31A2 and ten as 31A3. The patients were evaluated clinically, radiologically and functionally one week, two weeks, one month, two months, six months and one year after the operation. Results: The clinical complications comprised five cases of death, one case of calcaneal ulcer, one case of acute arterial obstruction and two cases of deep vein thrombosis. The radiographic evaluation showed that the mean cervicodiaphyseal angle in the immediate postoperative period was 132.5°. The mean tip-apex index was 22.8 mm. After one year, the mean cervicodiaphyseal angle was 131.7°. Fracture consolidation was seen in all the patients six months after the operation, except in one case that presented cut-out. There were no cases of fracture below the implant. The functional evaluation using the Harris score after one year showed a mean of 69.3 points. The evaluation of walking progress showed that after one year, 40.6% of the patients had the same ability to walk that they had before the fracture. The visual analogue pain scale showed that a significant decrease in pain complaints occurred, going from 5.19 in the first week to 2.25 after 1 year. Conclusion: Osteosynthesis using a cephalomedullary nail resulted in low rates of clinical and mechanical complications and adequate functional outcomes.

Chronic postoperative osteomyelitis represents an important health problem due to its significant morbidity and low mortality rate. This pathology is challenging because of difficulties in understanding the pathogenesis and the decision-making involving the treatment. The present article had the goal of reviewing the definition, pathogenesis, clinical aspects, diagnosis, and treatment of chronic postoperative osteomyelitis, and of gathering this information in a single Brazilian updated publication.The PubMed, LILACS, and the Cochrane Library medical databases were analyzed using pertinent keywords. Current and relevant articles were selected.The present article gathered the established information, as well as innovations related to chronic osteomyelitis and its treatment, to offer updated data to assist the professionals involved in the management of chronic osteomyelitis.

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Objectiveto evaluate the return to sport after surgical treatment for pubalgia among 30 professional soccer players and describe the surgical technique used.Methodthis case series was evaluated by means of a questionnaire and physical examination on 30 male professional soccer players of mean age 24.4 years (range: 18–30). The mean duration of the symptoms was 18.6 months (range: 13–28). The diagnosis was made through clinical investigation, special maneuvers and complementary examinations, by the same examiner. All the patients underwent surgical treatment after conservative treatment failed; all procedures were performed by the same surgeon using the same technique. Nonparametric comparisons were made to investigate the time taken to recover after the surgery, for the patients to return to their sport.Resultsfive patients evolved with hematoma, with the need to remove the stitches three weeks after the operation because of a small dehiscence at the site of the operative wound. The wound healed completely in all these cases by five weeks after the surgery. Four patients presented dysuria in the first week, but improved in the second postoperative week. The mean time taken to return to training was around eight weeks (range: seven–nine). All the players returned to competitive soccer practice within 16 weeks. When asked about their degree of satisfaction after the operation (satisfied or dissatisfied), taking into consideration their return to the sport, there was 100% satisfaction, and they returned to professional practice at the same competitive level as before the injury. This degree of satisfaction continued to the last assessment, which was made after 36 months of postoperative follow-up.Conclusionthe surgical technique presented in this case series, with trapezoidal resection of the pubic symphysis in association with bilateral partial tenotomy of the long adductor, was a fast and effective procedure with a low rate of postoperative complications. It was shown to be an excellent treatment option for refractory cases, with a return to sports activity among professional soccer players.

Stress fractures are common injuries in sports medicine. Among these fractures, femoral neck stress fractures frequently have a benign course, especially when it happens in the medial aspect of the neck. This case report describes a stress fracture of the medial aspect of the femoral neck that developed a complete fracture and underwent surgical fixation.