Long-term outcomes of distal locking in extracapsular fractures treated with trochanteric Gamma3 nails

Background Few publications have assessed long-term results of distal locking of short endomedullary nails for extracapsular hip fracture. Virtually all of them focus on immediate differences. Criteria for the use of static or dynamic locking are unclear in most nailing systems, and use is advised in unstable fracture patterns or with risk of bell-clapper effect, but often influenced by the “orthopaedic school”. Materials and methods This is a historical cohort study on patients diagnosed and operated in 2014 and followed up until endpoint, considered as consolidation or major complication, plus evaluation of overall long-term survival. They were categorised as static distal locking (ST) or dynamic distal locking (DN). Both are comparable, except for all stable pre-operative classifications, Fracture Mobility Score (FMS) at discharge, and immediate post-operative loading, all of which were in favour of DN. Results Consolidation took place in > 95% of patients, with a non-statistically significant delay trend in ST. Less than 6% in both ST and DN had major complications, with no differences. Most cases suffered early cut-out. Significant fracture collapse was the most frequent minor complication. There were more statistically significant minor and total complications in ST. Infection, without differences, can precede cut-out. Lateral thigh pain was similar and could be related to back-out. In DN, 21.1% of cases were truly dynamised. We did not find differences in mobility or in long-term survival. Conclusions Any type of distal locking seems to be safe for consolidation, despite a slightly longer consolidation time in static locking. Early cut-out was the main complication, while others were very infrequent, which is an advantage over helical blade devices. There was a higher rate of minor and overall mechanical complications in ST, but infection and lateral thigh pain were similar. Most non-traumatic mechanical complications occurred around 5–6 weeks. About one in five of the DN truly dynamised, with all cases occurring before 8 weeks. Mobility until endpoint and overall long-term survival were not influenced by the locking mode used. Level of evidence Therapeutic study, level 2b.

Rest-pause and drop-set training elicit similar strength and hypertrophy adaptations compared to traditional sets in resistance-trained males

The present paper aimed to compare the effect of drop-set (DS) and rest-pause (RP) systems versus traditional resistance training (TRT) with equalized total training volume on maximum dynamic strength (1RM) and thigh muscle thickness (MT).Twenty-eight resistance-trained males were randomly assigned to either RP (n = 10), DS (n = 9) or TRT (n = 9) protocols performed twice a week for 8 weeks. 1RM and MT of the proximal, middle and distal portions of the lateral thigh were assessed at baseline and post intervention.A significant time x group interaction was observed for 1RM (P = 0.025) in the barbell back squat after 8-weeks. Post hoc comparisons revealed that RP promoted higher 1RM than TRT (P = 0.001); no statistical differences in strength were observed between the other conditions. A significant main effect of time was revealed for MT at the proximal (P = 0.0001) and middle (P = 0.0001) aspects of the lateral thigh for all training groups; however, the distal portion did not show a time effect (P = 0.190). There were no between-group interactions for MT. Our findings suggest that RP promotes slightly superior strength-related improvements compared to TRT, but hypertrophic adaptations are similar between conditions. Novelty bullets • Rest-pause elicited a slightly superior benefit for strength adaptations compared to traditional resistance training. • Resistance training systems do not promote superior hypertrophic adaptations when total training volume is equalized. • Muscle thickness in distal portion of thigh are similar to baseline. Although modest, effect sizes tended to favor rest-pause.

SQUAMOUS CELL CARCINOMA OF THE TEMPORAL REGION MANAGED WITH WIDE LOCAL EXCISION AND FREE LATERAL THIGH FLAP COVER

Squamous cell carcinoma is the second most common form of cutaneous malignancy and is usually due to exposure of ultraviolet radiation (UV-B), inammation (from trauma or burns), chemical exposure and immunosuppression. Squamous cell carcinoma is a malignant proliferation of the epidermal keratinocyte. It is most common in elderly Caucasian population. Lesions occur most commonly on the face, neck, ears, hands and arms but metastases are rare. Here, we present a case of an elderly gentleman who came with an ulceroproliferative lesion of the left temporal scalp for 6 months. Biopsy proved to be a well differentiated squamous cell carcinoma. Wide local excision was done and the defect was closed using a free thin lateral thigh ap.

Does Performing Different Resistance Exercises for the Same Muscle Group Induce Non-homogeneous Hypertrophy?

The study aimed to compare the effect of performing the same or different exercises for a muscle group on resistance training (RT) sessions on muscle hypertrophy at different sites along muscle length. Twenty-two detrained men (23.3±4.1 years) were randomly allocated to the following groups: a group that performed the same exercises in all training sessions (N-VAR=11) or one that varied the exercises for the same muscle groups (VAR=11). All were submitted to 3 weekly sessions for nine weeks. Muscle thickness was assessed at the proximal, middle, and distal sites of the lateral and anterior thigh, elbow flexors, and extensors by B-mode ultrasound. The VAR group significantly increased all the sites analyzed (P<0.05). Furthermore, the proximal site of the lateral thigh showed a larger relative increase when compared to the middle site (P<0.05). In contrast, the N-VAR group were not revealed significant improvements only for the middle site of the lateral thigh and the proximal site of the elbow flexors (P>0.05). Our results suggest that to perform different resistance exercises can induce hypertrophy of all sites assessed in detrained young men.