CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / The Ibandronate sodium is a drug used for clinical treatment of osteoporosis and for anti-catabolic action and cause osteoclast apoptosis, an important cell responsible for bone remodeling, it was hypothesized an effect on fractures in the consolidation phase of callus remodeling.The aim of this study was to evaluate the effect of ibandronate sodium in the fracture of femurs of rats subjected to intramedullary fixation. This study used 48 adult male rats, Wistar, with the average weight of 336.63 g. All animals underwent surgery for intramedullary osteosynthesis of the right femur and subsequently performed a standardized fracture. They were divided into two groups: the ibandronate, which was administered a single dose of 15mg/kg by gavage and the control group was administered a single dose of 1.0 ml of 0.9% saline by gavage also on the same day of the procedure surgery. At 7, 14, 28 and 42 days postoperatively six animals from each group were euthanized and the femurs were subjected to X-ray study to analyze the optical density and area of callus and histological study, using samples stained with picrosirius red and analyzed under polarized light, to quantify the density of collagen type I and type III in the cortical region near the fracture and callus. The radiographs showed that the area of the callus showed no statistically significant differences between groups control and ibandronate, but in the intragroup analysis 28 and 42, the callus was significantly higher on day 7 in both groups. The optical density of intergroup evaluation showed that ibandronate group at day 42, showed a higher density than the control group. In the study of collagen in the callus, the density of type I collagen seen in the ibandronate group was higher than that observed in the control group on days 7 and 14, since the density of type III collagen found in the ibandronate group was lower than in the 7 days Control group. In the study of collagen in the cortex, collagen type I in the ibandronate group was significantly greater on day 7 than the control group and type III collagen in the ibandronate group was lower than the Control group. The results are consistent enough to say that this drug has an effect on bone fracture healing by increasing the density of type I collagen in the early stages of consolidation. / O Ibandronato de sÃdio à um medicamento utilizado para o tratamento clÃnico da osteoporose e por ter aÃÃo anticatabÃlica e causar apoptose no osteoclasto, uma importante cÃlula responsÃvel pela remodelaÃÃo Ãssea, foi hipotetizado um efeito na consolidaÃÃo fraturas na fase de remodelaÃÃo do calo Ãsseo. O objetivo deste estudo foi avaliar o efeito do ibandronato de sÃdio na consolidaÃÃo das fraturas de fÃmures de ratos submetidos à osteossÃntese intramedular. Neste estudo foram utilizados 48 ratos machos, adultos, da linhagem Wistar, com o peso mÃdio de 336,63g. Todos os animais foram submetidos a procedimento cirÃrgico para osteossÃntese intramedular do fÃmur direito e posteriormente realizado uma fratura padronizada. Eles foram divididos em dois grupos: o grupo Ibandronato, em que foi administrada dose Ãnica de 15mg/Kg por gavagem e o grupo controle foi administrado dose Ãnica de 1,0ml de soluÃÃo fisiolÃgica 0,9% tambÃm por gavagem, no mesmo dia do procedimento cirÃrgico. No 7Â, 14Â, 28 e 42 dia de pÃs-operatÃrio seis animais de cada grupo eram eutanasiados e os fÃmures foram submetidos a estudo radiogrÃfico para analisar a densidade Ãptica e Ãrea do calo Ãsseo e estudo histolÃgico, utilizando amostras coradas com picrosirius red e analisadas sob a luz polarizada, para quantificar a densidade de colÃgeno tipo I e tipo III na regiÃo cortical prÃxima a fratura e no calo Ãsseo. A anÃlise das radiografias mostrou que a Ãrea do calo Ãsseo nÃo apresentava diferenÃas estatisticamente significantes entre os grupos Controle e Ibandronato, mas que na anÃlise intragrupo os dias 28 e 42 o calo era significantemente maior que no dia 7, em ambos os grupos. A densidade Ãptica na avaliaÃÃo intergrupos mostrou que o grupo Ibandronato, no 42 dia, apresentava uma maior densidade que o grupo controle. No estudo do colÃgeno no calo Ãsseo, a densidade do colÃgeno tipo I verificada no grupo Ibandronato foi maior que a observada no grupo Controle nos dias 7 e 14, jà a densidade de colÃgeno tipo III verificada no grupo Ibandronato foi menor no dia 7 que no grupo Controle. No estudo do colÃgeno da cortical prÃxima ao foco de fratura, o colÃgeno tipo I no grupo Ibandronato foi significantemente maior no dia 7 que o grupo controle e o colÃgeno tipo III no grupo Ibandronato foi menor que o grupo Controle. Os resultados encontrados sÃo consistentes o suficiente para afirmar que este fÃrmaco exerce efeito na consolidaÃÃo de fraturas Ãsseas aumentando a densidade do colÃgeno tipo I nas fases iniciais da consolidaÃÃo. / O Ibandronato de sÃdio à um medicamento utilizado para o tratamento clÃnico da osteoporose e por ter aÃÃo anticatabÃlica e causar apoptose no osteoclasto, uma importante cÃlula responsÃvel pela remodelaÃÃo Ãssea, foi hipotetizado um efeito na consolidaÃÃo fraturas na fase de remodelaÃÃo do calo Ãsseo. O objetivo deste estudo foi avaliar o efeito do ibandronato de sÃdio na consolidaÃÃo das fraturas de fÃmures de ratos submetidos à osteossÃntese intramedular. Neste estudo foram utilizados 48 ratos machos, adultos, da linhagem Wistar, com o peso mÃdio de 336,63g. Todos os animais foram submetidos a procedimento cirÃrgico para osteossÃntese intramedular do fÃmur direito e posteriormente realizado uma fratura padronizada. Eles foram divididos em dois grupos: o grupo Ibandronato, em que foi administrada dose Ãnica de 15mg/Kg por gavagem e o grupo controle foi administrado dose Ãnica de 1,0ml de soluÃÃo fisiolÃgica 0,9% tambÃm por gavagem, no mesmo dia do procedimento cirÃrgico. No 7Â, 14Â, 28 e 42 dia de pÃs-operatÃrio seis animais de cada grupo eram eutanasiados e os fÃmures foram submetidos a estudo radiogrÃfico para analisar a densidade Ãptica e Ãrea do calo Ãsseo e estudo histolÃgico, utilizando amostras coradas com picrosirius red e analisadas sob a luz polarizada, para quantificar a densidade de colÃgeno tipo I e tipo III na regiÃo cortical prÃxima a fratura e no calo Ãsseo. A anÃlise das radiografias mostrou que a Ãrea do calo Ãsseo nÃo apresentava diferenÃas estatisticamente significantes entre os grupos Controle e Ibandronato, mas que na anÃlise intragrupo os dias 28 e 42 o calo era significantemente maior que no dia 7, em ambos os grupos. A densidade Ãptica na avaliaÃÃo intergrupos mostrou que o grupo Ibandronato, no 42 dia, apresentava uma maior densidade que o grupo controle. No estudo do colÃgeno no calo Ãsseo, a densidade do colÃgeno tipo I verificada no grupo Ibandronato foi maior que a observada no grupo Controle nos dias 7 e 14, jà a densidade de colÃgeno tipo III verificada no grupo Ibandronato foi menor no dia 7 que no grupo Controle. No estudo do colÃgeno da cortical prÃxima ao foco de fratura, o colÃgeno tipo I no grupo Ibandronato foi significantemente maior no dia 7 que o grupo controle e o colÃgeno tipo III no grupo Ibandronato foi menor que o grupo Controle. Os resultados encontrados sÃo consistentes o suficiente para afirmar que este fÃrmaco exerce efeito na consolidaÃÃo de fraturas Ãsseas aumentando a densidade do colÃgeno tipo I nas fases iniciais da consolidaÃÃo. / The Ibandronate sodium is a drug used for clinical treatment of osteoporosis and for anti-catabolic action and cause osteoclast apoptosis, an important cell responsible for bone remodeling, it was hypothesized an effect on fractures in the consolidation phase of callus remodeling.The aim of this study was to evaluate the effect of ibandronate sodium in the fracture of femurs of rats subjected to intramedullary fixation. This study used 48 adult male rats, Wistar, with the average weight of 336.63 g. All animals underwent surgery for intramedullary osteosynthesis of the right femur and subsequently performed a standardized fracture. They were divided into two groups: the ibandronate, which was administered a single dose of 15mg/kg by gavage and the control group was administered a single dose of 1.0 ml of 0.9% saline by gavage also on the same day of the procedure surgery. At 7, 14, 28 and 42 days postoperatively six animals from each group were euthanized and the femurs were subjected to X-ray study to analyze the optical density and area of callus and histological study, using samples stained with picrosirius red and analyzed under polarized light, to quantify the density of collagen type I and type III in the cortical region near the fracture and callus. The radiographs showed that the area of the callus showed no statistically significant differences between groups control and ibandronate, but in the intragroup analysis 28 and 42, the callus was significantly higher on day 7 in both groups. The optical density of intergroup evaluation showed that ibandronate group at day 42, showed a higher density than the control group. In the study of collagen in the callus, the density of type I collagen seen in the ibandronate group was higher than that observed in the control group on days 7 and 14, since the density of type III collagen found in the ibandronate group was lower than in the 7 days Control group. In the study of collagen in the cortex, collagen type I in the ibandronate group was significantly greater on day 7 than the control group and type III collagen in the ibandronate group was lower than the Control group. The results are consistent enough to say that this drug has an effect on bone fracture healing by increasing the density of type I collagen in the early stages of consolidation.

Abstract Although nonoperative treatment is recognized as an effective treatment method for humeral shaft fractures, it is associated with an approximately 10% risk of nonunion and long-term impairments of the shoulder joint. There is a growing interest to treat even simple humeral shaft fractures operatively to avoid these problems. Intramedullary (IM) nailing has proven to be very effective in the treatment of femoral and tibial shaft fractures and the same method has been adopted for humeral shaft fractures. However, the results regarding union rate and shoulder joint function after antegrade insertion of an IM nail have been very controversial. The purpose of this study was to investigate fracture union, shoulder joint function and symptoms after antegrade IM nailing of humeral shaft fractures, to assess safety and results of IM nailing in pathological fractures, to evaluate the efficacy of exchange nailing and Ilizarov's technique in the treatment of nonunion after IM nailing and to find out, by comparing shoulder joint symptoms and function after antegrade IM nailing and dynamic compression (DC) plate fixation, whether antegrade access to the medullary cavity is the main reason behind shoulder joint problems. During the years 1987-1997, 126 humeral shaft fractures were operated upon in Oulu University Hospital using antegrade IM nailing. The nonunion rate was 22% and distraction of the fracture fragments was the most important risk factor associated with nonunion. The reoperation rate, for various reasons, was 25%. Shoulder joint pain and impairment of function was present in 37% of the patients. In the treatment of 18 pathological fractures IM nailing was a rapid and safe operation, associated with good pain relief. Exchange nailing of 13 cases of nonunion after IM nailing resulted in a union rate of 47% and this method is not useful in the humerus in contrast to tibial and femoral fractures. Permanent nonunion leaves the patient with severe impairment of the shoulder joint and a loose nail may lead to severe osteolysis of cortical bone. In complicated nonunion with poor bone quality, Ilizarov's technique, although associated with a high rate of minor complications and reoperations, worked well. When IM nailing was compared with DC plating it was found that there were no significant differences in shoulder pain, function scores, range-of-motion and strength. Antegrade insertion of the nail, if carried out properly, is probably not the main reason for shoulder joint impairment after IM nailing. Antegrade IM nailing of humeral shaft fractures is associated with several problems, e.g. shoulder joint impairment and difficulties in reconstruction after nonunion, and indications for this method may be exceptional, such as comminuted and pathological fractures.

This diploma thesis is focused on designing innovation of manufacturing calcaneal nail C-NAIL. The thesis contains analysis of technological processes of current manufacturing. There is also information about materials which are used for the manufactory. Finally, the thesis contains a designed technological process for manufacturing calcaneal nail C-NAIL.

The presented Master’s Thesis aims at determining stress and strain analysis of femur with fracture fixed by intramedullary nail and cerclage cable. The one of the goals of this work was create computational model which will be able simulate problem. Computational model consist of model of femur , it’s geometry was created on basis of CT data, than there was created model of intramedullary nail and cerclage cable on a basis of real objects. In this work was created simply model of femur with the same material features and characteristic proportions as analyzed model of femur. On this model was investigated direct impact of cerclage cables on deformation, respectively displacement in a surroundings of femoral fracture. On a final model were applied the real loads conditions. Preload in a cerclage cable was simulated by cooling down to a temperature from analytical calculation. Concluding analysis was powered by Finite Element Method (FEM) applied in system ANSYS Workbench 14.5 . Due to a results of analysis, we could say that using cerclage cables in combination with intramedullary nail is an effective way for healing femoral shaft fractures.

INTRODUCTION: The treatment of chronic intramedullary infection of the long bones relies on microbe-specific antibiotics in conjunction with surgical removal of infected necrotic material. We discuss the use of reamer-irrigator-aspirator(RIA) for debridement of the intramedullary canal instead of conventional reaming techniques. This is the first case report to explore the use of RIA for osteomyelitis. CASE REPORT: We discuss the use of the RIA in treatment of a 26-year-old female presenting with chronic osteomyelitis of the left distal femoral shaft. She had normalization of infection laboratories at 6 weeks and complete resolution of symptoms at 3 months and was released at 6 months. CONCLUSION: Recent exploration of the RIA system's (Synthes®, Inc. West Chester, Philadelphia) multipurpose applications has indicated use in long bone debridement. While further exploration and high-quality studies are needed to make robust claims of efficacy, we believe that the use of RIA in the context of chronic osteomyelitis is a superior alternative to conventional reaming techniques.

Background and Objectives: Freehand distal interlocking of intramedullary nails is technically demanding and prone to handling issues. It requires precise placement of a screw through the nail under fluoroscopy guidance and can result in a time consuming and radiation expensive procedure. Dedicated training could help overcome these problems. The aim of this study was to assess construct and face validity of new Digitally Enhanced Hands-On Surgical Training (DEHST) concept and device for training of distal interlocking of intramedullary nails. Materials and Methods: Twenty-nine novices and twenty-four expert surgeons performed interlocking on a DEHST device. Construct validity was evaluated by comparing captured performance metrics—number of X-rays, nail hole roundness, drill tip position and drill hole accuracy—between experts and novices. Face validity was evaluated with a questionnaire concerning training potential and quality of simulated reality using a 7-point Likert scale. Results: Face validity: mean realism of the training device was rated 6.3 (range 4–7). Training potential and need for distal interlocking training were both rated with a mean of 6.5 (range 5–7), with no significant differences between experts and novices, p 0.234. All participants (100%) stated that the device is useful for procedural training of distal nail interlocking, 96% wanted to have it at their institution and 98% would recommend it to colleagues. Construct validity: total number of X-rays was significantly higher for novices (20.9 6.4 versus 15.5 5.3, p = 0.003). Success rate (ratio of hit and miss attempts) was significantly higher for experts (novices hit: n = 15; 55.6%; experts hit: n = 19; 83%, p = 0.040). Conclusion: The evaluated training device for distal interlocking of intramedullary nails yielded high scores in terms of training capability and realism. Furthermore, construct validity was proven by reliably discriminating between experts and novices. Participants indicate high further training potential as the device may be easily adapted to other surgical tasks.

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Τα τροχαντήρια ενδομυελικά εμφυτεύματα τύπου Fi χρησιμοποιούνται σε περιπτώσεις μη σταθερών διατροχαντήριων καταγμάτων του ισχίου. Από κλινικής άποψης, δύο βασικά προβλήματα που αφορούν την αποτελεσματικότητα της χρήσης του ενδομυελικού εμφυτεύματος τύπου Fi είναι: ποια είναι η βέλτιστη θέση εισαγωγής της περιφερικής βίδας και το εάν πρέπει να χρησιμοποιηθεί μία περιφερική βίδα ή ένα ζεύγος περιφερικών βιδών. Προκειμένου να μελετηθούν οι επιδράσεις αυτών των δύο παραμέτρων, ένα σύνολο απλοποιημένων και πλήρως ολοκληρωμένων μοντέλων μοντέλων αναπτύχθηκαν και αναλύθηκαν με τη Μέθοδο των Πεπερασμένων Στοιχείων (ΜΠΣ). Η ανάλυση με χρήση της Μεθόδου των Πεπερασμένων Στοιχείων (ΜΠΣ) μπορεί να δώσει σημαντικές πληροφορίες που αφορούν στην ευαισθησία της συμπεριφοράς του εμφυτεύματος σε σχέση με τα άλλα τμήματα της κατασκευής του εμφυτεύματος (ήλος, lag βίδα, περιφερική βίδα). Σκοπός της εργασίας αυτής είναι η εύρεση της επίδρασης της θέσης της περιφερικής βίδας (των θέσεων των περιφερικών βιδών) στη μηχανική συμπεριφορά του συναρμολογήματος μηριαίου οστού/ενδομυελικού ήλου, όταν: 1.έχει ολοκληρωθεί η ενδομυελική οστεοσύνθεση 2.έχει διαγνωσθεί τυπικό διατροχαντήριο κάταγμα τύπου 31-Α1.3 κατά Müller AO/ASIF. / Trochanteric Fi-nail intramedullary fixation devices are used in cases of unstable intertrochanteric hip fractures. From a clinical point of view, two questions of high importance concerning the efficiency of the Fi-nail approach refer to where to put the distal screws and whether a single distal screw or a pair of distal screws should be used. In order to disclose the effect of those two parameters, a series of models were developed and then analyzed with the Finite Element Method (FEM). Finite element analysis can offer valuable information concerning the sensitivity of the implant’s behaviour in relation to the other parts of the implant’s structure (nail, lag screw, distal screw). The aim of this study is to examine the influence of the distal screw’s position in the mechanical behaviour of the femur/Fi-nail assembly: 1.when the intramedullary osteosynthesis has already been completed (case of healed femur) 2.when a typical intertrochanteric fracture (type 31-Α1.3, according to Müller AO/ASIF) has been diagnosed.

Η ενδομυελική ήλωση αποτελεί πλέον μια κοινώς αποδεκτή και καταξιωμένη μέθοδο, στην αντιμετώπιση καταγμάτων διάφυσης μακρών οστών (και όχι μόνο). Μετά από μισό και πλέον αιώνα εφαρμογής της, έχει αποκτηθεί σημαντική εμπειρία και για πολλούς Ορθοπαιδικούς χειρουργούς αποτελεί μέθοδο εκλογής στην καθημερινή χειρουργική πρακτική. Πολλές πτυχές της μεθόδου έχουν αποτελέσει αντικείμενο διεξοδικής μελέτης αλλά το ζήτημα της περιφερικής ασφάλισης των ενδομυελικών ήλων, εξακολουθεί να προκαλεί ίσως το μεγαλύτερο προβληματισμό για τον χειρουργό. Η «δια χειρός» (free-hand) αναζήτηση των οπών περιφερικής ασφάλισης του ήλου είναι μια διαδικασία χρονοβόρα, συχνά τραυματική και κυρίως επιβαρυντική με ακτινοβολία Χ λόγω χρήσης ακτινοσκοπικού μηχανήματος διεγχειρητικά, ακόμη και για έμπειρους χειρουργούς. Τα μηχανικά σκόπευτρα (στις διάφορες παραλλαγές που μέχρι τώρα έχουν χρησιμοποιηθεί) μπορούν να βοηθήσουν. Η συχνά αναπόφευκτη όμως παραμόρφωση του ήλου κατά την εισαγωγή του στον αυλό, καθιστά προβληματική τη λειτουργικότητα και μειώνει σημαντικά την αποτελεσματικότητα τους. Αυτό σε συνδυασμό με το συχνά περίπλοκο εξοπλισμό αλλά και την απαιτούμενη εκμάθηση της τεχνικής, αποθαρρύνουν σε πολλές περιπτώσεις το Χειρουργό, που καταφεύγει τελικά εκ νέου στη free-hand τεχνική. Η εκτεταμένη πλέον χρήση των ηλεκτρονικών υπολογιστών και στη χειρουργική, έχει βρει πεδίο εφαρμογής και στο θέμα αυτό. Πολύπλοκα λογισμικά με αντίστοιχο εξοπλισμό και μεθοδολογία, φιλοδοξούν να κατευθύνουν με ακρίβεια το χέρι του Χειρουργού στις οπές ασφάλισης του ήλου. Μέχρι σήμερα τέτοια συστήματα αποτελούν «σενάριο απ’ το μέλλον» για το μέσο Ορθοπαιδικό Χειρουργό (και ειδικότερα για τα δεδομένα του Ελληνικού χώρου). Οι υψηλές απαιτήσεις τους σε τεχνογνωσία και εξοπλισμό σε συνδυασμό με το σημαντικό κόστος τους, είναι λόγοι για τους οποίους δεν μπορούν να θεωρηθούν ρεαλιστική λύση επί του παρόντος. Το σύστημα περιφερικής σκόπευσης του ήλου S2 ανήκει στην κατηγορία των μηχανικών σκοπεύτρων. Χωρίς να διαφέρει σημαντικά στις απαιτήσεις του ως προς την εκμάθηση της συναρμολόγησης και χρήσης του από τον Χειρουργό (και το βοηθητικό προσωπικό του χειρουργείου) σε σχέση με άλλα μηχανικά σκόπευτρα, παρουσιάζει ένα ιδιαίτερο χαρακτηριστικό. Η προσαρμοστικότητα του μηχανισμού σκόπευσης παρέχει τη δυνατότητα απόσβεσης της γεωμετρικής παραμόρφωσης (προσθιοπίσθιας, πλαγιοπλάγιας και στροφικής) του ήλου μετά την εισαγωγή του, εντός φυσικά ορισμένων ορίων με αξιόλογο όμως εύρος. Η παρούσα διατριβή παρουσιάζει τα μετρήσιμα ευρήματα από μια σειρά 190 περιστατικών, στα οποία εφαρμόστηκε κλινικά για πρώτη φόρα ο ήλος S2 σε κατάγματα μηριαίου και κνήμης, καθώς επίσης και συγκριτική μελέτη αποτελεσματικότητας του σκοπεύτρου του ήλου S2 και της «δια χειρός» περιφερικής σκόπευσης για την ασφάλιση του ήλου G-K. Το ενδιαφέρον εστιάστηκε στην ευστοχία του σκοπεύτρου, στην ταχύτητα εφαρμογής της μεθόδου και ιδιαίτερα στην μείωση της χρήσης ακτινοσκοπικών λήψεων. Τα ευρήματα αυτά σε σύγκριση με αντίστοιχα άλλων μεθόδων, όπως προκύπτει από τα έως τώρα βιβλιογραφικά δεδομένα, καθιστούν τον ήλο S2 και το σύστημα σκόπευσης του, μια ιδιαίτερα αποτελεσματική και κυρίως ελάχιστα επιβαρυντική ως προς την ακτινοβολία (για ασθενή, Χειρουργό και βοηθητικό προσωπικό) μέθοδο. / Intramedullary nailing is a well known, successful and widely accepted method in treatment of diaphyseal fractures (and not only) of long bones. After more than a half of century of application of intramedullary nails, important experience has been acquired and for many Orthopaedic surgeons the specific method constitutes the treatment of choice in the daily chirurgical practice. Many aspects of the method have been studied extensively but the part of distal locking of intramedullary nails continues to be troubleshooting for many Surgeons. “Free-hand” technique is excessively used as a targeting method for distal locking despite the fact that it is a time-consuming process, frequently traumatic and mainly aggravating with radiation, as the use of image intensifier is mandatory intra-operatively. Mechanical targeting devices (in many variants) that up to now have been used, can help. However the deformation of nail, usually inevitable during its import in the intramedullary canal, turns out to be the main cause of limited effectiveness. This, in combination with the relatively complex equipment, but also the required learning time of technique, usually discourage surgeon of using these mechanical targeting devices and finally the free-hand technique turns again to be the method of choice in distal locking. The extensive henceforth, use of computers in operating theatre has also found a challenging field of application in this subject. Complicate software with corresponding equipment and methodology aspire to drive surgeon’s hand with precision to distal screw holes of intramedullary nails. Still, such systems seem to be “script of future” for the average Orthopaedic surgeon. High requirements in know-how and equipment, in combination with considerable cost of computer-assisted navigation, are strong reasons for not being considered as a realistic solution on the present. S2 nails with associated distal targeting system, belong in the category of nail mounted, mechanical targeting devices. Without differing considerably in requirements and learning demands from the Surgeon (and the assisting personnel in operating theatre), in comparison with other mechanical devices, it presents one particular characteristic. The adaptability of targeting system provides the ability of damping of nail deformation (during intramedullary application), inside limits with appreciable breadth. This dissertation presents the measurable findings of the first 190 cases of femoral and tibial shaft fractures treated by intramedullary nailing with S2TM nail and S2TM distal targeting device, and also a comparative study between S2 distal targeting device and ‘free-hand’ technique for G-K distal locking. The interest was focused in the effectiveness of the device, the duration of the procedure (distal locking screws placement and total intramedullary nailing time) and particularly in the reduction of image intensifier use (reduction of patient, surgeon and personnel exposition to x-rays). Results were compared to bibliographic data of other well-studied methods of distal targeting in intramedullary nailing and in conclusion, S2TM nail and its distal targeting device is a significantly effective and mainly minimally aggravating with x-ray radiation, method.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / O objetivo do estudo foi verificar os efeitos do carbonato de lodenafil no processo de consolidaÃÃo Ãssea nos fÃmures de ratos reduzidos com fio de Kirshner. Os fatores vasculares sÃo extremamente importantes para a formaÃÃo do calo Ãsseo. O carbonato de lodenafil causa efeitos vasodilatadores, pertence ao grupo dos inibidores da fosfodiesterase seletiva para o tipo 5 (PDE5), enzima que hidrolisa monofosfato de guanosina cÃclico (GMPc). O GMPc induz o relaxamento da musculatura lisa, sendo utilizado no tratamento da disfunÃÃo erÃtil. Foram utilizados 36 ratos machos, adultos, da linhagem Wistar, com o peso mÃdio de 300g. Todos os animais foram submetidos a cirurgia em que era realizada a fratura da diÃfise femoral com uma guilhotina romba. Os animais foram divididos em 2 grupos: o grupo lodenafil, que recebeu, via oral, doses diÃrias de carbonato de lodenafil (10mg/kg) e o grupo controle. Os animais foram sacrificados com 7, 14 e 28 dias de pÃs-operatÃrio. Houve duas mortes, dois falsos trajetos do fio e em trÃs animais nÃo foi estabelecida a fratura. Foram realizados estudo radiogrÃfico com filme de mamÃgrafo para analisar a densidade Ãptica e Ãrea do calo Ãsseo, medida em mm e estudo histolÃgico, utilizando amostras coradas com picrosirius red sob a luz poralizada do microscÃpio, para quantificar a formaÃÃo de colÃgeno tipo I e tipo III na regiÃo cortical prÃxima a fratura e no calo Ãsseo. A densidade de colÃgeno tipo I na regiÃo cortical do fÃmur prÃximo à fratura verificada no grupo lodenafil foi significantemente menor que a observada no grupo controle com 28 dias de consolidaÃÃo Ãssea (**P = 0,0028). Os resultados encontrados nÃo sÃo consistentes o suficiente para afirmar que este fÃrmaco exerce algum efeito na consolidaÃÃo Ãssea. Verificou-se que o Carbonato de lodenafil nÃo influenciou no processo de consolidaÃÃo Ãssea nos fÃmures de ratos reduzidos com fio de Kirshner. / The study was to investigate the effects of Lodenafil Carbonate in the process of bone healing in femurs of rats with reduced KirshnerÂs wire. The vascular factors are extremely important for the formation of callus. Lodenafil Carbonate cause vasodilatory effects, belongs to the group of selective phosphodiesterase type 5(PDE5) inhibitors, that enzyme inhibits cyclic guanosine monophosphate (GMPc) and relaxation of smooth muscles and are used to treat erectile dysfunction. It used 36 male rats, adult male rats, with the average weight of 300g. All animals underwent surgery in which fractures to the femoral shaft with a blunt guillotine. The animals were divided into 2 groups: lodenafil group, wich received oral doses of carbonate lodenafil (10mg/kg) and the control group. The animals were sacrificed at 7, 14 and 28 days postoperatively. There were two deaths, two false paths of the wire and three animals was not established fracture. Were performed radiographic studies with film mammography to analyze the optical density and area of callus, measured in mm  and histological study, using samples stained with picrosirius red under microscope light polarization, to quantify formation of collagen type I and type III in the cortical region near the fracture and callus. The density of type I collagen in the cortical region of the femur near the fracture observed in group lodenafil was significantly lower than that observed in the control group at 28 days of bone (** P = 0.0028). The results are not consistent enough to say that this drug has an effect on bone healing. It was found that the carbonate lodenafil not influence the process of bone healing in femurs of rats with reduced wire Kirshner.