[Hip fractures].
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Femoral Neck Fractures↗
Biomedical subjects
A Alho
Publications and source records attributed to A Alho.
Holding power of the 4.5 mm AO/ASIF cortex screw in cortical bone in relation to bone mineral.
To obtain basic data about the holding power of a 4.5 mm AO/ASIF cortex screw in cortical bone in relation to bone mineral as expressed by densitometric methods, uniaxial pull-out tests were performed on 14 human cadaver femurs. The mechanical parameters were correlated with bone mineral which was assessed by quantitative computed tomography (QCT) and dual energy X-ray absorptiometry (DXA). High correlations were found between the QCT mass, the DXA density and content values and the holding power of the screw. The QCT density values, expressing the physical density of the bone, did not correlate similarly well.
Aged↗
Nonunion of tibial shaft fractures treated with locked intramedullary nailing without bone grafting.
Twenty-five nonunions of tibial fractures were treated with Grosse-Kempf slotted, locked nails in 20 men and 5 women 6 to 54 months after fracture. No bone grafts were performed in connection with nailing. For better alignment, opening of the nonunion site, fibular osteotomy/resection, or both were used. In one patient reoperation with nailing and bone grafting was necessary after the first nail broke. There were three postoperative infections (12%), two with persistent drainage. All nonunions healed. In one patient an external rotatory malalignment was corrected by a later osteotomy. In no case was the function of the ankle or foot impaired by the index operation. Static locking was not unfavorable for healing. We conclude that bone grafting is rarely needed and function is restored early after locked nailing of tibial nonunions.
Adolescent↗
Prediction of fixation failure in femoral neck fractures. Comminution and avascularity studied in 40 patients.
We performed 99m-Tc diphosphonate scintimetries in 40-elderly patients who had undergone screw fixation for a recent subcapital femoral fracture and analyzed their preoperative radiographs. The data were subjected to a logistic regression analysis. Both comminution of the calcar femorale and reduced scintimetric uptake were predictive for failure of the osteosynthesis during the first year. Fracture comminution was more predictive for early failures during 3 months and scintimetry for the later failures.
Aged↗
Mineral and mechanics of bone fragility fractures. A review of fixation methods.
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Aged↗
[Country-wide product control of total hip prostheses].
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Hip Prosthesis↗
Slotted versus non-slotted locked intramedullary nailing for femoral shaft fractures.
Experimentally, two slotted nails, the Grosse-Kempf nail and the AO/ASIF universal femoral nail, were compared to the non-slotted Grosse-Kempf nail and control bone using a cadaver femoral osteotomy. The stiffnesses and strengths of the osteotomies fixed with slotted nails in 10-30 degrees torsion were 6-8% and the values of non-slotted nails 40% of control bone. The maximal moments were 14-18% and 48%, respectively. In the "clinical range" of torsion, the implant-bone construct never failed or was deformed. Clinically, 46 femoral shaft fractures were randomized to treatment with Gross-Kempf nails, 24 with slotted nails and 22 with non-slotted nails. Four complications in the slotted nail group and three in the non-slotted nail group were considered to be independent of the choice of nail and did not affect the end result. Three splinterings of the distal fragment, one resulting in a change of the osteosynthesis implant to a condylar plate, were considered to result from the high stiffness of the non-slotted nail. Osteosynthesis of femoral shaft fractures using slotted nails has not resulted in healing disturbances, which could be accounted for by the high torsional elasticity of the nail; there seems to be no indication for high-stiffness nails in femoral fractures.
Adolescent↗
Prediction of disturbed healing in femoral neck fracture. Radiographic analysis of 149 cases.
To determine factors predictive of early healing disturbances after fixation of femoral neck fracture, the radiographic and clinical data of 149 patients were subjected to a logistic regression analysis comparing them with the results 3 months postoperatively. As in previous studies, fracture reduction distinguished between fractures with or without healing disturbances. The following signs in the preoperative radiographs were predictive of unfavorable outcome: small head fragment, comminution of the calcar femorale, and varus angulation of the head. Fractures with negative predictive signs may be selected for primary arthroplasty.
Age Factors↗
Implant holding power of the femoral head. A cadaver study of fracture screws.
The holding power against axial pull-out forces of eight different screws implanted in the femoral heads of cadavers was tested. The Olmed screw had the greatest resistance to pull-out forces followed by the recently designed Ullevaal screw with long threads, and the von Bahr screw. There were substantial differences in the holding power in the four sectors of the femoral head. The holding power was strongly correlated with the logarithm of the moment of inertia of the screw threads, which is a function of the area and number of the threads (r = 0.94, P = 0.0002).
Adult↗
A case of multifocal liposarcoma?
A 53-year-old man presented with a grade 2 liposarcoma in his left thigh and grade III liposarcomas in the mediastinum and omentum. Later, a grade 2 tumor was discovered in the musculature of his right thigh. In addition to recurrences, he developed lesions that were considered metastatic. He died 3 years later of multiple lesions. The case may represent a multifocal liposarcoma, which has been previously reported in only 35 cases.
Abdominal Neoplasms↗
Acute compartment syndrome: for how long can muscle tolerate increased tissue pressure?
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Adult↗
Femoral shaft fractures in the elderly treated with Grosse-Kempf slotted locked intramedullary nail.
Thirty-one femoral shaft fractures in patients over 60 years of age were treated with the Grosse-Kempf slotted, locked intramedullary nail and followed for a median of 24 months. The patients tolerated the operation reasonably well and the mortality was not higher than the mortality connected with femoral neck fractures. Three reoperations were performed due to intra- and postoperative complications. The main reason for the less satisfactory result was shortening > 2 cm after unstable dynamical locking. This occurred in 8 of 15 dynamically nailed fractures with locking screw(s) in one end of the nail only. A 9 cm shortening among these was the reason for one of the two poor results in the series. The other poor result was a malalignment of the distal fragment in a statically locked fracture. We conclude that locked intramedullary nailing is a good way to treat femoral shaft fractures in the elderly, the high subtrochanteric, midshaft and infraisthmic fractures.
Aged↗
Comparison of functional bracing and locked intramedullary nailing in the treatment of displaced tibial shaft fractures.
Thirty-five displaced tibial shaft fractures, treated with functional bracing were compared with 43 similar fractures, treated with locked intramedullary nailing. There were 22 excellent/good results in the brace group and 38 in the nail group. There was one infection in the brace group and three in the nailed group. There were five delayed unions and two nonunions in the brace group and one delayed union in the nail group. The functional results in the nailed group were better than the braced group but locked intramedullary nailing of tibial shaft fractures require special resources and training. Locked intramedullary nailing fullfils all the functional criteria for acceptable fracture care.
Adolescent↗
[Fractures of the distal radius. Guidelines for treatment].
Fractures in the distal part of the radius are a common injury in the elderly and in an increasing number of young patients as well. In order to obtain optimal function it is essential, in older and younger patients alike, to secure anatomic length of the radius and anatomic congruency of the joint. Fractures with a tendency to secondary dislocation after primary good reduction should be recognized. Rereduction and fixation with percutaneous K-wires secure the position of the fracture. In some patients primary pinning or primary treatment with an external fixator should be considered, depending on the type of fracture. Guidelines are outlined for the treatment of this very frequent fracture.
Colles' Fracture↗
[Bone transplantation. Where are we in 1991?].
Bone transplants are used in acute injuries, non-unions, defects after tumour, and total joint surgery. Autogenous cancellous bone from the iliac crest is still the most frequently used material. Allogeneic cadaver bone is an acceptable alternative for treating major defects after tumour resection, especially as osteoarticular graft about the knee. Allografts in total hip revisions have not been successful. Demineralized allogeneic bone matrix, bone morphogenetic protein and various bone mineral substitutes are experimental. There are distinct indications for pedicled and vascularized autografts which should be available whenever their use is warranted.
Biocompatible Materials↗
Locked intramedullary nailing of femoral shaft fractures.
One hundred twenty-three femoral shaft fractures were treated with Grosse-Kempf slotted, locked nails and followed for a median 20 (range, 12-60) months. There were eight intraoperative and 11 postoperative complications, among them two superficial and two deep infections. Most of the intraoperative complications and some postoperatively lost reductions could have been prevented by a better operative technique and judgment of stability. Seventy-eight results were graded as excellent, 24 as good, 19 as fair, and two as poor (one 9-cm shortening and one 40 degrees external malrotation). All fractures united without further procedures during the first year.
Adolescent↗