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PubMed1994

Anterograde interlocked nailing of distal femoral fractures after gunshot wounds.

Standard treatment for distal femoral fractures has been with blade plate or condylar screw plate devices. Excellent fixation is obtained, but bone grafting is required and the procedure exposes the fracture site. More recently, indirect methods of reduction have been initiated to limit the devascularization of the fracture site. Anterograde interlocked nailing has the advantage of using an incision far from the fracture site, and the technique is familiar to most surgeons. It can be performed regardless of the degree or length of comminution. Thirty-eight patients 16-50 years of age who underwent anterograde interlocked nailing for fractures of the distal femur were retrospectively studied. Follow-up averaged 24 months. All patients sustained their injury from a gunshot wound (GSW). Thirty-one had angiograms. The distance from the fracture to the distal screws was < 5 cm in all cases. There were five Winquist 2, eight Winquist 3, and 25 Winquist 4 type fractures. In five patients the rod tip was cut off to place the screw holes more distally, and in four patients only three corticies were obtained by the distal locking screws. Early motion was obtained in all patients. Fractures healed at an average of 8.6 weeks. No primary or secondary bone grafts were performed. Three of the six patients positioned laterally had 5 degrees or more of valgus angulation, and five of the 34 patients positioned supine had > or = 5 degrees of posterior angulation. A method of using smooth Steinman pins as joysticks to control the distal fragment is presented. Anterograde interlocked intramedullary (IM) nailing is an effective means of fixation for distal femur fractures.

Adolescent↗
PubMed1990

[Femoral fractures in school age (6th-12th year)].

The femoral fracture is a paradigme for problems arising in fracture of the growing skeleton: length recovering growth and overgrowth, axial and rotational correction during physiological variation of the anteversion of the femoral neck will be discussed and their impact considered. Different types of overgrowth are accounted for. Our own patients, treated conservatively, showed a mean initial shortening of 0.85 cm. Their mean total overgrowth was 0.6 cm, so that their final grown-up leg length was -0.25 cm on the fractured side. Our small series did not indicate, that a consolidation with a modest angulation of less than 20 degrees and/or an initial shortening of less than 2 cm gave rise to a final over-length of some importance. The anteversion of the femoral neck of the broken leg compared with the other leg showed a mean difference of 13 degrees. None of the patients showed an abnormal gait. We discuss the unanswered question, if torsion deformities will be spontaneously corrected by growth-dependent modification of the anteversion of the femoral neck alone or by detorsion of the diaphysial femur too. We present the modalities of conservative treatment and the indications of operative treatment. We finally will raise the problem about the nature of the bone-remodeling mechanisms: role of the vascular distribution, of tissue hormones and of the streaming potentials. The hypothesis of streaming potentials forming the short-time memory of bone, and their transformation into a pattern of bipolar collagen fibres is fascinating.

Bony Callus↗
PubMed1999

Conservative versus surgical treatment for femoral fracture after total or hemiarthroplasty of hip.

This retrospective study compared internal fixation of a femoral fracture following total or hemiarthroplasty of hip with conservative treatment. Sixteen patients were included in the study and classified according to Johannsen. Seven of these patients were treated conservatively by skeletal traction (group A), while the remaining nine patients underwent internal fixation by Mennen plate in conjunction with bone graft (group B). All patients were followed for at least 2 years and evaluated clinically and radiographically using the Mayo Clinic score. The results of group B were superior to those of group A for fracture lines located proximally or extending distally to the tip of the prosthesis. Furthermore, two patients from group A in whom conservative treatment had failed underwent internal fixation, improving their final outcome. Regarding fracture distal to the tip of the prosthesis, there was no significant difference in final outcome between the groups. Our conclusion is that Mennen plate fixation should be considered the treatment of choice in femoral fracture around the tip of a prosthesis, and Mennen plate fixation for fracture distal to the tip should remain as a good option, especially for patients who would like to reduce the length of postoperative hospitalization.

Aged↗
PubMed2005

[Assessment of quality of life of patients after hemiarthroplasty for proximal femoral fractures].

OBJECTIVES: The quality of life of patients was assessed with the SF-36 Health Survey following hemiarthroplasty for hip fractures. METHODS: Forty patients were divided into two groups according to the type of hip fracture. Group 1 included femoral neck fractures (24 patients; 21 women, 3 men; mean age 76 years; range 64 to 94 years) treated with straight stem prostheses. Group 2 included intertrochanteric femoral fractures (16 patients; 13 women, 3 men; mean age 81 years; range 62 to 102 years) treated with calcar replacement prostheses (Leinbach). The SF-36 questionnaire was administered before and at least six months after surgery to assess changes in the quality of life. The effect of gender, fracture type, and the type of prosthesis on the SF-36 scores were examined. RESULTS: In group 1, the mean preoperative and postoperative physical health scores were 53.4 and 41.7, the mean mental health scores were 55.2 and 48.5, respectively. The mean corresponding scores were 52.8 and 35.1 for physical health, and 55.2 and 48.9 for mental health in group 2, respectively. Significant decreases were found in physical health and mental health scores postoperatively (p<0.05), with all the patients having decreased quality of life compared to the preoperative levels. The highest decrease was observed in physical role (56.8%), followed by physical function (42.8%) and mental role (42.9%) scores. The least affected were mental health (10.3%) scores. Gender, fracture type, and the type of prosthesis were not found to have a significant effect on the summary scores (p>0.05). CONCLUSION: Health related quality of life significantly decreases following hemiarthroplasty in elderly patients with hip fractures. Nonetheless, arthroplasty procedures enable these patients to maintain basic activities of daily living.

Aged↗
PubMed2005

[Operative treatment of supracondylar femoral fractures].

OBJECTIVE: Biomechanical properties between retrograde nail and condylar buttress plate for supracondylar femoral fracture were tested and compared. The functional operative results were also followed and analyzed. METHODS: (1) Six fresh adult moist cadaveric femoral specimens were used to create femoral supracondylar fracture models. Six specimens were divided into two groups. Group 1 was fixed with retrograde locking intramedullary nail and group 2 with condylar buttress plate. All specimens undergone biomechanical test and the data were analyzed using SPSS software. (2) From August 1995 to December 2000, 36 cases (37 limbs) of femoral supracondylar fracture were included. The follow-up period ranged from 2.1 years to 7.5 years. RESULTS: (1) Biomechanical tests showed: The stiffness of the condylar buttress plate in resisting axial compression force was smaller than that of the retrograde locking intramedullary nail. condylar buttress plate showed larger stiffness in resisting bending force than the retrograde locking intramedullary nail. (2) Clinical outcomes: According to Neer rating system, the functional scores were excellent in 26 cases, good in 8, fair in 1 and poor in 2. The excellent-good rate was 91.9%. The excellent-good rate of plating cases was 94.7% and retrograde nail was 93.3%. ROM of the knee joint ranges from 60 degrees to 135 degrees , with an average of 110 degrees. CONCLUSION: The excellent or good outcomes of femoral supracondylar fracture could be obtained through the operative treatment. The fixation of the retrograde locking and condylar buttress plate have their own advantages in biomechanical properties.

Adolescent↗
PubMed1982

Epidemiology and treatment of distal femoral fractures in adults.

Fractures of the distal femur comprise 4 per cent of all femoral fractures. The records of a consecutive series, from 1969 to 1976, of 135 adult patients with 137 fractures, not caused by malignant disease, were reviewed for age, sex, previous disease, type of fracture, treatment and end-result. Eighty-four per cent of the patients were over 50 years of age, 19 per cent had other general factors predisposing them to fracture, and 42 per cent had previous or current disease of the fractured leg. Eight-three fractures were caused by moderate and 52 by severe trauma. Unicondylar fractures were separated into lateral or medial type. Ten fractures were open and 45 were operated on primarily, mostly using condylar plates, screws or Rush pins. Satisfactory results (pain-free knee without angular deformity and at least 90 degrees of motion) were achieved in two-thirds of the fractures following both non-surgical and surgical treatment. However, the surgical group was an average of 8 years younger and contained a higher proportion of bicondylar fractures than the nonsurgical group. Treatment in traction involved a mean period of 7 weeks for 47 patients. This expensive treatment is no longer used for femoral neck, trochanteric or shaft fractures. In distal femoral fractures the goal should also be early mobilization, if necessary using surgical treatment.

Adolescent↗
PubMed2006

Prognosis of proximal femoral fracture in patients aged 90 years and older.

PURPOSE: To examine the walking ability and survival outcome of patients aged 90 years and older who sustained proximal femoral fractures, and to compare the findings with those of younger patients reported in previous studies. METHODS: Between January 1997 and June 2004 inclusive, 56 patients (11 men and 45 women) aged 90 years and older (range, 90-103 years; mean, 93 years) with hip fracture were reviewed. Their walking ability and survival outcome at discharge was investigated. Comparison was made between patients aged 60 to 89 years and those aged 90 years and older with respect to sex, fracture type, and other characteristics. RESULTS: Of 56 patients, 26 injured the right side and 30 the left side. Before injury, 33 (59%) were living at home and 23 (41%) were institutionalised in long-term care facilities or other hospitals. Fracture occurred at the femoral neck in 14 patients and at the trochanter in 42. Ten patients were treated conservatively because of severe dementia, co-morbidity, or refusal of surgery by the patients or their families, whereas 46 underwent surgery. Of the 45 who were previously ambulatory, 22 regained walking ability on discharge from hospital. None of the 10 patients treated conservatively were ambulatory on discharge. During hospitalisation, 4 became bedridden and 5 died (mainly due to pneumonia); among these 9 patients, 5 were deemed physically unfit for surgery. CONCLUSION: Surgery is the treatment of choice for patients aged 90 years and older with proximal femoral fracture. However, they have a lower rate of regaining pre-injury walking ability and a higher in-hospital death rate than younger patients.

Age Distribution↗
PubMed2006

Limb malalignment and functional outcome after antegrade versus retrograde intramedullary nailing in distal femoral fractures.

BACKGROUND: Torsional malalignment and mechanical axis deviation (MAD) are worrisome complications after nailing of distal femoral fractures. Variable, sometimes contradictory, reports about these problems have been published. METHODS: In a retrospective nonrandomized study, 41 patients (mean age, 44.5 years) with distal third femoral fractures that were operatively treated using either antegrade (20 cases) or retrograde (21 cases) intramedullary nailing during a period of 2 years have been reviewed. Goniometric measurement was done using a navigated ultrasound examination whereas functional evaluation and return to sports were assessed using Merle d'Aubigné functional grading system and Tegner and Lysholm activity score. RESULTS: There was no difference in femoral length, torsion, or MAD between patients treated using antegrade nails and those treated with a retrograde nail. There was a greater limitation of knee motion with retrograde nailing and of hip motion with antegrade nailing. The functional grading and activity evaluation showed, however, no difference between both groups. CONCLUSIONS: The study cohort showed that no treatment method had proved an advantage over the other regarding limb geometry or the functional outcome. The proper operative indication, intraoperative control, and the surgeon's experience seem to be more important in this regard than the nailing technique.

Adolescent↗
PubMed1989

Intraoperative femoral fractures associated with cementless total hip arthroplasty.

Between 1982 and 1986, 56 femoral fractures associated with cementless total hip arthroplasty (THA) were evaluated and compared to a randomly selected cementless THA control group without fractures. Depending upon the femoral shaft location, these fractures were classified as Types I, II or III. There were 45 (80%) Type I, 9 (16%) Type II, and 2 (4%) Type III fractures. Patient evaluations were quantified using a modified d'Aubigne-Harris scoring system. Nonparametric statistical methodology was used for fracture and control group comparisons. Treatment protocols were divided into various modalities, depending upon fracture classification. Type I and Type II fractures have no long-term prognostic hazards associated with them (P greater than 0.1), while Type III fractures appear to have analogous clinical results (sample size was too small for statistical analysis).

Adult↗
PubMed1994

Factors affecting the outcome after proximal femoral fractures.

One hundred and forty-two consecutive patients with proximal femoral fractures were audited prospectively over a 1-year period. Mobility, age and sex were recorded along with timing of surgery, complications, 'will to live', length of admission, mortality, mobility and housing requirements on discharge. Operative procedures were performed mostly by intermediate surgical staff, on night-time emergency lists shared with other specialties. Patients were treated on a ward with nursing staff levels less than the minimum recommended by professional bodies. Mean hospital stay was 31 days. In-patient mortality was 37 per cent in males and 5 per cent in females. It was possible to predict protracted hospital stay in 84 per cent, mortality in 84 per cent, mobility on discharge in 92 per cent and need for rehousing in 83 per cent of patients. Of the 10 principal variables that affected outcome, four could be influenced by hospital practice. These variables were associated with 1284 hospital bed days, which constituted 30 per cent of total bed occupancy. Fifty-five per cent of these were associated with non-medical delay to surgery, 25 per cent with wound infection or re-operation and 20 per cent with broken pressure areas. There would appear to be the potential to improve outcome in proximal femoral fractures by stabilizing fractures within 24 h, adopting measures additional to antibiotic prophylaxis to reduce infection and ensuring that patients do not develop pressure sores.

Activities of Daily Living↗
PubMed2005

Delayed presentation of ipsilateral femoral neck fractures in diaphyseal femur fractures.

Femoral neck fractures with delayed presentation following ipsilateral femoral diaphyseal fracture stabilization have been described as clandestine, attributed to missed diagnosis, or related to surgical technique. Clandestine fractures are present from time of injury but not detectable. The authors hypothesize that femoral neck fractures with delayed presentation can be clandestine, missed, or caused by surgical technique. A retrospective study and a comprehensive literature review are presented to determine the true incidence and etiology of these fractures.

Diaphyses↗
PubMed2003

Clostridium difficile-associated diarrhoea after internal fixation of intertrochanteric femoral fractures.

The aim of the study presented here was to record the incidence and outcome of Clostridium difficile-associated diarrhoea in patients undergoing surgery for intertrochanteric femoral fractures. Between January 2000 and June 2001, a total of 239 patients who underwent surgery after sustaining an intertrochanteric femoral fracture were included in the study. Seventeen patients developed Clostridium difficile-associated diarrhoea (incidence risk, 7.1%), and six patients died after developing the condition (case fatality rate, 35%). Thus, Clostridium difficile-associated diarrhoea was found to cause significant morbidity and mortality after surgery for intertrochanteric femoral fractures, and antibiotics should be used judiciously in this group of patients.

Age Distribution↗
PubMed1993

Intramedullary supracondylar nailing of femoral fractures. A preliminary report of the GSH supracondylar nail.

From 1987 through 1990, 34 acute supracondylar femoral fractures in 33 patients were treated with an interlocking closed-section intramedullary nail inserted retrograde into the femur through the intercondylar notch. Follow-up data of at least five months were available for 25 of these fractures. The patients suffered injuries more extensive than comparable patients reported in the literature. All fractures healed clinically and radiographically. The average arc motion at the most recent evaluation was 100 degrees. The average operative time was 156 minutes and the average estimated blood loss was 224 ml. Complications related to this treatment were successfully resolved. The genucephalic nail is a good treatment for supracondylar femoral fractures.

Adolescent↗
PubMed2004

Retrograde intramedullary nailing in distal femoral fractures--results in a series of 46 consecutive operations.

We present a series of 44 consecutive patients with 46 distal femoral fractures, who were treated with a retrograde intramedullary nail (Distal Femoral Nail (DFN)). Operational data, per- and post-operative complications and the outcome were studied retrospectively after a mean follow-up of 9 months. The final union rate was 95%, with a mean union time of 17.5 (8-68) weeks. Restoration of the limb axial alignment and length was inadequate in two cases, whereas three losses of reduction and one non-union were observed. Two cases of distal locking screw breakage were also observed. Moreover, one patient suffered from an iatrogenic lesion of the branch of the deep femoral artery. No deep, but three superficial infections were observed. In conclusion, our results suggest that DFN is a reliable alternative in distal femoral fracture treatment with a low complication rate.

Adult↗
PubMedDate not supplied

[Treatment of periprosthetic femoral fractures associated with total hip arthroplasty].

AIM: Periprosthetic femoral fractures represent a heterogeneous type of injury with a variety of treatment options. By retrospectively analysing our data, the results of different therapeutic procedures are compared and, reviewing previously published cases, suggestions for the management have also been developed. METHOD: This study is based on the analysis of records and radiograph series of 43 patients (50 procedures) with periprosthetic fractures. 22 patients could be followed-up using the Harris Hip Score at an average of 4.8 years after injury. RESULTS: Factors predisposing to fractures were found in 41 patients, only 9 fractures were due to an adequate trauma. According to the classification of Johansson et al., 15 fractures of type I and type II each and 20 fractures of type III were treated. In 23 cases open reduction and internal fixation (ORIF) with a plate was used, 10 fractures were stabilised by minimal osteosynthesis, in 8 cases a modular prosthesis for bone replacement was used, 6 times a revison stem was implanted, and in 2 fractures osteosynthesis of the femur could only be accomplished after the complete removal of implants. The mean Harris Hip Score was 69.9 points at the follow-up examination. Local surgical complications were more often observed than general. CONCLUSIONS: Due to their different clinical presentations periprosthetic fractures need to be managed individually and in most cases operatively. Internal fixation with a plate proved to give the best functional results for stable stem implants. Loosening stems have to be replaced by revision implants with long stems for intramedullary fixation. Alternative osteosynthetic techniques and additive minimal osteosynthesis can be favoured in special cases. Modular prostheses for bone replacement are reserved for fractures with extensive bone loss.

Adult↗
PubMed1982

Deformities, gonarthrosis and function after distal femoral fractures.

Sixty-two patients treated for distal femoral fractures from 1969-1976 were re-examined, after a mean follow-up period of 5 years, to study deformities, gonarthrosis and function. These fractures occur mainly in elderly persons with bone fragility due to age and disease. The deformities were analysed from precisely defined radiographic projections. An anatomical classification into supracondylar, unicondylar and bicondylar fractures, with subdivisions for undisplaced and displaced fractures was used. A special group for transcondylar fractures was included. Displaced bicondylar fractures mostly healed with varus and anterior angulation, medial unicondylar fractures with varus and lateral unicondylar fractures with valgus angulation. Most of the healed supracondylar fractures showed varus angulation. Three patients developed arthrosis in both the femoro-tibial and patellar compartments, and eleven only in the patellar area. Intercondylar or transcondylar diastasis, or difference of level in the joint surface exceeding 3 mm, caused a significant degree of gonarthrosis. Function was assessed using the Knee Disability Sheet prepared at the Hospital for Special Surgery. The necessity of radiographic examination of the patellar joint in the axial projection on admission is stressed. Accurate reduction and adequate stabilization of intra-articular fractures seem to be important for reducing the risk of gonarthrosis and later impairment of function.

Adolescent↗
PubMed1996

[Treatment concepts of femoral fractures after total endoprosthetic replacement of the hip or knee joint: intra- or extramedullary stabilization?].

A comparison between intramedullary (n = 13) and extramedullary (n = 37) stabilization was performed in 50 patients (mean age 67.4 years) after fractures of the femoral shaft following knee or hip arthroplasty. Fracture of the femoral shaft (mean 5.5 years after the implantation) is observed especially often in patients with osteoporosis, loosening of the prosthesis, and rheumatoid arthritis. The ratio between cemented and uncemented endoprosthesis was 4:1. The investigation shows that extramedullary stabilization by means of plates and screws is the preferred treatment for younger patients and in the case of distal fractures, while in older people intramedullary fixation in combination with an additional osteosynthesis allows early mobilization. The number of complications observed is higher than with primary arthroplasty. The frequency of further operations, postoperative fractures and unsatisfactory results is significantly higher than in primary hip and knee surgery or uncomplicated fracture of the femur.

Adult↗
PubMed1991

[The functional treatment of diaphyseal femoral fractures].

Severely comminuted and wide open fractures of the femoral shaft, with or without condylar involvement, have always been very difficult to deal with order to assess the quantitative. Over a period of ten years, 35 "problem" fractures, selected from a series of 129 femoral shaft fractures, were managed by "functional treatment" with the aim of avoiding the risks inherent to osteosynthesis and achieving rapid healing while maintaining, from the very beginning, full function of the injured limb. The most frequent fractures in this series were severely comminuted and open fractures. All fractures healed within a mean time of 12.5 weeks. The results, evaluated according to the score table of the Functional Treatment Study Group, were as follows: excellent in 32 cases, good in 2 cases, and poor in one case (refracture). Functional treatment of "problem" femoral shaft fractures has proven to be reliable in light of the good results, despite the fact that the technique employed for this particular bone and type of fracture requires great care and expertise as well as careful patient selection.

Adolescent↗