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At least 325 records · Page 18Linked to original sources
PubMed1999

Cortical strut allografts for the treatment of femoral fractures and deficiencies in revision total hip arthroplasty.

Thirty-three hips had revision total hip arthroplasty, using an average of three cortical strut allografts fixed to the femur with cables and followed-up for a mean of 4 years. The indications for strut allografts were ectatic femurs or segmental defects of the femoral diaphysis (22 hips), femoral fractures (10 hips), and severe proximal femoral osteolysis (1 hip). Twenty-one hips had an excellent or good clinical result, 6 had a fair clinical result, and 6 had a poor clinical result. Reoperation was done in six hips, but in only two hips was reoperation related to failure of the allograft. Nine of the 10 femoral fractures repaired with allograft struts healed by 3 to 6 months. Radiographs showed partial or complete bridging of the allograft to host bone with peripheral remodeling and minimal resorption in 30 of 33 hips. Strut allografts, fixed with multiple cables, are an important adjunct to femoral component revision for the restoration of deficient femoral bone stock and in the treatment of periprosthetic femur fractures.

Adult↗
PubMed1999

Femoral fracture at the proximal end of an intramedullary supracondylar nail: a case report.

Retrograde intramedullary supracondylar nails have been added to the orthopedic armamentarium for treatment of distal femoral fractures. Major complications of this new technique have not been noted. We report a case of a femoral fracture at the proximal end of a retrograde intramedullary supracondylar nail. We hypothesize that this complication may be due to the proximal end of the nail acting as a stress riser, with the cortical holes drilled for the interlocking screws compounding this effect.

Accidents, Traffic↗
PubMedDate not supplied

Retrograde nailing of femoral fractures distal to a Moore prosthesis.

Fractures distal to uncemented hemiprostheses are difficult to treat. This paper describes a simple procedure: retrograde nailing of femoral fractures below a Moore prosthesis. We report on seven elderly female patients in whom clinical and radiographic evaluations were done after seven to fifteen months. No major complications occurred and all fractures healed. All patients returned to their preinjury level of housing, and all but one regained their preinjury walking status. We conclude that retrograde nailing of a femoral fracture distal to a Moore prosthesis is a quick and simple method that allows immediate mobilization and results in a good functional recovery for elderly, often fragile patients.

Aged↗
PubMedDate not supplied

Management of pediatric femoral shaft fractures.

Femoral shaft fractures are the most common major pediatric injuries managed by the orthopaedic surgeon. Management is influenced by associated injuries or multiple trauma, fracture personality, age, family issues, and cost. In addition, child abuse should be considered in a young child with a femoral fracture. Nonsurgical management, usually with early spica cast application, is preferred in younger children. Surgery is common for the school-age child and for patients with high-energy trauma. In the older child, traction followed by casting, external fixation, flexible intramedullary nails, and plate fixation have specific indications. The skeletally mature teenager is treated with rigid intramedullary fixation. Potential complications of treatment include shortening, angular and rotational deformity, delayed union, nonunion, compartment syndrome, overgrowth, infection, skin problems, and scarring. Risks of surgical management include refracture after external fixator or plate removal, osteonecrosis after rigid antegrade intramedullary nail fixation, and soft-tissue irritation caused by the ends of flexible nails.

Adolescent↗
PubMed1997

Uncemented revision stem for biological osteosynthesis in periprosthetic femoral fractures.

Fractures around a femoral prosthesis have been treated with plating and additional cement, but this leads to further reduction of bone stock in the proximal femur. Since February 1992, we have dealt with this problem in 12 patients by revision using a long uncemented stem and distal interlocking combined with homologous bone grafting. Bony ingrowth and remodelling led to restoration of the proximal femur. After bone healing, removal of the distal interlocking screws converts the distal load transfer to the proximal anchoring of the revision stem so that osteointegration can occur in the trochanteric region. The clinical results were good in all the patients after a mean follow up of 23.5 months. This is a method which provides biological osteosynthesis and is especially indicated in younger patients.

Adult↗
PubMed2002

Osteopetrosis, femoral fracture, and chronic osteomyelitis caused by Staphylococcus aureus small colony variants (SCV) treated by girdlestone resection--6-year follow-up.

Chronic osteomyelitis caused by Staphylococcus aureus small colony variants in combination with osteopetrosis is a unique combination of disorders that confronted us with major challenges. The therapeutic approach included four serial debridements and antimicrobial therapy. The aggressive treatment led to an instability of the brittle and hard osteopetrotic bone, and after 11 weeks, a fracture of the femoral neck occurred. A salvage procedure of the femur was performed, and the cultures obtained during this intervention remained negative. At a 6-year follow-up, the girdlestone situation still showed an acceptable functional outcome without any recurrence of osteomyelitis.

Adult↗
PubMed1998

Femoral fracture and iatrogenic hyperthyroidism in spinal cord injury.

Analysis of the clinical case of a male aged 30 years, presenting with T6 complete paraplegia in 1991, demonstrated the existence of aggravating factors for disuse osteoporosis of spinal cord injury, possibly leading to bone density values below the fracture threshold with the risk of spontaneous fractures. This patient was admitted to hospital for multiple pressure sores requiring prolonged local dressings before and after plastic surgery performed in July 1995. In January 1996, following exercise, he developed a fracture of the femoral diaphysis with a cystic demineralized appearance of the bone. The etiologic work-up demonstrated hyperthyroidism due to iatrogenic iodine overload secondary to Betadine. A review of the literature revealed numerous cases of thyroid dysfunction secondary to iatrogenic iodine saturation. This case justifies regular surveillance of thyroid function tests during prolonged treatment with Betadine and identification of patients with a clinical predisposition.

Administration, Topical↗
PubMed1986

[Surgical treatment of extension contractures of the knee joint after femoral fractures complicated by osteomyelitis].

An experience with the treatment of 26 patients has shown high efficiency of open mobilization of the knee-joint in extension contractures following fractures of the femoral bone complicated by osteomyelitis. Extended scarry degeneration of certain muscles is not thought to be a contraindication for operation provided the intact muscle heads are sufficiently trained. The aggravation of osteomyelitis in part of the patients at late terms did not deteriorate favorable functional outcome of the mobilizing operation.

Adult↗
PubMed2005

Periprosthetic femoral fractures--a comparison between cemented and uncemented hemiarthroplasties.

Over a 2-year period, 244 patients underwent hemiarthroplasty for a displaced intracapsular femoral neck fracture. Seventy patients had a cementless Austin-Moore prosthesis (AMP) inserted and 174 patients were treated using a cemented Thompson hemiarthroplasty. All the AMPs were inserted by or under the supervision of an orthopaedic consultant. Five patients (7%) from the AMP group sustained a periprosthetic femoral fracture. Two were iatrogenic and three occurred postoperatively after a simple fall. The fractures occurred proximally around the prosthesis (Johansson type I). Four required revision surgery. There were no periprosthetic femoral fractures in the Thompson group. When compared to the cemented Thompson hemiarthroplasties, the number of periprosthetic femoral fractures was significantly greater with the AMP. Patients in the AMP group were significantly older, although there was no significant difference in ASA grade between the two groups. There was no significant difference in age or gender between those who sustained a periprosthetic fracture and those who did not. These findings suggest that due to the increased risk of periprosthetic femoral fracture, cemented hemiarthroplasty is preferable. Furthermore, with modern cementing techniques, elderly frail patients appear to tolerate bone cement, which may serve to reinforce an osteoporotic proximal femur.

Aged↗
PubMed1982

Femoral fractures in head-injuries adults.

The records of 65 head injured adults with 68 concomitant femoral fractures were reviewed. All patients were victims of high energy accidents. Forty-three fractures were treated by nonoperative methods. Treatment of 30 fractures with traction alone or with hip spica casts resulted in greater than 10 degrees of anterior angulation in 12 fractures (40%), greater than 5 degrees of valgus angulation in 13 fractures (43%), and shortening of greater than 2 cm in 13 fractures (43%). of eight fractures treated with a cast brace, two had shortening of 2.5 cm. Cast braces offered better fracture alignment, less shortening and more knee motion than traction and hip spica casts. The average time to union was four months. These fractures generally healed in the same fashion and at a similar rate as those of the general population. Ipsilateral hemiplegia prolonged union by one month but was not associated with excessive callus. Twenty-five fractures were treated by open reduction and internal fixation. Deep wound infection occurred in four femoral (16%) and osteomyelitis in two (8%). Reoperation was required in six femora (24%) as a consequence of the initial surgery. Excessive calculus was noted in 13 fractures (52%). Open reduction and internal fixation of femoral fractures in this population almost invariably required less nursing care, earlier mobilization, fewer angular deformities, less shortening and greater knee motion when compared to traction and hip spica casts.

Adolescent↗
PubMed1990

Mechanics of intramedullary nails for femoral fractures.

Biomechanical studies were carried out to assess the function and performance of intramedullary (IM) nails for femoral fractures. An appropriately sized femoral IM nail with a radius of curvature of about 109 cm would most closely match the anterior bow of most human femora. A number of parameters can interact to result in bursting of the femur during insertion of the nail. These include mismatch in curvature of the nail and femur, high stiffness in bending, and poor location of the starting hole. An anatomic starting position for the IM nail is just medial to the greater trochanter and anterior to the pyriformis recess. Moving anterior to the midline of the femur significantly increases the potential for bursting the femur during insertion of the nail. Other factors can decrease the force of insertion of the IM nail in the femur. These include overreaming, shortening the axial length of the fracture component, and use of a nail of lower bending rigidity. IM-nail-fixed femoral shaft fractures with locking bolts can be expected to have about 75% the rigidity of the intact femur in bending and can support about 400% of normal body weight (= 70 kg). Slotted IM nail/femur constructs have only about 3% the rigidity of the intact femur in torsion, while an unslotted (closed) section implant produces constructs with about 50% the rigidity. The distal locking bolts increase the torsional rigidity and maximum axial load capacity of the construct, and reduce the potential for shortening and the residual deformation upon release of a torsional load. Two distal bolts reduce the toggle of the nail in the femoral shaft.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomechanical Phenomena↗
PubMed1998

Fragment reconstruction and bone plate fixation versus bridging plate fixation for treating highly comminuted femoral fractures in dogs: 35 cases (1987-1997).

OBJECTIVE: To compare fragment reconstruction and bone plate fixation versus bridging plate fixation for treating highly comminuted (> 4 fragments) femoral fractures in dogs. DESIGN: Retrospective study. ANIMALS: 35 dogs with highly comminuted fractures of the femur. PROCEDURE: Medical records of all dogs included in this study were reviewed. Dogs had been treated with fragment reconstruction and bone plate application (n = 20) or major fragment alignment and bridging plate fixation (15). Postoperative and follow-up radiographs were evaluated. Operating and hospitalization times, bone alignment, bone healing, and complications were considered. RESULTS: There were no differences in hospitalization times, limb alignment, and complications between dogs with fractures treated with fragment reconstruction and dogs with fractures treated with bridging plate fixation. Dogs with fractures treated with bridging plate fixation had shorter operative times and faster times to radiographic evidence of bone healing. CLINICAL IMPLICATIONS: Bridging plate fixation is quicker to perform and results in faster healing than fragment reconstruction and bone plate fixation when used to treat comminuted femoral fractures.

Age Factors↗
PubMed2003

Comparison of in situ and in vitro CT scan-based finite element model predictions of proximal femoral fracture load.

Hip fracture is a serious and common injury that can lead to permanent disability, pneumonia, pulmonary embolism, and death. Research to help prevent these fractures is essential. Computed tomographic (CT) scan-based finite element (FE) modeling is a tool that can predict proximal femoral fracture loads in vitro. Because this tool might be used in vivo, this study examined whether FE models generated from CT scans in situ and in vitro yield comparable predictions of proximal femoral fracture load. CT scans of the left proximal femur of two human cadavers were obtained in situ and in vitro, and three-dimensional FE models employing nonlinear mechanical properties were generated from each CT scan. The models were evaluated under single-limb stance-type loading by applying displacements incrementally to the femoral head. The FE-predicted fracture load (F(FE)) was the maximum femoral head reaction force. F(FE) for the in situ-derived models for the two subjects were 5.2 and 13.3% greater than for the in vitro-derived models. These results demonstrate that using CT scan data obtained in situ instead of in vitro to generate FE models can lead to substantially different predicted fracture loads. This effect must be considered when using this technology in vivo.

Bone Density↗
PubMed1989

A custom-made prosthesis for the treatment of supracondylar femoral fractures after total knee arthroplasty: report of four cases.

Four supracondylar femoral fractures following total knee arthroplasty, two because of intraoperative notching of the anterior femoral cortex and two because of osteoporosis, were revised using a custom-made prosthesis with femoral condyle section. At 1-6 year follow-up (median 3 years) after the revision, all patients had an excellent clinical result, although 2 had a prolonged rehabilitation period because of severe osteoporosis. At roentgenographic examination, no signs of loosening of the prostheses at the cement-bone interface were present.

Aged↗
PubMed1983

Use of Ender's nails in unstable trochanteric femoral fractures.

Eighty consecutive patients with unstable trochanteric femoral fractures treated by the Ender technique have been studied. Early fixation failure was seen in 18% of patients. Leg shortening and external rotation deformities due to uncontrolled fragmentary collapse were found in almost 80% of the 57 surviving patients at 3 months, and caused severe disability. The continued use of the Ender technique in unstable fractures is questioned.

Aged↗
PubMed2004

[Dynamic internal fixation of the periprosthetic femoral fractures after total hip arthroplasty].

Periprosthetic fractures of the femur after total hip arthroplasty are a big orthopaedic problem, particularly in elderly patients and quite a challenge for orthopaedic surgeons. There is no universal method in treating these fractures. Rigid plates fixation can be limited and aggravated especially in the proximal part of the femur where the endoprosthesis stem does not allow for an undisturbed fixation of both femur cortexes by means of screws. Mitkovic's dynamic internal fixator is an original implant allowing for an undisturbed fixation of both femur cortexes regardless of the presence of the endoprosthesis stem. Fixation is made possible by means of movable clamps and a convergent possibility to place screws. A dynamic internal fixator can fix all types of periprosthetic femoral fractures. The paper shows the early experience in fixating periprosthetic femoral fractures after total hip arthroplasty in 14 patients, average age 69.7. According to Vancouver classification, 3 patients had the type A fracture, 9 patients had the type B fracture, and 2 patients had the type C fracture. All fractures were fixed by Mitkovic's dynamic internal fixator. The fracture occurred 2-12 years after primary total hip arthroplasty. The follow-up of the operated patients was 12 months. The method is less invasive than the methods described in books. Mechanical complications are not likely to appear due to the fracture dynamics along the femoral shaft axis, which is made possible by this implant. Our initial experience in femur fracture fixation after hip arthroplasty ahows that it is modern and effective dynamic implant which will contribute significantly to the improving of the treatment of these often very complicated fractures.

Aged↗
PubMed1991

[Correction of malunion of femoral fractures by Ilizarov's device in children].

Cast immobilisation of femoral fractures in children may sometimes be subject to important displacements. Absence of survey leads to malunions which may make a secondary correction necessary. In two such cases the authors used Ilizarov's external fixation which allowed correction of both angulation and shortening without direct approach. Rapid healing occurred. The authors made a comparative analysis of the different possibilities for treatment of these severe femoral malunions.

Bony Callus↗
PubMed1990

Segmental femoral fractures: surgical strategies.

The authors identify six kinds of segmental femoral fractures. Such classification, however, does not simplify the problem of therapeutic approach. Since every fracture combination has its own unique characteristics, prearranged outlines of treatment are useless. A satisfactory surgical solution cannot be achieved without a general clinical evaluation.

Bone Nails↗