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In a follow-up of 97 operated distal femoral fractures good and satisfactory results were found in 64% of the cases. 22% unsatisfactory and 14% poor findings attribute mainly to the comminuted supracondylar fracture types. More than half of the patients were multiple injured. In 83% of the cases the internal fixation was obtained by the use of the condyle buttress plate.
BACKGROUND AND AIMS: The number of fractures of the proximal femur is increasing faster than the number of elderly people. The aim of the study was to record all complications after operative treatment of proximal femoral fractures in order to reduce the incidence of these complications in the future. MATERIAL AND METHODS: The files of 334 patients with proximal femoral fractures were retrospectively analyzed. The number of all general and operative complications were recorded. RESULTS AND CONCLUSIONS: The primary mortality was 8 percent. The most common general complication was a thromboembolic one. Local complications were recorded in 66 cases. Thirty-eight percent of femoral neck fractures treated by internal fixation were complicated. Increased attention should be focused on the sufficient antithrombosis prophylaxis, which should be continued at least during the whole convalescence period at the hospital. It remains to be clarified, if improved technical skill may improve the results of femoral neck osteosynthesis, which in this group of patients appeared far from satisfactory. The development of post-operative care and selection of right patients to an appropriate rehabilitation program is perhaps the most important factor today, in order to reduce complications in general.
The treatment of oblique subtrochanteric femoral fractures is often difficult. Both fixation with a nail and plate, and intramedullary nailing have several pitfalls. Four cases treated with intramedullary Ender nailing combined with Parham modified bands are presented. The method is technically simple, gives complete reduction, allows early mobilization and gives a good functional result.
We report on our early experience with the use of the Partridge nylon cerclage. This system was employed as a supplementary fixation in 18 femoral fractures in elderly patients (average age, 78 years). Indications of its use were reduction of comminuted fragments and enhancement of the grip of the main fixation device on osteoporotic femora or in femora with a prosthesis in situ. All fractures but one healed primarily. At an average follow-up time of 25 months, 15 of the 18 patients were ambulatory. Radiographic review showed that the cerclage did not cause cortical avascularity and that none of the straps used failed. We concluded that the internal fixation of difficult femoral fractures in the elderly can be easily and effectively strengthened by the use of this cerclage system.
Retrograde intramedullary locking nailing as well as the LIS system are propagated as minimally invasive treatment options for distal femoral fractures following total knee arthroplasty. In a retrospective study, we reviewed the clinical results after operative treatment of 18 periprosthetic supracondylar femoral fractures. The fracture was stabilized with the less invasive stabilization system (LISS) in nine patients (average age: 80.3 years) and with a retrograde intramedullary locking nail in the remaining nine patients (average age: 76.8 years). The mean follow-up was 18.2 months (6-35 months). We did not find significant differences concerning the operation time (nailing 99.8 min vs 102.3 min with the LISS) or the length of stay in the hospital (nailing 10.6 days vs 12.7 days with the LISS). In one patient of the nailing group we found a valgus malalignment of 18 degrees. Seven patients in each group were satisfied with the clinical results. In one patient of the LISS group a revision due to an infection was necessary. In one patient of the nailing group a reosteosynthesis had to be performed. To sum up, both systems are useful tools in the treatment of dislocated periprosthetic fractures and both systems are not without any problems. However, under special consideration of the complications we found in our study, the LISS seems to be a better alternative in osteoporotic bone with a small distal fragment. The choice of the optimal implant should therefore depend on the type of fracture and knee arthroplasty, the type of bone, and the experience of the surgeon.
From January 1982 to June 1987 a total of 189 patients with 199 fractures of the femoral shaft were treated by internal plate fixation. Aseptic complications were found in 41 osteosyntheses (20.5%) and were due variously to implant deficiencies (11%: loosening 2.5%, deformation 1.0%, implant fracture 7.5%), delayed union (3%), non-union (4.5%), axial deformities (2.5%) and differences in femoral length (5%). Septic complications were seen in 2.5%. There are three main ways of limiting the rate of aseptic complications: (1) restrictive indications for internal plate fixation or femoral shaft fractures; (2) a precise surgical technique taking account of local biomechanical and biological needs; and (3) generous application of bone grafting.
Hip fracture is an important cause of morbidity and mortality among the elderly. Current methods of assessing a patient's risk of hip fracture involve local estimates of bone density (densitometry), and are limited by their inability to account for the complex structural features of the femur. In an effort to improve clinical and research tools for assessing hip fracture risk, this study investigated whether automatically generated, computed tomographic (CT) scan-based finite element (FE) models can be used to estimate femoral fracture load in vitro. Eighteen pairs of femora were examined under two loading conditions one similar to loading during the stance phase of gait, and one simulating impact from a fall. The femora were then mechanically tested to failure and regression analyses between measured fracture load and FE-predicted fracture load were performed. For comparison, densitometry measures were also examined. Significant relationships were found between measured fracture load and FE-predicted fracture load (r = 0.87, stance; r = 0.95, fall; r = 0.97, stance and fall data pooled) and between measured fracture load and densitometry data (r = 0.78, stance; r = 0.91, fall). These results indicate that this sophisticated technique, which is still early in its development, can achieve precision comparable to that of densitometry and can predict femoral fracture load to within -40% to +60% with 95% confidence. Therefore, clinical use of this approach, which would require additional X-ray exposure and expenditure for a CT scan, is not justified at this point. Even so, the potential advantages of this CT/FE technique support further research in this area.
Periprosthetic supracondylar femoral fractures after total knee arthroplasty (TKA) are difficult surgical problems. We report a case of an 84-year-old female, in which an original method was applied to treat a periprosthetic supracondylar femoral nonunion just proximal a femoral component. The new method features extending the stem of the femoral component with a Küntcher nail. Eventually bony union was obtained and the patient is now able to walk without any support.
A syndrome characterized by limb hyperextension, generalized muscle atrophy, abducted gait, and a limited range of joint motion is reported in five dogs, four of which were immature. Distal femoral fractures, of traumatic origin, were found in all dogs; four dogs were subjected to limb immobilization in extension for three to seven weeks. Lesions in muscle biopsies included fiber size variability, increased prominence of subsarcolemmal nuclei, increased perimysial fibrosis and focal necrosis. Histochemical and morphometric studies demonstrated a significant (p less than 0.05), Type I fiber atrophy in the vastus lateralis muscles in the limbs with femoral fractures treated by hyperextension. The shortest time period between onset of fracture and the presence of type I fiber atrophy was seven weeks.
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The use of the Wagner leg lengthening external fixator is described in six patients with extensive segmental fractures of the femoral shaft. Good fixation of the fracture is combined with the facility for distraction and lengthening of the early reparative callus up to 10 weeks after injury. The method is recommended for those patients in whom shortening and malalignment of the fracture persist as union proceeds.
In seven patients who sustained eight distal femoral fractures following knee arthroplasty all fractures were treated operatively. Seven with open reduction internal fixation and one with external fixation. Seven of eight fractures had an unsatisfactory result. This was due not only to bone quality and fracture comminution, but also to technical problems and choice of implant. Revision surgery is often required.
BACKGROUND: Many femoral fracture patterns in children cannot be stabilized sufficiently by intramedullary nailing only. Such fractures may require additional cast bracing or cerclage wiring after nailing. To overcome this problem, pediatric Ender nails that can be interlocked were designed to achieve better fracture stabilization. METHOD: Seventeen children (age, 2.5 to 15 years) were treated with this method for unstable traumatic fractures of the femur. The average follow-up period was 11.8 months. RESULTS: All fractures healed within 4 weeks in the mean. There were no major complications. CONCLUSION: This new method prevents shortening and axial deviation of the fractured femur. Start of postoperative mobilization and increase of weight-bearing is mainly determined by the child.
The effect of surgery for femoral neck fracture on whole blood coagulation and the relationship of altered coagulation to deep venous thrombosis were investigated in 250 patients. Whole blood coagulation was measured using thrombelastography preoperatively, in the early postoperative period and at 6-week review. Significant hypercoagulability was demonstrated after surgery and persisted to 6-week review. A significant correlation between hypercoagulability and the development of deep venous thrombosis is demonstrated. Hypercoagulability is shown to be a major factor in thrombosis formation following proximal femoral neck fracture surgery.
The anti-estrogen tamoxifen is the prevalent endocrine treatment in postmenopausal breast cancer patients. However, nothing is known about the long-term effects of the drug on the skeleton as assessed by the occurrence of fractures. We investigated the occurrence of fractures of the femur in patients from a Danish Breast Cancer Cooperative Group (DBCG) trial initiated in 1977 by a linkage of data from the Danish National Registry of Patients with data from the DBCG registry. 1716 postmenopausal women with high-risk breast cancer were randomized to local radiotherapy with or without tamoxifen, 30 mg daily for 1 year. Fifty-one patients in the control group had one femoral fracture and 64 tamoxifen treated patients had one femoral fracture. Eleven patients in the control group had one trochanteric fracture compared to 27 patients in the tamoxifen group (logrank = 5.28. P = 0.022; hazard ratio = 2.12, 95% CL 1.12, 4.01). The results could not be explained by a longer survival in the tamoxifen group nor by bone metastases with pathological fractures. In conclusion, our study suggests that tamoxifen does not seem to offer protection against fractures in old age and may even increase the risk of fractures at particular sites. This hypothesis needs to be disproved or confirmed in other trials.
BACKGROUND: An orthopaedic management/patient-focused care unit (OMPFCU) involving a dedicated orthopaedic-geriatrics liaison team was established at the Royal Brisbane Hospital in 1994 in an effort to safely accelerate rehabilitation of patients with proximal femoral fractures. METHODS: The surgical outcomes of the patients were monitored in order to determine whether accelerated rehabilitation had any significant adverse effects on the surgical outcomes, measured by mortality, readmission to hospital, deep wound infection, fracture union delay, mobility and the revision surgery rate. RESULTS: No significant difference was recorded in mortality and morbidity, deep wound infection and revision surgery rates between patients in the Royal Brisbane Hospital OMPFCU and those in standard care in the orthopaedic surgery wards. CONCLUSION: Accelerated rehabilitation for patients with a proximal femoral fracture in a major teaching hospital can be accomplished safely.
OBJECTIVE: To compare the results of stabilising impending and actual pathological femoral fractures using the long Gamma nail with the published results of other methods. DESIGN: Retrospective study. SETTING: 20 hospitals throughout The Netherlands. PATIENTS: 101 patients with metastases in 110 femurs, which were stabilised with a long Gamma nail. MAIN OUTCOME MEASURES: Functional results and complications. RESULTS: Minimum follow-up was 1.5 years or until death, Mean survival was 12 months (range 0-82). 14 patients died in hospital; 5 had technical complications and fat embolism was suspected in 3 patients. 92% of the patients became mobile and pain was absent or acceptable in 93%. CONCLUSION: The use of the long Gamma nail produces better functional results, fewer technical complications, and an incidence of general complications no different from those reported for other methods.
From July 1990 to December 1991, femoral fractures in seven patients were stabilized using the Ilisarov apparatus. Second-degree open communited fractures in four patients were stabilized primarily by this technique. Three other patients suffered from redislocations following internal fixation (n = 2) or a refracture (n = 1). The average duration of fixation in shaft fractures (n = 3) was 21 weeks, in supracondylar fractures (n = 4), 13.5 weeks. The fixation period we observed was thus shorter than that reported for other external fixation devices. Because of the complications that were noticed, however, the Ilisarov technique should only be used in particular cases.