Professional liability #10. Treatment of a femoral fracture.
Explore the source record for details and available documents.
Femoral Fractures↗
SEARCH · Search PubMed
Results for “FEMORAL FRACTURES”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Role of dual energy X-ray absorptiometry in monitoring fracture healing in a rat femoral fracture model.
OBJECTIVE: To dynamically monitor the bone mineral density (BMD) and the histomorphological changes during fracture healing in a rat femoral fracture model and to explore the role of dual energy X-ray absorptiometry (DEXA) in evaluating bone fracture healing. METHODS: Sixty three-month-old female Sprague Dawley rats were used to establish right femoral fracture models. The BMD of the callus of the fractured right femur were scanned by DEXA at 2, 4, 6, 8, 10 and 12 weeks after operation, respectively. A light microscope was used to evaluate the callus of each rat at the same time. The corresponding segment of the left femur was taken as a control. RESULTS: The BMD at the fractured site increased significantly during the process of fracture healing, which shows an obvious healing trend. The callus BMDs were 29.5%, 48.3%, 85.3%, and 105.2% of the BMD of the control limb at 2, 4, 6 and 8 weeks after fracture, respectively. There was a significantly difference between the groups. A compatibility on time was found between the BMD and the histomorphological characteristics at the fractured site during the process of fracture healing. The fracture healing was almost completed at 8 weeks after fracture as assessed by its histomorphological characteristics when the callus BMD reached to 105.2% of the BMD of the control limb. The BMD of the distal metaphysis decreased until 12 weeks after fracture. CONCLUSIONS: DEXA can evaluate the mineralization of the callus during the fracture healing process accurately and quantitatively and is more sensitive than plain radiography in detecting impaired bone unions, which indicates that it may play an important role in monitoring fracture healing.
Absorptiometry, Photon↗
External fixation of pediatric femoral fractures.
Fifteen pediatric femoral fractures in 14 patients were treated with external fixation using the EBI Orthofix unilateral external fixator. The average patient age was 8.5 years (range, 3-13 years). There were 7 children with multiple injuries and 7 with isolated fractures. The average duration in the fixator was 63 days; average followup was 34 months. All 15 fractures healed without additional operative intervention. Average angulation at the fracture site was 4.4 degrees in the anteroposterior plane (range, 0 degrees-10 degrees) and 4.6 degrees in the lateral plane (range, 0 degrees-11 degrees). There were 5 pin tract infections, all of which resolved with systemic antibiotics. There was 1 case of refracture in a boy with muscular dystrophy. Ten patients had clinically equal leg lengths, 3 patients had < 1 cm of inequality, and 1 patient had a 1.5 cm discrepancy. External fixation is a well-proven technique for managing pediatric femoral fractures in the child with multiple injuries. It is also an effective means of treating isolated femoral fractures in the pediatric population.
Adolescent↗
A biomechanical study comparing cortical onlay allograft struts and plates in the treatment of periprosthetic femoral fractures.
BACKGROUND: Periprosthetic femoral fractures with well-fixed femoral components can be difficult to manage and internal fixation is usually necessary. This study was designed to determine the effect of cable plate, strut allograft and combined plate and strut allograft fixations of periprosthetic femoral fractures. METHODS: A transverse fracture at the level of the tip of the femoral stem was simulated in six cadaveric femurs. The fracture was fixed with a plate-strut graft construct with and without proximal screws, a plate only construct with and without proximal screws and with both anterior and lateral struts grafts of 12 cm or 20 cm in length. The intact femur and the six constructs were tested using anteroposterior and axial loads to simulate the forces at the hip during gait. The interfragmentary motions were measured with an optoelectronic camera system. FINDINGS: The highest median interfragmentary translations were observed with the plate only construct without proximal screws. No significant differences in median translations were found between the combined plate-strut and the strut-graft alone constructs. Median interfragmentary rotations were largest with the plate only construct and lowest with the plate-strut constructs. INTERPRETATION: The best fracture fixation was achieved with the combined plate and strut graft constructs particularly in combination with the two unicortical screws above the fracture. The plate only constructs may not provide sufficient fixation stability in rotation for the simulated transverse fracture. The within-construct interfragmentary motions were not significantly different except for the plate only constructs. This suggests that the fixation construct type is the determining factor of interfragmentary motion.
Arthroplasty, Replacement, Hip↗
[Osteosynthesis of proximal femoral fractures using short proximal femoral nails].
PURPOSE OF THE STUDY: A group of 147 patients with proximal femoral fractures treated with the use of the proximal femoral nail, manufactured by the Synthes company, in the period between October 1997 and June 2001 were retrospectively evaluated. MATERIAL: The group of 147 patients whose average age was 69 years consisted of 59 men (average age, 59 years) and 88 women (average age, 75 years). The most frequent fracture occurring in 54% of the patients was an unstable pertrochanteric fracture (Kyle III); persubtrochanteric and subtrochanteric fractures were treated in 27% and 19% of the patients, respectively. METHODS: In 1997, a new implant, the proximal femoral nail manufactured by the Synthes company (PFN), was introduced in the Czech Republic. In addition to all advantages of a nail to be implanted intramedullary, it has several other favorable characteristics: its length is 240 mm, pre-drillings is not necessary, it can be dynamically locked, it has a high rotation stability, and mechanical stress concentration on the implant-bone interface is low. This evaluation is based on the type of fracture, the duration of healing, the duration of surgery and X-ray exposure. RESULTS: The patients were followed up at 6 months, 3, 6 and 12 months, and once a year. The fracture healed in the anatomical position by 6 months in 95% of them. The average operative time was 56 min and X-ray exposure lasted on average 1 min. We recorded 14 intra-operative complications in nine patients, which included incomplete reduction in four cases, fixation in distraction in two, incorrect length of screws in one, fracture at the site of distal locking in two and incorrect insertion of femoral neck screws in five cases. Early post-operative complication involved seven cases of hematoma in the operation wound with the necessity to re-operate in five cases. Late complications occurred in two patients and included pseudoarthrosis and necrosis of the femoral head after healing. Most of the complications were found in subtrochanteric fractures. DISCUSSION: The treatment of unstable fractures of the proximal femur is still associated with some failures. The reasons are: disregard for biomechanics, overestimation of the potentials of new surgical techniques or new implants or poor adherence to established procedures. PFN is a novel, modern implant based on experience with the gamma nail. Since relevant literature data are very few, any comparison of our results is very difficult. The lower average age of our group was due to the intentional selection of our patients for this type of surgery. CONCLUSIONS: PFN is an excellent implant for the treatment of unstable fractures of the proximal femur. The terms of successful outcome include a good understanding of fracture biomechanics, correct indication and exactly performed osteosynthesis.
Aged↗
[Treatment of adduction fractures of the femoral fracture with Seppo's fixation device].
Explore the source record for details and available documents.
Aged↗
Proximal femoral fractures in children.
Proximal femoral fractures in children can be divided into three groups: femoral neck fractures, apophyseal trochanteric separations and subtrochanteric fractures. Femoral neck fractures are extremely rare. They are classified according to Delbet and Colonna into four types. The more lateral is the line of the fracture, the better is the prognosis, and the less sequelae occur. The treatment of femoral neck fractures in children is in nearly all cases surgical, only in some pertrochanteric and in the minority of non-complete basicervical fractures conservative treatment can be considered. The surgical treatment is either a closed manipulation with internal fixation, or an open reduction with fixation. The authors prefer closed manipulation, if it is possible to perform. They have themselves treated 5 pathological separations of the femoral head of the coxxa vara adolescentium origin. These injuries are aligned with femoral neck fractures, because they are caused by a traumatic mechanism, and are to be treated like a fracture. Further the authors have treated two cervicotrochanteric fractures by open reduction and 4 patients with pertrochanteric fractures conservatively by skin traction. Apophyseal trochanteric separations are convenient to be treated conservatively, only in case of greater displacement of the greater trochater can an open reduction and internal fixation by traction cerclage be recommended because of the risk of a valgous deformation of the femoral neck. The authors have treated conservatively 3 patients with a separation of the lesser and 2 patients with a separation of the greater tochanter. Subtrochanteric femoral fractures are different from typical diaphyseal fractures.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Neck fracture femoral heads for impaction bone grafting: evolution of stiffness and compactness during impaction of osteoarthrotic and neck-fracture femoral heads.
BACKGROUND: The need for safe bone allografts is increasing and preservation of femoral heads from patients being operated on with hip arthroplasty should be encouraged. However, should we preserve femoral heads from patients operated on for neck fracture as tissue mechanical quality may not be satisfactory? MATERIAL AND METHODS: We compared the evolution of stiffness and compactness of fresh-frozen morselized bone obtained from osteoarthrotic femoral heads and those from neck fractures. Both materials were also compared after freeze-drying and irradiation. We used 6 osteoarthrotic and 6 neck-fracture femoral heads to prepare 4 batches of morselized bone. 18 samples from each batch were impacted in a contained cylinder. Frozen bone grafts were tested after thawing at room temperature for 2 hours and freeze-dried grafts were tested after 30 minutes of rehydration. RESULTS: The stiffness of fresh-frozen neck fracture bone was lower than that of fresh-frozen osteoarthrotic bone at 150 impactions. The stiffness of freeze-dried irradiated bone was higher than that of the fresh-frozen bone and did not differ between osteoarthrotic and neck-fracture bone. INTERPRETATION: Solvent-treated freeze-dried bone from femoral heads procured during arthroplasty for sub-capital hip fractures represents a valuable source of material for allografts, addressing concerns regarding serological testing, medical history and bone quality.
Aged↗
Features of femoral fractures in nonaccidental injury.
Femoral fracture is one of the most common long bone fractures owing to nonaccidental injury, but there is little evidence in the literature about their characteristics. It is important medicolegally to establish a diagnosis of child abuse. Fourteen femoral fractures from definite nonaccidental injury were analysed and compared with 33 femoral fractures caused by definite accident. The age, site, and fracture patterns were carefully studied. Of inflicted femoral fractures, 92.8% (13 of 14) occurred in children younger than 1 year old. On studying the fracture morphology, we conclude that there is no specific roentgenographic site or fracture pattern that allows differentiation between accidental and nonaccidental femoral fractures.
Child↗
Ipsilateral proximal and shaft femoral fractures: spectrum of injury involving the femoral neck.
Medical records and radiographs of 52 patients were studied after inclusion/exclusion criteria were met. The anatomical location of proximal femoral fractures that involved the femoral neck were examined after the primary fracture planes were drawn onto templates of the proximal femur. The AO classification is comprehensive and widely accepted. It has not been used in this injury combination in a large series of patients. Therefore, we classified each fracture by the AO method and then the AO classes were tabulated and analysed. Only three patterns of proximal femoral fractures appeared. The inferior aspect of the fracture line clustered in the inferomedial aspect of the femoral neck above an intact lesser trochanter in each separate pattern: 55 per cent were AO B2.1 (basilar); 35 per cent AO B2.3 (intracapsular); and 10 per cent AO A1.2 (pertrochanteric) fractures). Eleven fractures (21 per cent) were not detected initially. None of these were A1.2, eight were B2.1 and three were B2.3. Despite many proximal femoral fracture types reported in the literature only three fracture patterns were noted in this large study group. A new finding of clustering of these fractures in the inferomedial femoral neck was noted. AO class B2.1 fractures were the most common fractures missed at initial presentation and were the most common type seen.
Femoral Fractures↗
Management of subtrochanteric femoral fractures and metastases using long proximal femoral nail.
We report our initial experience with a new reconstruction nail, the long proximal femoral nail (L.PFN), in the treatment of subtrochanteric femoral fractures and metastases. We performed 52 L.PFN in 49 patients over a period of 18 months with an average follow-up period of 47.7 weeks. Group I consisted of 24 patients, who had L.PFN for traumatic subtrochanteric femoral fractures. Group II consisted of 25 patients, who had L.PFN for femoral metastases and pathological fractures. (Three bilateral.) In nine patients in group I, the fracture was extending to the intertrochnateric region with involvement of the piriformis fossa. Eight patients in group I had open reduction and cerclage cabling of the fracture prior to L.PFN. All the traumatic fractures in group I had united with an average time to union of 19.4 weeks. In eight operations there were technical difficulties with the insertion of proximal locking screws. Five patients in our series had complications but we had no mechanical failures of the implant. L.PFN is a reliable implant for subtrochanteric femoral fractures and metastases. We also showed that open reduction and cerclage cabling of unstable subtrochanteric fractures prior to nailing was not detrimental to fracture healing in our series.
Adult↗
Angulated screw placement in the lateral condylar buttress plate for supracondylar femoral fractures.
Certain supracondylar femoral fractures are not amenable to internal fixation with fixed angle devices. In these instances, the condylar buttress plate is the recommended alternative; however, this is a less rigid device. Because of the decreased rigidity and strength of this device, there is a tendency toward varus angulation and malunion. In six fresh-frozen human knee specimens, segmental osteotomies were created to mimic supracondylar femoral fractures. The medial cortex was completely removed to make the fracture unstable to varus deformity. The fracture was fixed with a lateral condylar buttress plate using 4.5 mm screws. Each specimen was tested once with all the screws installed perpendicular to the plate, and again with the middle screw, just proximal to the fracture, angled 45 degrees diagonally across the fracture into the subchondral bone of the medial femoral condyle. For the construct with all screws placed perpendicular to the buttress plate, the initial stiffness was 410 N/mm, and after 1000 cycles it was 230 N/mm. With a screw placed diagonally across the fracture site, stiffness increased to 833 N/mm on the first cycle, and 796 N/mm after 1000 cycles. In all specimens with the screws placed perpendicular to the plate, the distal fragment had a permanent varus deformity after 1000 cycles, under no load, of 0.91 mm. For the diagonal screw condition, the average magnitude for all six specimens was 0.42 mm. This simple means of screw angulation in the plate strengthened the overall construct to resist the tendency toward varus deformity. The attractive features include the ease of application, and the use of an existing construct.
Aged↗
[The value of Ender nailing in hip para-articular femoral fractures in gerontologic traumatology. Ender nailing--hip para-articular femoral fractures--gerontologic traumatology].
Nailing according to Ender is one of several competing methods of osteosynthesis for treating per- and subtrochanteric fractures of the femur in geronto-traumatology. Within 5 years we have treated 62 geriatric patients by this procedure. The average-age of our patients was about 76 years. Only 20 of them were able to be examined after a time of ca. 37 months post operationem. Intraoperative complications were backing out of the femur corticalis at the entry hole, followed by perforations of the head or neck of the femur. In one case we saw a supracondylar fracture. In the postoperative period we mostly found dislocations of the nails to cranial or caudal. Moreover there were one wound infect and one pseudarthrosis. The mortality rate came to 6.5% and was never caused by the method. When leaving the hospital the majority of the elderly patients was mobilized and able to walk. In spite of reduction of function of hip and knee and external rotation deformity and shortened legs the patients declared to be content with the result of the operation. Important geronto-traumatological aspects of the Endernailing-method could be seen in the simple procedure, the short operating time, a minimal surgical trauma and a diminishing of the risk of the mostly multi-morbid patients. Regarding the great number of specific complications competing methods are going on to be preferred. Meanwhile the application of Endernails is an exception in geronto-traumatology.
Aged↗
Technique and considerations when using external fixation as a standard treatment of femoral fractures in children.
Femoral fractures in children can be treated effectively and with a low complication rate by using external fixation. However, as with most treatment modalities there is a learning curve to be considered. The aim of this paper is to report "tricks" and different considerations that we have learned to be of value based on experience gained during a prospective and consecutive study of 98 femoral fractures in children aged 3-15 years. Our experience is based on the use of a unilateral fixator with the option to apply axial dynamisation. Traction prior to operation is not needed if the child is operated on within 24h. During surgery a traction table will prevent significant malrotation and facilitate reduction prior to insertion of the pins. Four 4 or 5mm pins are sufficient for adequate stability in children. Transverse skin incisions are preferable for pin insertion as the scars become smaller and the soft tissue irritation during activity is less when compared with longitudinal incisions. Unrestricted weight-bearing can be allowed. A nihilistic approach to pin site care with daily showers is as effective as more aggressive treatment with local antiseptics. Pin infections can occur but are mild and can be treated locally or with a short period of antibiotics taken orally. Pin-loosening and deep infections are very uncommon. By using external fixation, malunion, overgrowth or delayed union can almost be avoided completely. Re-fractures are rare and occur only after significant trauma. Treatment time is relatively short. No physiotherapy or further protection of the leg is necessary during or after healing.
Adolescent↗
[Surgical treatment for proximal femoral fracture in osteoporosis].
Proximal femoral fracture is one of the common fractures in osteoporosis, and the incidence of it is rising. Early restoration of the patient's preinjury activity level is the primary goal in the treatment of proximal femoral fractures in the elderly to avoid complications. Surgery should be carried out as soon as is practicable. Proximal femoral fracture is classified into femoral neck fracture (intracapsular fracture) and trochanteric fracture (extracapsular fracture). The standard of care for undisplaced femoral neck fracture is primarily internal fixation, and hemiarthroplasty for displaced neck fracture in elderly patients. Internal fixation is indicated for trochanteric fractures.
Aged, 80 and over↗
The use of the supracondylar nail in the management of femoral fractures in the presence of other femoral implants in the very elderly.
In a retrospective study we review the use of the supracondylar nail for the treatment of distal femoral fractures above existing knee prostheses or below upper femoral implants in a very elderly population of mean age 85. Over a 2 year period we have used the Smith and Nephew supracondylar nail to stabilise seven distal third femoral fractures either distal to a femoral implant (six cases) or proximal to a total knee replacement. One patient died soon after surgery, one patient had an extension of the fracture proximal to the nail but the others made an excellent functional recovery with early mobilisation of the knee. We recommend the use of the supracondylar nail in the management of these difficult cases. The very elderly patient benefits from the early and stable fixation of these fractures.
Aged↗
Comments on "Prediction of femoral fracture load using automated finite element modeling" by J.H. Keyak et al. and "Prediction of femoral fracture load using finite element models: an examination of stress- and strain-based failure theories" by J.H. Keyak et al.
Explore the source record for details and available documents.
Automation↗
The results of quadricepsplasty on knee motion following femoral fractures.
Knee motion following femoral fractures is often less than satisfactory. Surgical procedures to increase knee motion are rarely done. This paper presents a series of nine patients who had severe femoral fractures, primarily in the distal third. Once union was obtained, all patients had knee flexion incompatible with normal gait (average 30.2 degrees). All patients underwent a quadricepsplasty at Rancho Los Amigos Medical Center. Eight of the nine achieved knee flexion allowing normal gait (average 78 degrees). This paper presents our indications, methods, results, and complications in performing quadricepsplasty to achieve knee flexion following femoral fractures.
Adult↗