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At least 37 records · Page 2Linked to original sources
PubMed1982

[Femur remodelling procedures following osteotomies at the coxal end of the femur in the treatment of congenital dislocation of the hip (author's transl)].

This paper was prepared on the basis of 801 case histories (1019 hips) of children treated for congenital dislocation of the hip in our clinic during the last 25 years. Over the years a variety of surgical methods have been employed in the clinic in the treatment of congenital dislocation of the hip, such as open repositioning (with detorsion osteotomy), reconstructive repositioning after Colonna-Zahradnicek, and in recent years open repositioning with pelvic osteotomy. All these interventions were always accompanied by osteotomy of the coxal end of the femur. The type of osteotomy performed depended on requirements: detorsion osteotomy without altering the diaphysis-collum angle (CCD), detorsion varisation adduction osteotomy with or without shortening of the femur. If the need for detorsion osteotomy is completely beyond doubt, we believe that adduction is usually unnecessary and sometimes even detrimental, especially in cases with preoperative growth disturbances of the proximal epiphysis and metaphysis. In none of the cases with permanent inhibition of growth of the acetabular margin did the adduction operation (varisation) have a favorable effect on hip development. Detorsion osteotomy without adduction (and if necessary with abduction) and with simultaneous pelvic osteotomy is the best point of departure for subsequent physiological development of the hip in children.

Acetabulum↗
PubMed1980

[The stresses in femur. I. Intact femur without consideration of the iliotibial tract (author's transl)].

Stresses in femur under different load conditions were computed with the finite element method. The computer model was composed of 1950 spatial elements. The calculated results were confirmed using 34 strain gauge rosettes, attached on the femur surface. The load conditions were chosen as at the stance phase of walking and as standing on two legs. Additionally, the effect of joint forces under different directions were investigated. It is the main conclusion of this work that the computed quantitative results are only relevant when the geometry and the material properties of the metaphysical bone are copied exactly for the computer model.

Biomechanical Phenomena↗
PubMed2001

Tall cell papillary thyroid carcinoma metastatic to femur: evidence for thyroid hormone synthesis within the femur.

A 67-year old man with a 3-month history of left hip pain had a history of Graves disease, treated with 131I 20 years before admission, and papillary thyroid carcinoma, treated with cervical lymphadenopathy 9 years before admission. Removal of a 3.5- x 5-cm mass from the left femur revealed it to be a tall cell variant of papillary thyroid carcinoma. Removal of this mass resulted in his thyrotropin level increasing from 2 (presurgery) to 23 mIU/mL, whereas his thyroxine level simultaneously decreased from 5.79 (presurgery) to 2.29 microg/dL 12 days after surgery despite continuation of levothyroxine of 0.137 mg/day. On histological examination, the tall cell variant in the femur was producing abundant thyroglobulin. This first case of a metastatic papillary thyroid carcinoma in bone producing thyroid hormone to the extent that the patient became hypothyroid after removal of this metastasis illustrates that metastatic thyroid lesion(s) may produce significant amounts of thyroid hormone.

Aged↗
PubMed2001

[Effect of osteotomy metal plate anastomosis with the femur on stimulation of lower femur growth in children].

The aims of this study were (1) to examine structural, electrostatic and thermal changes taking place in the vicinity of a metal plate; (2) to establish factors that affect the growth of the operated extremity; (3) to quantify the extent and dynamics of growth enhancement depending on retention time of the plate and distance of the plate from growth cartilage; and (4) to draw practical conclusions. The study consisted of an experimental and a clinical part. The experimental part was done in 45 children aged 2 to 14 years and included histology of tissues sampled from the vicinity of bone fixation, examination with a thermographic camera of temperature distribution around the operated hip joints, and measurements of the electric potential between the plate stabilizer and femur. In the clinical part, an orthopedic examination was performed in 100 children treated surgically between 1990 and 1993 at the Department of Pediatric Orthopedics of the Pomeranian Academy of Medicine. In order to reveal any differences in limb length and to verify the measurements done with a tape, AP radiograms of femoral bones with both epiphyses were obtained. The following conclusions were drawn from the results: (1) In the vicinity of the metal plate, processes of remodeling and destruction take place, most evident in the area of contact between the plate and bone; (2) Brown amorphous deposits of iron were present in all samples from the vicinity of bone fixation; (3) Temperatures near the operated joint were highest during the first six months after surgery and gradually decreased thereafter; (4) The electric potential between the plate and bone increased with time, but this did not enhance growth of the operated extremity; (5) Placement of the horizontal arm of the plate near the growth cartilage of the femoral head enhanced growth of the operated extremity; (6) Enhancement of growth was greatest in children operated between 2 and 10 years of age and growth was distinguished by regular increase in length during the first 12 months from surgery; (7) Fixation of the osteotomy of the proximal femur in children may be one of the causes of enhancement of growth of the operated extremity. Early removal of the fixation device after healing of the osteotomy may arrest further growth of the extremity; (8) Coexistence of Ehlers-Danlos syndrome does not essentially influence enhancement of growth of the operated extremity.

Adolescent↗
PubMed2006

[Finite Element Analysis (FEA) for the structure capacity of proximal femur during falling--(II). The effects of falling configuration and load locations on the structural capacity of the proximal femur].

The effects of loading conditions on the structural capacity of the proximal femur were investigated parametrically by Finite Element Analysis (FEA) combined with Hoffman failure criterion. The loading conditions included the fall configuration angles, load locations and the friction resistance in hip joint. The results of this parametric study revealed that the load locations are the keys to determining the structural capacity of the proximal femur. There are two low peaks of the structural capacity when the loads are applied to femoral head. If the impact load were applied in this area, the fracture risk would be great. The frictional resistance of the hip joint can severely affect the failure load, which has far reaching implications in terms of osteoarthritis.

Accidental Falls↗
PubMed1989

[Surgical treatment of unstable trochanteric fractures of the femur. II. Elastooptic and tensometric studies of the isolated femur and fixed bones in trochanteric fractures using angular or intramedullary Y nails].

Here are presented the results of investigations on the isolated femur and after osteotomy the re-enacting of experimental 2nd degree trochanteric fractures. The connection of fractured bone fragments has been performed with the use of the angular or intramedullar Y nail. It has been stated that pressures (overload 2000 N) on the fracture surface in the bone connected by the use of the intramedullar Y nail are lower than the bone tension prior to fracture in the same place. So far as the angular nail is concerned the connections made by the use of that nail is characterized by lower pressures than tensions prior to fracture (overload 1000 N) and is 20% higher than tensions in the site of hypothetic fracture (overload 2000 N). Moreover, the intramedullar Y nail transfers the pressure below the site of the trochanteric fracture cross-section, relieving the pressure of the fracture site. The length of the intramedullar part of the Y nail is equal to 3/4's of the femur length and is sufficient for stabilization of post-fracture bone fragments.

Bone Nails↗
PubMed1977

Necrosis of the proximal epiphyseal plate cartilage of the femur following detachment of the perichondral ring. Its relationship to the etiology of proximal epiphysiolysis of the femur.

A histological study of the proximal epiphyseal plate cartilage of rabbit femurs following detachment of the perichondral ring was performed. 15 animals were used, 5 of which being controls. Slight to severe necrotic changes in the plate were present in 9 out of 10 animals. In severe necrosis there was formation of fissures similar to those seen in human femoral epiphysiolysis. The necrosis was considered ischemic in nature and due to the detachment of the perichondral ring with involvement of the blood supply for the femoral epiphysis. Also the epiphyseal and metaphyseal bone marrow and bone tissue, as well as the articular cartilage, presented necrotic changes in a few animals. Such necrosis of the epiphyseal plate may be a factor in the pathogenesis of human proximal epiphysiolysis of the femur.

Animals↗
PubMed1980

Articulated prosthesis for the head of the femur in subcapital fractures of the neck of the femur.

The introduction of christiansen's prosthesis for the head of the femur has altered the balance between the two alternative surgical solutions for subcapital fractures of the neck of the femur (osteosynthesis and endoprosthesis). The writers report their results on the first forty-five patients treated surgically with the new prosthesis, illustrating its functional advantages as compared with the "single block" endoprosthesis. The risk of wear and tear of the acetabulum is practically abolished.

Adult↗
PubMed1981

[Classification of fractures of the distal distal femur - late results of 31 supracondylar fractures of the femur treated by surgery (author transl)].

At the 20th annual meeting of the Austrian Society of Surgeons in Innsbruck (1979) a new scheme of classification for fractures of the femur was established. The advantages of this scheme are outlined. Own experiences with 31 supra-diacondylar fractures of the femur are reported; the late results after internal fixation are discussed.

Adult↗
PubMed2001

[Experimental examination for optimized stabilisation of trochanteric femur fractures, intra- or extramedullary implant localisation and influence of femur neck component profile on cut-out risk].

INTRODUCTION: Fractures of the proximal femur are typical injuries of the elderly. Therefore immediate restoration of weight-bearing capacity and prevention of local complications with the need for of secondary surgical procedures are very important. METHODS: In an experimental test the weight-bearing capacity under alternating load up to 2,000 N and 4,000 cycles was analysed in the newest implants for extramedullary fixation (the DHS with lateral buttress plate, DHS) and for intramedullary fixation (the gliding nail, GN). If no instability occurred a static maximum load test was performed. To avoid the influence of other variables the tests were performed with sowbone femora with A2, A31, (AO classification) subtrochanteric reversed and subtrochanteric transverse osteotomies. To analyse the influence of long term alternating load and of the biological bone, a pair of cadaver femora were tested with 100,000 cycles of 2,000 N alternating load after GN and DHS osteosynthesis. In a second examination the influence of the profile of the femur neck component on the migration and cut-out risk was tested. Nine head and neck parts of sowbone femora with a A2 osteotomy 1,000 alternating load tests at 1,000 and 1,500 N were performed after GN I beam plate, gamma nail and PFN screw fixation. Additionally, three pairs of cadaver femora were tested with 6,000 cycles from 1,000-3,500 N of alternating load comparing GN vs gamma, GN vs PFN and gamma vs PFN to avoid influence of the biological variability on the ranking. RESULTS: The weight-bearing capacity of the GN (4,230-5,557 N) was about 100% higher than that of the DHS (2,465-3,049 N). The total deformation was 1/3 higher for the DHS (17.3 +/- 2.06 mm) than for the GN (10.73 +/- 4,33 mm). After 100,000 alternating load cycles no instability and a total deformation of 13.3 mm was found for the GN, but for the DHS instability occurred after 15,800 cycles. The migration of the I-beam GN plate at 1,000 N in sowbone femora was 0.7 mm for the gamma screw 1.69 mm and for the PFN 2 mm but one cut-out was observed. At 1,500 N the difference are even higher, all three PFN showed a cut-out and in two of the three gamma screws rotation of the head and neck around the screw was observed. In the cadaver tests similar differences were found with a migration at least double that of the GN I beam plate for the gamma screw and the PFN double-screw fixation. There was no difference between the gamma and PFN fixation in the cadaver pair test.

Aged↗
PubMed1980

Total femur replacement in sarcoma of the distal end of the femur.

Five patients with sarcoma of the distal end of the femur were treated by a total resection of the femur and its replacement by an endoprosthesis. This was to preserve the body image, prevent mutilation and permit independent ambulation. A chemotherapy program was established with administration of a high dose of methotrexate plus citovorum factor, adriamycin and vincristine. surgical removal of pulmonary metastases and other local recurrences was performed where and when possible. The functional results were excellent in four and poor in the remaining patient. All of the patients rapidly achieved physical rehabilitation and developed a stable and painless gait. This approach to the treatment of osteogenic sarcoma attempts to eliminate the primary tumor, the micrometastases and the overt metastatic disease, leaving the patient to follow as normal a life a possible, which is not the case when a high thigh amputation or a hip disarticulation is performed.

Adult↗
PubMed2002

[Growth prognosis after para-epiphyseal tangential epiphysial injuries of the lower extremity exemplified by the distal femur: outcome after injuries of epiphyses of the distal femur].

Fractures of the distal end of the femur are rare. Premature partial closure of the physis may occur after metaphyseal fractures. After epiphyseal fractures it has a high incidence of occurrence. The cause of physeal arrest is not known. Stimulation of the physes ends in leg length discrepancy and was seen in 50% of all cases. Spontaneous correction of an axis deviation is possible after antecurvation up to an age of 5 years. But this should be only accepted during therapy of metaphyseal fractures of the distal femur. Side-to-Side deviations remodel in all cases. Aim of therapy in distal epiphyseal fractures should be an anatomical reduction and a definitive retention. Screw osteosynthesis seems to have an advantage.

Adolescent↗
PubMed1989

[Surgical treatment of unstable trochanteric fractures of the femur. IV. Evaluation of the surgical treatment of trochanteric fractures of the femur using intramedullary Y nails].

Here is shown a method of operating a trochanteric fractures of the femur by use of a modified intramedullary Y nail. During a period of 18 months this method was performed on 36 patients with unstable trochanteric fractures. It was established that this operating procedure is simple, from a technical point of view. It ensures excellent stabilization of bone fragments in all types of trochanteric fractures, including fractures of the IV degree, as well as enabling the patient to be completely weight bearing immediately after operation on the injured extremity. Stabilization of bone fragments in trochanteric fractures can be achieved due to the fact that part of the intramedullary nail is 3/4 the length of the femur. The possibility of early weight bearing on the operated extremity caused that 70% of operated patients regained efficiency of movement similar to efficiency prior to fracture of the extremity, 6 weeks after being operated on.

Adult↗
PubMed1979

The use of Kiton Fast Green to measure the viability of the head of the femur after fractures of the neck of the femur.

An intravital staining method was used to predict the viability of the femoral head at operation in 36 patients with fractures of the neck of the femur. Life was predicted in 18 heads, death in 16 and in 2 there was some doubt. In the group which was predicted to be live, 15 fractures united uneventfully, 1 developed late collapse and 2 became infected and died. Of the heads predicted to be dead, 3 united without evidence of necrosis, four had radiological changes suggesting that necrosis had been followed by revascularization and 10 required further operations. Histological evidence was later obtained in 19 cases. Of 6 heads predicted to be live, 4 had united without evidence of necrosis, 1 showed necrosis and collapse and 1 was infected and dead. Of the heads predicted to be dead, 8 were dead, 4 showed revascularization taking place and 1 showed no evidence of bone necrosis. Intravital staining is a relatively easy technique but has limitations as a means of predicting the clinical outcome.

Adult↗
PubMed2000

Cancellous impaction grafting in the human femur: histological and radiographic observations in 6 autopsy femurs and 8 biopsies.

6 whole postmortem femurs and 8 femoral biopsies were studied histologically, 3 months to 8 years after cancellous impaction grafting with a cemented stem for aseptic loosening. All stems were stable. Radiographs showed cortical healing in 5 cases, trabecular remodelling in 1, and trabecular incorporation in 9. There was a radiolucent line in 1 case. The histology varied. There was always a viable cortical shell around the grafted area. 1 patient showed complete bony restitution. The others still had varying amounts of remaining graft in the neo-medullary cavity, even after 8 years. The graft particles were usually embedded in dense fibrous tissue, thus forming a supporting composite tissue capable of carrying load. There was no time-dependent deterioration in the histological appearance. Radiographically, cortical healing and trabecular remodeling corresponded to viable bone. The lack of a radiolucent line said little about the viability of the tissue closest to the cement. The radiographs did not detect thin soft tissue membranes. Radiographic criteria used to assess primary total joint replacement do not necessarily apply to impaction grafting, and radiographic changes should be interpreted cautiously, especially as regards tissue viability.

Aged↗
PubMed2005

Fetal age assessment based on femur length at 10-25 weeks of gestation, and reference ranges for femur length to head circumference ratios.

BACKGROUND: The aim of the present study is to establish new reference charts for gestational age assessment based on fetal femur length (FL), and new reference ranges for FL to head ratios at gestational weeks 10-25, and to determine the effect of maternal and fetal factors on these charts. METHODS: Six hundred fifty low-risk women with regular menstrual periods and singleton pregnancies were recruited to a prospective cross-sectional study after obtaining written consent. FL, outer-outer biparietal diameter (BPD), and head circumference (HC) were measured at 10-25 weeks of gestation. We used regression analysis in order to construct mean curves and to assess the effect of maternal and fetal factors on age assessment. RESULTS: The new chart for age assessment by means of FL was based on 636 measurements. The 95% CI of the mean corresponded to <1 day. The variation between the mean and the 90th percentile was 5, 6, and 7 days at 13, 18, and 23 weeks, respectively, similar to the results when using BPD or HC. Maternal age modestly influenced gestational age assessment (1.3 days/10 years, P = 0.005), whereas smoking, height, body mass index, multiparity, fetal sex, cephalic index, and breech presentation had no impact. Reference charts for FL to head ratios have been presented. Maternal age, fetal sex, and cephalic index influenced the FL/BPD ratio, whereas only fetal sex influenced FL/HC. CONCLUSIONS: Fetal age assessment based on FL is an equally robust method as using HC. FL/HC is a more robust ratio to characterize fetal proportions than is FL/BPD.

Adolescent↗
PubMed1992

Biparietal diameter/femur length ratio and actual femur length/expected femur length ratio: a sonographic screening method for Down's syndrome.

Several ultrasonographic signs have been described in second-trimester Down's syndrome fetuses. Previously published reports have shown that fetuses affected with Down's syndrome have normal biparietal diameter (BPD), high BPD-to-femur length (FL) ratio, and low actual FL-to-expected FL ratio. A retrospective comparison of the BPD-to-FL ratio and actual FL-to-expected FL ratio was made between 3 fetuses with Down's syndrome diagnosed prenatally by second-trimester amniocentesis and 189 normal fetuses with gestational age varying from 13-25 weeks who were seen in the Ultrasound Unit of Department of Obstetrics & Gynaecology, Chulalongkorn Hospital between January 1, 1989 and May 31, 1990. The sensitivity of BPD-to-FL ratio and actual FL-to-expected FL ratio as a screening technique for Down's syndrome in this study was 66.7 and 100 per cent, with a specificity of 93.4 and 89.2 per cent respectively. These sonographic parameters appear to be a useful screening method for Down's syndrome.

Down Syndrome↗