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.

SourceResearch connectionFrom yearThrough year

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 361 records · Page 20Linked to original sources

PubMed1981

Force and pressure recordings from patients with femoral fractures treated by cast-brace application.

Five patients with midshaft femoral fractures treated by early cast-brace application and ambulation were studied. With the patients in lying and standing postures, force transmitted through the knee hinges, ground reaction and pressure under the thigh cast were measured each week. When standing on the injured limb, the maximum load tolerated increased as the fractures healed and ranged from 39-61% body weight and 97-100% body weight at weeks two and eight respectively. In this posture in three cases, force transmitted across the knee hinges did not exceed 35% body weight or alter significantly throughout healing, the other two reached maxima of 67 and 60% body weight at week five and values decreased to less than 50% at week ten. By week six, each patient was transmitting significant force across the fracture (31, 12, 7, 36 & 55% body weight). Vertical force on the thigh cast due to rigid soft tissue containment was calculated to be between 3.6 and 10.8 X 9.8 Newtons throughout healing in all cases. Force transmitted through the knee hinges and pressure under the thigh cast, increased linearly as the injured limb was loaded.

Adult↗

PubMed1998

One hundred pediatric femoral fractures: epidemiology, treatment attitudes, and early complications.

Analysis of 100 consecutive femoral fractures admitted to our institution revealed an incidence of about 1 fracture per 2,000 children per year. Epidemiologic data may help to promote prevention. Initial treatment was performed by many doctors, thus rendering guidelines to safe and cost-effective management indispensable. In the last decade, growing concern to reduce hospital stays and costs led to new approaches that replaced traction as a therapeutic principle. Today, we consider immediate spica casting a good option for the group 0-5 years old, whereas in the age group 5-12 years old elastic stable intramedullary nailing (ESIN) produces reliably good results. Minor complications were common and could be avoided partially, but they did not affect the good final outcome.

Adolescent↗

PubMed2001

Low-intensity pulsed ultrasound accelerates rat femoral fracture healing by acting on the various cellular reactions in the fracture callus.

Low-intensity pulsed ultrasound (LIPUS) has been shown to accelerate fracture healing in both animal models and clinical trials, but the mechanism of action remains unclear. In fracture healing, various consecutive cellular reactions occurred until repair. We investigated whether the advanced effects of LIPUS depended on the duration and timing of LIPUS treatment in a rat closed femoral fracture model to determine the target of LIPUS in the healing process. Sixty-nine Long-Evans male rats that have bilateral closed femoral fractures were used. The right femur was exposed to LIPUS (30 mW/cm2 spatial and temporal average [SATA], for 20 minutes/day), and the left femur was used as a control. Rats were divided into four groups according to timing and duration of treatment (Ph-1, days 1-8; Ph-2, days 9-16; Ph-3, days 17-24; throughout [T], days 1-24 after the fracture). Animals were killed on day 25. After radiographs and microfocus X-ray computed tomography (muCT) tomograms were taken, the hard callus area (HCA), bone mineral content (BMC) at the fracture site, and mechanical torsion properties were measured, and histological analysis was conducted. Interestingly, the maximum torque of the LIPUS-treated femur was significantly greater than that of the controls in all groups without any changes in HCA and BMC. The multiviewing of three-dimensional (3D) muCT reconstructions and histology supported our findings that the partial LIPUS treatment time was able to accelerate healing, but longer treatment was more effective. These results suggest that LIPUS acts on some cellular reactions involved in each phase of the healing process such as inflammatory reaction, angiogenesis, chondrogenesis, intramembranous ossification, endochondral ossification, and bone remodeling.

Animals↗

PubMed2005

Importance of pre-clinical testing exemplified by femoral fractures in vitro with new bone preparation technique.

BACKGROUND: A new bone preparation technique, using smooth tamps for bone compaction, has increased crucial initial implant stability. However, preparing the femur with bulky smooth tamps, which from size to size increases the same amount in anterior to posterior as in lateral to medial dimensions, has increased the risk of a femoral fracture. This study examined whether compaction also involved an increased femoral fracture risk when using newly developed smooth tamps with a slim anterior to posterior dimension. METHODS: One femur in each pair of 10 cadaver femurs was prepared by the compaction technique using cylindrical reamers and smooth tamps. The contralateral femur was conventionally prepared with conical reamers and toothed rasps. The tamps and rasps differed in design as a proximal lateral tip was only present on the smooth tamps. Using a standardized test protocol, the instruments were driven into the femoral canal in controlled manner by a drop tower. FINDINGS: At maximum test conditions, five of 10 femurs in the compaction group had fractured, as compared with no fractures in the rasping group. All fractures were longitudinal fissures in the greater trochanter, and these fissures were associated with the extended proximal lateral tip of the tamps. INTERPRETATION: Since the lateral fractures in the compaction group were associated with the extended proximal lateral tip of the tamps, it seems that fracture rates are influenced by instrumentation design. Therefore adequate pre-clinical evaluation is warranted prior to the introduction of new implantation techniques.

Aged↗

PubMed1998

The management of elderly patients with femoral fractures. A randomised controlled trial of early intervention versus standard care.

OBJECTIVE: To determine the effect of an early intervention program in an acute care setting on the length of stay in hospital of elderly patients with proximal femoral fractures. SETTING: Acute orthopaedic ward of a large teaching hospital. DESIGN AND PARTICIPANTS: A randomised controlled trial comparing 38 Intervention patients with 33 Standard Care patients. INTERVENTION: Early surgery, minimal narcotic analgesia, intense daily therapy and close monitoring of patient needs via a multidisciplinary approach versus routine hospital management. MAIN OUTCOME MEASURES: Length of stay (LOS); deaths; level of independent functioning. RESULTS: Mean LOS was shorter in the Intervention group than in the Standard Care group (21 days v. 32.5 days; P < 0.01). After adjusting for other factors that could affect LOS (eg, age, sex, pre-trauma functional levels, pre-trauma comorbidity and postsurgical complications), the Intervention program was significantly predictive of shorter LOS (P = 0.01). The Intervention group did not experience greater numbers of deaths, deterioration in function or need for social support than the Standard Care group. CONCLUSION: This early intervention program in an acute care setting results in significantly shorter length of hospital stay for elderly patients with femoral fractures.

Aged↗

PubMed1979

The treatment of femoral fractures by cast-brace and early walking: a review of seventy-nine patients.

Seventy-nine cases of fracture of the femoral shaft treated by cast-brace and early walking have been reviewed. Discrepancy in femoral length was assessed by scanogram. The cases were analysed to relate the incidence of shortening greater than 2 centimetres to the type and site of the fracture, and the time which elapsed from injury until the cast-brace was applied. Such shortening was encountered most frequently when the cast-brace was applied within the first two weeks from injury or after six weeks and in those patients with comminuted fractures of the middle third of the femoral shaft.

Adult↗

PubMed2005

Neglected femoral diaphyseal fracture.

Femoral diaphyseal fractures usually result after trauma of high magnitude and because of this, can be life-threatening injuries or may result in considerable physical disability if not treated with care and caution. Nonoperative treatment of these fractures continues to be popular among the patient population in the Indian subcontinent, which in majority of cases, leads to healing in malalignment, shortening of the limb, chondromalacia patellae, and loss of knee motion. Although the majority of these fractures are being treated by operative methods today, success of the treatment depends largely on the surgeon's familiarity with the procedure or the type of fracture pattern (comminuted or segmental) particularly in a polytraumatized patient. Delayed union and nonunion of femoral-diaphyseal fractures and implant failures usually result after these procedures or the type of injury. The purpose of this study is to discuss various types of neglected femoral diaphyseal fractures and to review the literature on their treatment.

Adolescent↗

PubMed2005

Outcome following stabilization of type B1 periprosthetic femoral fractures.

We present results of internal stabilization of 16 type B1 periprosthetic femoral fractures following total or hemiarthroplasty of the hip. Seven patients had cemented stems, and the rest had cementless, extensively hydroxyapatite-coated stems. Fourteen were managed by a cable-grip plating system, 1 by Dynamic compression plate, and 1 had insertion of cables only. Minimum follow-up was 1 year. Four patients had a major complication: 2 had deep infection; 1 had nonunion requiring amputation; and 1 had persistent hip pain requiring removal of all metalwork, including the hip prosthesis. The average time to healing in the remaining patients was 16.3 weeks. Harris Hip Scores dropped from an average of 86.8 preoperatively to 73.4 on last follow-up. Periprosthetic fractures are a significant injury, with a high risk of complications.

Adult↗

PubMed2003

[Stabilisation of unstable trochanteric femoral fractures. Dynamic hip screw (DHS) with trochanteric stabilisation plate vs. proximal femur nail (PFN)].

The dynamic hip screw (DHS) with trochanteric stabilisation plate (TSP) as the extramedullary power transmission system and the proximal femur nail (PFN) as the means of intramedullary stabilisation are both standard in the treatment of unstable trochanteric femoral fractures in the case of old people. A total of 129 patients (average age: 81,5 years) with 31 A2.2 and A2.3 as well as per-/subtrochanteric femoral fractures were treated by means of osteosynthesis with DHS and TSP (n=64) or with PFN (n=65),and the results plotted in a retro-/prospective study. At low complication rates, the radiological operation results are equally good. 6 revisions were necessary in the case of the DHS with TSP and 4 in the case of PFN. A significantly shorter operation time (44.3 vs. 57.3 min) and a considerably shorter in-patient stay (18.6 vs. 21.3 days) were common with PFN. The application of full-weightbearing immediately after the operation was possible for 97% of the PFN patients and 88% of the DHS patients. In a follow-up 6 months after the operation, the PFN patients displayed a significantly lower pain intensity in the operated leg at the same score for ambulation and the same subjective degree of satisfaction. Unstable pertrochanteric and per-/subtrochanteric femoral comminuted fractures can be treated just as well with PFN as with DHS and TSP. Our study results,however, lead us to recommend treatment with PFN.

Age Factors↗

PubMed1996

Mechanical failure of the intramedullary hip screw in a subtrochanteric femoral fracture.

The Gamma nail, an implant specifically designed for intertrochanteric and subtrochanteric femoral fractures, has been criticized for its high risk of secondary shaft fractures. A modified design, the intramedullary hip screw has recently been introduced to correct this complication. We present a case of mechanical failure of this new implant that occurred in a pathological subtrochanteric fracture. The centering sleeve of the implant became loose and migrated while the head screw penetrated the acetabulum. Refixation was successful.

Aged↗

PubMed1993

The association of age, race, and sex with the location of proximal femoral fractures in the elderly.

A retrospective study of the data on 27,370 hospital discharges of patients who had been admitted to non-federal Maryland hospitals from 1979 through 1988 for a fracture of the proximal part of the femur and who had been at least sixty-five years old at the time of the fracture showed that the ratio of trochanteric fractures to fractures of the femoral neck increased linearly with age in white and black women. For men, this ratio was stable across age-intervals, being slightly more than one in white men and less than one in black men. Black patients who had a fracture of the hip were more likely than white patients to have a subtrochanteric, open, or femoral neck fracture. The rate of occurrence of fractures of the hip was highest in white women; the rate decreased successively in white men, black women, and black men. The higher over-all rate of fractures of the hip in white patients was disproportionately influenced by the much higher rate of trochanteric fractures in these patients.

Age Factors↗

PubMed1992

The floating hip. Ipsilateral pelvic and femoral fractures.

A consecutive series is reported of 17 patients who underwent early surgical treatment for acetabular or unstable pelvic fractures associated with ipsilateral fractures of the femur. Treatment included external and internal fixation, and required careful consideration of the surgical approach and the positioning of the patient. The multiple injuries sustained by these patients required simultaneous procedures by several surgical teams. All the femoral fractures were internally fixed at the initial operation and eight patients had primary definitive treatment of all their other fractures as well. In nine patients the definitive treatment of their other fractures was delayed for an average of 11 days. There were no deaths, and no serious infections. The long-term morbidity resulted from the associated injuries and not from the pelvic or femoral fractures.

Acetabulum↗

PubMed2001

Results of the long Gamma nail for complex proximal femoral fractures.

The results for a series of 35 patients with complex proximal femoral fractures treated with the long Gamma nail are presented. Fracture healing occurred in all surviving patients, but there were four technical problems associated with the implant. Two nails broke associated with delayed union of the fracture necessitating revision of the implant, one fracture of femur at the site of distal locking occurred during surgery and there was one later fracture at the tip of the nail. All but one failures of fixation were revised with another Gamma nail and healed uneventfully. Overall the number of fracture healing complications compares favourably to contemporary implants and improvements in the design and strength of the nail may further improve results.

Adult↗

PubMed2003

Muscle strength in children treated for displaced femoral fractures by external fixation: 31 patients compared with 31 matched controls.

In a prospective study (1993-2000), we measured the isokinetic strength of the quadriceps and hamstring muscles in 31 children aged 5-17 years, on average, 3 (1.5-5) years after treatment for a displaced femoral fracture by external fixation and early mobilization. A group of age-, sex- and weight-matched children without previous injury were used as controls. The hop-index test was used to assess the patient's confidence in the injured limb and was similar in the fractured and unfractured legs as well as in the patients and controls. We measured the peak torque output at 2 angular velocities (60 degrees/s and 180 degrees/s) in the hamstring and quadriceps muscles, using Cybex testing equipment. Torque to body weight ratios were used to compare muscle strength in patients and controls. We found no differences in muscle strength between patients and controls or in the distribution of which leg was stronger, equal or weaker in the patients or controls at any test speed. External fixation and early mobilization seem to prevent residual muscle weakness, which occurs with traction or a cast for femoral fractures in children.

Adolescent↗

PubMed2006

[Surgical treatment of proximal femoral fracture].

In Denmark, 11,000 patients with proximal femoral fractures are admitted to hospital each year, using 2.2% of the national hospitalisation capacity. The patients are generally old and have a high degree of co-morbidities. In Denmark, the 30-day mortality rate is 10%, and on an international level, reoperation rates of 10-20% are reported. This article reports on current treatment stategies, classifications and surgical techniques and presents possible guidelines. The use of specialized centres and accelerated clinical programmes in Denmark is recommended.

Aged↗

PubMed1995

[The effect of bone marrow embolization on the choice of procedure in the stabilization of femoral fractures].

Because of an extended venous drainage system, especially in the supracondylar area, a pressure increase in the femoral cavity results in embolization of the contents of the bone marrow cavity. Bone marrow embolization alone is mostly not apparent clinically but together with cofactors it may result in severe pulmonary damage and occasionally even in death. Cofactors are volume deficit, shock, thoracic and polytrauma and preexisting pulmonary disease. In the field of traumatology a pressure increase in the femoral cavity regularly occurs during unavoidable movement of femoral fragments in traction, during reduction, intraoperatively during intramedullary nailing, and in hip replacement. A hematoma acts as a hydraulic transmitter. Early osteosynthesis within 24 h avoids permanent intravasation of moderate amounts of the contents of the bone marrow cavity. Concerning intramedullary nailing, there are considerable differences between reamed and unreamed nailing. Reaming always leads to high-pressure increases in the femoral cavity, resulting in embolization. Therefore, reaming should not be performed if cofactors of manifestation of pulmonary impairment are present. Unreamed nailing results in less intravasation, but is not entirely harmless, as considerable pressure increases occur in unreamed nailing as well. The gap between the nail and the entrance of the distal fragment is the decisive parameter. Not just the smaller intravasation of bone marrow during unreamed nailing is important. After each reaming process, the bone marrow cavity rapidly refills with blood, which is activated concerning coagulation and pressed into the circulation during the following reaming process. Because of superior bone healing, interlocking nailing is the treatment of choice in diaphysial femoral fractures. As far as the differential indications of reaming are concerned, the discussion is not yet closed. However, reaming should undoubtedly be restricted to a few reaming processes. Before unreamed femoral nailing, the width of the bone marrow cavity must be examined exactly. If the width of the bone marrow cavity, the patient's condition and experience of the surgeon allow unreamed nailing, this procedure can be recommended. As the venous drainage system of the tibia is not important compared to the femur, the question of reaming or not in tibial fractures is not influenced by the danger of embolization, but by soft tissue damage and the stability of interlocking bolts. In patients with femoral fractures and co-factors for the manifestation of pulmonary impairment, the choice of osteosynthesis type should take plating in its improved form into consideration, as this preserves the vascularity of the fragments.(ABSTRACT TRUNCATED AT 400 WORDS)

Bone Marrow↗

PubMed2001

Distal femoral fractures: current treatment, results and problems.

The evolution of treatment for supracondylar femoral fractures has sequentially addressed the difficulties of alignment, articular reduction, stabilization and fracture union. Adequate surgical stabilization and early motion diminished stiffness, while newer indirect techniques in handling periarticular tissues have greatly improved union rates. Indirect methods of reduction require an understanding of anatomy and deformity to avoid malalignment. The problems we currently face are fixation in osteoporotic bone or small distal articular segments.

Bone Plates↗

PubMed1992

A comparison of presenting characteristics of patients with intracapsular and extracapsular proximal femoral fractures.

The presenting characteristics of 1423 consecutive admissions with proximal femoral fractures were prospectively studied, to determine any differences that may exist between patients, dependent on the radiological site of the fracture. Patients with intracapsular fractures were of a lower average age, more mobile, less likely to use walking aids or live in residential accommodation, they also had a considerably shorter length of hospital stay than for those patients with extracapsular fractures. Comparison against previous series shows that the average age of hip fracture patients and the proportion of trochanteric fractures is increasing.

Age Factors↗