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PubMed1987

Radiographic analysis of the Brooker-Wills interlocking nail in the treatment of comminuted femoral fractures.

Forty-three patients with 43 comminuted femoral shaft fractures treated with the Brooker-Wills interlocking nail were followed through bony union to determine the device's ability to maintain length and rotational control of these difficult injuries. Only severely comminuted fractures, types III and IV, were included. Implant complications were also studied. Average shortening for type III and type IV fractures measured 0.43 and 0.51 cm, respectively. Overall average shortening measured 0.47 cm (range, 0.0-2.2 cm). Maximal shortening occurred in a 72-year-old osteopenic female. Six of the 23 femurs stabilized with the smaller 13- and 14-mm-diameter nails shortened more than 1.0 cm, whereas lesser degrees of shortening tended to occur with larger-diameter implants. The proximal locking diagonal screw provided adequate proximal control and was never found to be the cause of fracture shortening. Rod deformation occurred in nine patients (21%) and was seen only in 13.0- and 14.0-mm-diameter rods. The distal lock was found to control rotation clinically but played only a minor role in preventing shortening. Distal shortening appeared to be controlled by bone-rod contact at the metaphysis, as nailings within 0.5 cm of the epiphyseal scar resulted in the least amount of shortening. Although this intramedullary device produced adequate clinical and radiographic results in comminuted femoral shaft fractures in the young, multiply injured patient, we caution against the use of the 13.0- and 14.0-mm implants. In addition, the efficacy of this implant is unproved in the osteopenic patient.

Adolescent↗
PubMed2003

Sub- or intertrochanteric fracture following screw fixation of an intracapsular proximal femoral fracture: true complication or technical error?

PURPOSE: To review, retrospectively, the possible causes of sub- or intertrochanteric fractures after screw fixation of intracapsular fractures of the proximal femur. METHODS: Eighty-four patients with an intracapsular fracture of proximal femur were operated between 1995 and 1998 by using three cannulated 6.25 mm screws. The screws were inserted in a triangular configuration, one screw in the upper part of the femoral neck and two screws in the inferior part. Between 1999 and 2001, we use two screws proximally and one screw distally. RESULTS: In the first series, two patients died within one week after operation. Sixty-four fractures healed without problems. Four patients developed an atrophic non-union; avascular necrosis of the femoral head was found in 11 patients. Three patients (3.6%) suffered a sub- and/or intertrochanteric fracture after a mean postoperative time of 30 days, in one case without obvious trauma. In all three cases surgical revision was necessary. Between 1999 and 2001 we did not observe any fracture after screwing. CONCLUSION: Two screws in the inferior part of the femoral neck create a stress riser in the subtrochanteric region, potentially inducing a fracture in the weakened bone. For internal fixation for proximal intracapsular femoral fracture only one screw must be inserted in the inferior part of neck.

Adult↗
PubMed1987

Femoral fracture following hip arthroplasty.

In 1,961 primary total hip arthroplasties performed during a 14-year period, 11 proximal ipsilateral femoral fractures occurred postoperatively. Seven were located distally to the tip of the femoral stem; none was a comminuted fracture. Six of the fractures were primarily revised with a long-stem prosthesis. The results after 5(1-8) years were good.

Aged↗
PubMed1991

The ASNIS guided system for fixation of subcapital femoral fractures.

We report a prospective, consecutive series of 84 patients with 86 subcapital femoral fractures treated by internal fixation using ASNIS cannulated screws. At 1 year the clinical and radiological failure rate was 15 per cent. The failure rate was significantly influenced by age over 75 years, dementia, and fracture displacement (P less than 0.001).

Adult↗
PubMedDate not supplied

Retrograde nailing of femoral fractures distal to previous osteosynthesis.

As the proportion of elderly in the population grows, the incidence of femoral fractures distal to previous proximal osteosynthesis is increasing. When the gap between two rigid load-bearing fixations consists of osteopenic bone, the risk of further fractures increases. Herein the authors describe a load-sharing device that stabilizes the fracture and eliminates the osteopenic gap, allowing early mobilization and rapid return to the preinjury level of activity.

Aged↗
PubMed2006

Expandable intramedullary nailing for tibial and femoral fractures: a preliminary analysis of perioperative complications.

OBJECTIVE: To report the results of using the expandable nailing system in the treatment of femoral and tibial shaft fractures. DESIGN: Prospective, cohort series. SETTING: Two level-1 university trauma centers. PARTICIPANTS: Forty-eight patients with acute, traumatic diaphyseal fractures of the tibia or femur. INTERVENTION: Internal fixation of lower extremity long bone fractures using expandable intramedullary nailing. MAIN OUTCOME MEASUREMENTS: Perioperative complications and time to healing. RESULTS: Forty-nine long bone fractures were treated: 22 femoral fractures (OTA classification: 4 type A1, 6 A2, 7 A3, 1 B1, and 4 B2) and 27 tibial fractures (OTA classification: 4 type A1, 11 A2, 9 A3, 0 B1, and 3 B2). There were 13 open fractures and 37 closed fractures. Healing occurred in 37 (75%) fractures without additional interventions. There were 2 tibial delayed unions and 1 femoral and 1 tibial nonunion. Five tibial shaft fractures and 6 femoral fractures shortened by 1.0 cm or more postoperatively. In 3 tibias and 4 femurs, shortening occurred after fractures judged to be length-stable became unstable because of fracture propagation during nail expansion. Five tibias and 3 femurs were converted to standard locked nails because of shortening. The average time to healing, excluding nonunion, was 15 weeks in the tibia and 16 weeks in the femur. The expandable nail resulted in an unplanned reoperation in 12 cases (25%). CONCLUSION: We found a high complication rate because of shortening, which was independent of fracture classification. Consequently, we cannot recommend the use of an unlocked, expandable nail in diaphyseal fractures of the femur or tibia.

Female↗
PubMed2002

Altered venous function and deep venous thrombosis following proximal femoral fracture.

The effect of surgery for femoral neck fracture on lower limb venous blood flow and its relationship to deep vein thrombosis was investigated in 179 patients. Blood flow was measured using strain gauge plethysmography before surgery, in the 1st week after surgery, and at 6 week review. There was a significant reduction in both venous outflow and venous capacitance, affecting both fractured and non-fractured legs but significantly greater in the fractured leg. Venous function remained significantly impaired in both lower limbs 6 weeks after surgery. There was a significant correlation between the reduction in venous function and the development of deep vein thrombosis.

Aged↗
PubMed1998

Femoral fractures in the elderly treated with an unreamed titanium nail.

We present a review of 28 femoral fractures in 28 elderly patients treated with an unreamed titanium intramedullary nail (AIM femoral nail, ACE medical, Figure 1). The series included 11 male and 17 female patients with an average age of 74.5 yr (range 63.5-93 yr). One fracture was open and the rest, closed (six pathological). Average follow up was 6 months (range 4.5-21 months). Mean time to bony union was 19 weeks (+/- 3.5). The union rate was 91 per cent with two delayed unions; one was a subtrochanteric pathological fracture and the other a diaphyseal fracture. Shortening of 2 cm occurred in one patient and one had malrotation. There was no implant failure in our series either with the screws or the nails. We feel that titanium unreamed intramedullary femoral nailing is an effective way of treating subtrochanteric and shaft fractures of the femur in old and frail patients.

Aged↗
PubMed1990

[Subtrochanteric femoral fracture].

This is a report concerning 26 cases with subtrochanteric femoral fractures treated by "Ender" nailing. This operation can be performed quickly and allows early mobilisation of the patients. Most of the fractures consolidate within three months. Motility of knee and hip joint was good in the follow up group of eleven patients.

Adult↗
PubMed1994

Incidence of intraoperative femoral fracture. Straight-stemmed versus anatomic cementless total hip arthroplasty.

The authors report the incidence of intraoperative femoral fractures (16 cases) occurring during the course of 395 cementless total hip arthroplasties performed at the Rizzoli Orthopaedic Institute between November, 1980 and June, 1991. The straight stem (Lord prosthesis) caused an intraoperative fracture in 18% of the cases, whereas the anatomic stem (An.C.A.) caused a fracture in only 1.5% of the cases. An intraoperative fracture occurred in 13% of patients with osteoporosis and only in 1.4% of those with normal mineralization of the proximal femur. Seven cases required circlage wiring; one was treated with interfragmentary screws (in the diaphysis). The remaining patients were treated with casting or delayed weight-bearing. Fifteen fractures consolidated within an average of 10 weeks. One case treated with circlage wiring and screws resulted in a nonunion. After 7 months, internal fixation with a plate and screws was performed with consolidation 5 months later. All stems were radiographically stable at an average follow-up of 40 months.

Female↗
PubMedDate not supplied

Accelerated rehabilitation after proximal femoral fracture: a randomized controlled trial.

This randomized controlled trial compared accelerated rehabilitation after surgical treatment of proximal femoral fracture with conventional care and was conducted in a general hospital in an outer urban area. Participating were 261 sequentially admitted patients over the age of 50 years who met predetermined inclusion criteria and all were followed up until death or 4 months after fracture. Patients who were treated with the accelerated rehabilitation programme had a 20% reduction in length of hospital stay. Improved physical independence (as measured by Barthel Index) was observed after fracture in accelerated rehabilitation programme patients with limited pre-existing disability. Non-nursing-home patients receiving accelerated rehabilitation were also less likely to be discharged to nursing-home care or die in hospital. Accelerated rehabilitation led to a substantial reduction in length of hospital stay with a modest short-term improvement in level of physical independence and accommodation status after discharge.

Activities of Daily Living↗
PubMed1978

Changes in serum alkaline phosphatase after femoral fractures.

Osteomalacia may be a contributory factor in some patients in the development of fractures of the femoral neck and complicate the subsequent management. The level of serum alkaline phosphatase is often valuable in the diagnosis of metabolic bone disease but rises after any uncomplicated fracture, and since such a rise may limit the diagnostic usefulness of this measurement in detecting osteomalacia its extent was assessed in 106 patients. In the majority serum levels were normal on admission, rising after seven to nine days to reach a maximum within a month after fracture. Elevated levels on admission were found in patients with osteomalacia, liver damage or where there had been a delay of several weeks between injury and admission. In a small number of patients normal levels on admission subsequently reached very high values, usually in association with comminution or instability of the fracture. Elevated levels persisted for six to twelve weeks after fracture, the major influence upon the level at this time being the maximum value achieved rather than the presence of osteomalacia. If patients are to be screened for osteomalacia, the alkaline phosphatase must be measured within the first week after a fracture to avoid the distorting influences of the fracture itself.

Aged↗
PubMed1975

Femoral fractures in conjunction with total hip replacement.

We reviewed thirty-eight cases, in thirty-six patients, of fracture of the femur distal to the base of the neck incurred in conjunction with total hip replacement. There were thirteen preoperative, eighteen intraoperative, and seven postoperative fractures. The cases were contributed by thirteen surgeons. We found that the preoperative fractures with pre-existing disease in the hip joint were effectively treated by primary total hip replacement using custom-made femoral components with long necks or long stems, or both. The intraoperative femoral fractures usually occurred while the surgeon was reaming the canal, seating the femoral component, or manipulating the femur in patients who were predisposed to fracture. Theoretically these lesions can be treated like preoperative fractures, but this demands immediate access to custom-made femoral components with long necks or long stems, or both, along with an appreciation of the extent and significance of the fracture. Inadequate fixation was found to lead to painful non-union or late loosening of the femoral component in four of eighteen patients. Postoperative fractures occurred too rarely for us to draw any definite conclusions about management, except to say that surgical treatment can be hazardous and traction has been successful in this series and in other reports. Prophylactic measures, however, may help to prevent postoperative femoral fractures. Most of these fractures occur through a cortical defect near the tip of the femoral component. A long-stem femoral component may help to prevent postoperative fractures whenever a proximal cortical defect of the femur is present preoperatively or is created at surgery.

Adult↗
PubMed2002

Second-generation intramedullary supracondylar nail for distal femoral fractures.

The objective of this study was to review the use of intramedullary supracondylar (IMSC) nails for distal femoral fractures. We reviewed 24 fractures treated with second-generation IMSC nails. The fractures consisted of 18 type A1, one type A2, two type C1, one type C2, and two type C3 fractures. The relationships between clinical results and fracture type, approaches, and patient age were retrospectively reviewed. All fractures healed clinically and radiographically. Twenty-one patients maintained gait performance equivalent to that before injury. Average operating time was 108 min +/- 43 min. ROM in the knee of all patients was -5 degrees +/- 6 degrees in extension and 102 degrees +/- 38 degrees in flexion. Extension lag was influenced by surgical approach. The final knee arc was inversely correlated to patient age (R: 0.49, P<0.05). There were three varus/valgus deformities, two cases with loosening, and two with breakage of the distal locking screws, but no failure of the nail itself. Second-generation IMSC nailing for distal femur fractures was satisfactory in patients younger than 60 years of age.

Adult↗
PubMed2004

Femoral shaft medialisation and neck-shaft angle in unstable pertrochanteric femoral fractures.

We analysed the time-dependent mean changes in the femoral neck length, neck-shaft angle and hip offset in a randomised study comprising 48 patients who were treated with the dynamic hip screw (DHS) or the proximal femoral nail (PFN) for an unstable intertrochanteric femoral fracture. As a consequence of fracture compression, the mean post-operative neck length was significantly shorter in patients treated with the DHS. During the first 6 weeks after the operation, a mean decrease of 4.6 degrees was observed in the neck-shaft angle, but there was not a significant difference between the treatment groups. The radiographic measures remained virtually unaffected during the interval from 6 weeks to 4 months in both groups. When the operated hip was compared to the opposite hip, patients who had received the DHS showed significantly greater medialisation of the femoral shaft at 4 months than those treated with the PFN. We thus recommend that unstable intertrochanteric fractures should be initially reduced in a slight valgus position in order to achieve an outcome after healing that is as normal as possible. As a result of differences in operative technique and implant stability, the PFN may be superior to the DHS in retaining the anatomical relations in the hip region in unstable intertrochanteric fractures.

Aged↗
PubMed1989

[Managing pathologic femoral fractures in malignant bone tumors and skeletal metastases].

In adults pathological fractures of the femur are mostly caused by skeletal metastases. In our own collective of femoral fractures 58 were caused by skeletal metastases and five by multiple myeloma. Average age was 59.8 years, women prevailed. In most of the metastatic fractures breast cancer was found to be the primary tumour. In all cases fracture stabilization as a palliative measure was the only possible therapy. Two patients could not be operated on because of other vital problems. In femoral neck fractures resection and endoprosthesis was the operative measure of choice. The pertrochanteric and subtrochanteric fractures were mostly treated by composites of cement and the 95 degrees condylar-plate. Also in shaft fractures cement-implant composites were performed with straight plates. Rarely, intramedullary nailing was done. Exercising stability could always be achieved, weight-bearing stability in most of the cases. The mean survival time was 7.2 months regarding 43 patients with well documented course. Six patients are controlled regularly, the operative treatment was done on an average 16 months before.

Aged↗
PubMed1993

[Classification of proximal femoral fractures].

Based on the AO Classification of Fractures, the classification of fractures of the proximal femur will be explained. Especially the sub- and pertrochanteric fractures, as well as the fractures of the femoral neck will be considered. During the period from 1980-1989 26,126 fractures of the proximal femur were documented in the AO/ASIF Documentation Center. These fractures will be discussed regarding following aspects: dispersion of age and fractures, pre-existing systemic illnesses, general and local postoperative complications, choice of implant.

Aged↗