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PubMed1992

Repair of a proximal diaphyseal femoral fracture in a calf, using intramedullary pinning, cerclage wiring, and external fixation.

Repair of a comminuted, spiral oblique, proximal diaphyseal femoral fracture in a 7-day-old calf was achieved by use of an intramedullary pin, cerclage wires, and external fixator. Six stainless steel wires were used for full cerclage to secure a long butterfly fragment and multiple incomplete and complete nondisplaced fragments to the femur in order to create 2 principal fragments. Axial alignment and resistance to bending was provided by a round, double-pointed, end-threaded intramedullary pin (6.35 mm in diameter), which was inserted in a retrograde fashion. A type-1, double-connecting-bar external fixator, using 4 round pins (4.8 mm in diameter), was used to provide supplemental stabilization against shear and torsional forces. At 45 days after surgery, healing at the fracture site was seen on radiography of the limb, and the external fixator was removed. Eight months after surgery, the calf had a normal gait.

Animals↗
PubMed1993

Epidemiology of proximal femoral fracture in Gran Canaria (Canary Islands).

An epidemiological survey of proximal femoral fracture (PFF) was carried out in Gran Canaria (Canary Islands) in 1990. We identified 211 cases of PFF affecting residents, which gave an incidence of 161 per 100,000 per year (92 per 100,000 per year for men and 176 for women). Three quarters of all fractures occurred to residents of urban areas and nearly all fractures were caused by falls indoors. There was a higher incidence in winter than in summer months.

Africa, Western↗
PubMed1996

The orthopaedic lever: a simple method to reduce unstable posteriorly displaced or angulated proximal femoral fractures.

The satisfactory management of unstable posteriorly displaced or angulated proximal femoral fractures is an orthopaedic challenge. In these fractures, significant displacement of bony fragments is often associated with comminution and soft-tissue stripping. Unsatisfactory fixation may lead to serious complications such as refracture with failure of the fixation device. Accurate reduction, reconstruction and fixation of these fractures are demanding in both strength and technique of the surgeon. The orthopaedic lever providing means for pre-operative reduction that will maintain the reduced position while fixation is achieved is described.

Fracture Fixation, Internal↗
PubMed1978

[Tension band wiring of canine and feline supracondylar epiphyseal femoral fractures (author's transl)].

The present investigation describes the treatment of 27 cases of canine and feline supracondylar epiphyseal--metaphyseal femoral fractures with tension band wire. The wire was passed through transversal parallell drill holes, one in each fragment. The wires intercrossed dorsally. Stable fixation followed tightening of the wires. 20 out of 25 primarily successful cases were re-examined. 19 were completely well. One case showed a slight transient lameness following hard exercise.

Animals↗
PubMed1989

Early versus delayed stabilization of femoral fractures. A prospective randomized study.

A prospective randomized study comparing the results of early with delayed reduction and stabilization of acute femoral fractures in adults was performed over a two-year period in 178 patients. Only patients who were more than sixty-five years old and had a fracture of the hip were excluded. Arterial blood gases, injury-severity score at the time of admission, pulmonary function, days in the hospital, days in the intensive-care unit, and hospital costs were recorded for all patients. The patients were divided into two groups: those who had an isolated fracture of the femur and those who had multiple injuries. When stabilization of the fracture was delayed in the patients who had multiple injuries, the incidence of pulmonary complications (adult respiratory-distress syndrome, fat embolism, and pneumonia) was higher, the hospital stay was longer, and the number of days in the intensive-care unit was increased. The cost of hospital care showed a statistically significant increase for all patients who had delayed treatment of the fracture compared with those who had early stabilization.

Adolescent↗
PubMed2001

How risky is early intramedullary nailing of femoral fractures in polytraumatized patients?

There is controversy over both the time of intervention and the technique of surgical stabilisation of femoral fractures in polytraumatized patients. Retrospective analysis of data on 55 such patients revealed that stabilisation within the first 24 h using locked, unreamed nails had no negative impact on the rate of pulmonary complications. The frequency of complications was assessed by comparing immediate intramedullary (IM) osteosynthesis with extramedullary stabilisation in patients with or without concomitant blunt thoracic trauma. Due to the small study population and discrepancies the size of subgroups, no definite statistical conclusions were possible. However, our results suggest that the frequency of complications is determined by the overall severity of injury rather than by the type of acute surgical treatment.

Adolescent↗
PubMed1991

Open versus closed nailing of femoral fractures in the polytrauma patient.

Thirty-four patients with severe multiple injuries underwent either open or closed nailing of 35 femoral fractures. Open nailing was performed in 17 femurs and closed nailing in 18 femurs. The average abbreviated injury score was 27 in both the open group (range: 17-45) and closed group (range: 22-36). Soft tissue injuries were present in eight (47%) cases in the open group compared to three (16%) in the closed group. The treatment protocol was similar in both groups. Intramedullary nailing was delayed an average of 11 days in the closed group. This was significantly different than the open group where the average time to nailing was less than 24 hours (p less than 0.001). Reamed nails were used in all cases except for two in the closed group. The median time to fracture healing was 5.0 months in the open group and 4.1 months in the closed group, with an average follow-up of 18 months in both groups. Two cases required reoperation (one nonunion and one shortening at the fracture site). Both these cases were in the open group. There were no superficial or deep infections in either group. Closed reamed intramedullary nailing is recommended for treatment of diaphyseal femur fractures in patients with severe coexistent injuries. Open nailing should be reserved for cases in which an adequate reduction cannot be achieved by closed methods.

Adult↗
PubMed1998

Intramedullary fixation of high subtrochanteric femoral fractures: a study comparing two implant designs, the Gamma nail and the intramedullary hip screw.

OBJECTIVE: To compare two implants, the Gamma nail and the intramedullary hip screw (IMHS ), in the treatment of high subtrochanteric femoral fractures. STUDY DESIGN: Prospective, nonrandomized clinical study. METHODS: Eighty-seven consecutive patients with high subtrochanteric fractures of the Russell-Taylor Types 1A and 1B were treated with intramedullary fixation. The first fifty patients were treated with the Gamma nail and the next thirty-seven with the IMHS. The results of these operations were evaluated after a minimum follow-up of twelve months, and special emphasis was put on the complication rate. RESULTS: The number of noninfectious complications (intraoperative fractures, postoperative refractures and fixation failures) was significantly higher (p = 0.037) in the Gamma group (11 of 50, 22 percent) than in the IMHS group (2 of 37, 5 percent). The complication most often associated with the Gamma nail, postoperative fracture of the femoral shaft (six in our Gamma group), was not encountered with the use of the IMHS. The Gamma group also included three cases of intraoperative trochanteric extension of the fracture versus none in the IMHS group. The IMHS group included two mechanical fixation failures. CONCLUSIONS: The lower complication rate associated with the use of the IMHS implant could be attributable in part to the learning curve in the use of intramedullary implants. However, we consider that the evolution of the implant design contributes to the result.

Adolescent↗
PubMed2005

Reverse oblique intertrochanteric femoral fractures treated with the gamma nail.

We studied 47 reverse oblique intertrochanteric femoral fractures that were treated with gamma nails between 1992 and 2000. Fracture reduction was satisfactory in 38 patients (81%), the hip screw position was correct in 42 (89%) and there were no peri-operative complications. However, in three patients the nail displaced, resulting in non-union in one and protrusion into the acetabulum in another. A logistical regression analysis of our series showed that an incorrect position of the hip screw in the femoral head was the only predictor for complications. Thus, we consider that the gamma nail is a good option for the treatment of these complex fractures.

Adult↗
PubMedDate not supplied

Biomechanical analysis of antegrade and retrograde flexible intramedullary nail fixation of pediatric femoral fractures using a synthetic bone model.

Biomechanical testing was performed to evaluate the stability of simulated transverse and comminuted femoral fractures after retrograde and antegrade flexible titanium intramedullary nail fixation. Ten synthetic adolescent-sized femoral bone models were used. Five underwent retrograde fixation with two C-shaped nails inserted from medial and lateral entry portals. The other five underwent antegrade fixation using one C- and one S-shaped nail through lateral entry holes just inferior to the greater trochanter. Retrograde nail fixation demonstrated significantly less axial range of motion and greater torsional stiffness than antegrade fixation in both transverse and comminuted fracture patterns. However, there appeared to be a biomechanical trend of greater resistance to shortening for antegrade nails.

Adolescent↗
PubMed1999

The supracondylar intramedullary nail in elderly patients with distal femoral fractures.

From February 1994 until July 1997, a prospective study of all elderly patients with a displaced distal femoral fracture, who were treated with an intramedullary supracondylar nail, was made. The outcome of 31 fractures in 30 elderly patients was studied. The average age was 82 years (55-98). Two-thirds of the patients had had previous ipsilateral femoral pathology. Average acute hospital stay was 17 days. All patients were reviewed at 6 months and all cases have been followed for over 1 year. More than 90% of surviving fractures had healed within 6 months of the operation. Outcome scores were; 22 (85%) excellent or satisfactory, 2 (7.5%) unsatisfactory and 2 (7.5%) failures. The mortality rate was 17% at 6 months and 30% at 1 year, which is similar to patients with a fractured neck of femur. This nail is recommended for its versatility and favourable outcome scores in this age group.

Aged↗
PubMed1980

New casting material and improved functional design for lower femoral fracture bracing.

A new water setting light plastic plaster material, Crystona, is presented and its plaster room characteristics compared with plaster of Paris. Plaster of Paris is considered better as the "acute fracture splinting material" in the Accident Service setting. Crystona, however, has considerable advantages as the "dynamic bracing material" in the post-acute fracture period and is demonstrated in the functional bracing of femoral shaft fractures. An improved functional cast brace design is presented, the "Knee Hinge Cylinder Brace" with a simple waist belt suspension to a hinged tube cast without the foot in the treatment of distal half femoral fractures. Using Crystona and the cylinder brace design, the cast weight has been reduced by half and the functional limb bracing improved with free mobilization of the knee, ankle and foot. The prescription, application technique and early clinical experiences are presented.

Acrylic Resins↗
PubMedDate not supplied

Diffuse pulmonary calcinosis and multiple soft tissue calcification in renal failure patient with pathological femoral fracture.

The rare occurrence of diffuse pulmonary calcinosis is described with case illustration of a patient who presented with a pathological femoral fracture during end-stage renal failure. Associated metastatic soft tissue calcification with parathyroid hyperplasia requiring parathyroidectomy was observed. Roentgenologic evidence of hyperparathyroidism with osteitis fibrosa cystica and a high product of the calcium and phosphate values were indications for the parathyroidectomy. Recent literature review of pulmonary calcinosis and multiple soft tissue calcification is also presented.

Calcinosis↗
PubMed1996

Interlocking intramedullary nail stabilization of a femoral fracture in a dog with osteomyelitis.

Complications developed in a dog that underwent intramedullary pin and cerclage wire fixation of a comminuted femoral fracture. The fracture was unstable, the intramedullary pin protruded through the skin over the hip, and Staphylococcus sp was isolated from the fracture site. The loose pin was removed, and the fracture was restabilized with a 6.0-mm interlocking intramedullary nail and 3 interlocking screws. Cephalexin was given orally for 6 weeks. Eight weeks after the second surgery, the fracture was healed radiographically. Seventeen months later, the dog had a persistent mild lameness that was associated with low-grade osteomyelitis. The lameness resolved after the implants were removed, and antibiotics were administered. In human beings, interlocking intramedullary nail stabilization is an accepted treatment for open and contaminated fractures. Chronic infection of bone may be attributable to bacteria in biofilm surrounding implants, necessitating implant removal for resolution.

Animals↗
PubMed1984

[Stabilization of proximal femoral fractures using the compression and sliding screw].

Between 1979 and 1983 we treated 169 fractures with a sliding compression hip screw out of 402 operated fractures of the upper femur. The indication for this method included all types of proximal femoral fractures. In case of instable trochanteric fractures convincing results of treatment could be achieved because of early weight bearing. As complications could be found in two cases loss of fixation. The mortality rate was 17.8 per cent. Still 2/3 of the injured with an average age of 76.2 years could leave the hospital walking on their own after an average stay of 37.6 days.

Adolescent↗
PubMed1990

Natural history of impacted subcapital femoral fractures and its relevance to treatment options.

A study of 123 patients with impacted, subcapital femoral fractures was undertaken to determine the natural history of this injury. It was found that the angle of the fracture, the degree of valgus and the degree of retroversion were without significant effect on the incidence of subsequent disimpaction. Age was important, with a 20 per cent incidence of disimpaction in patients over the age of 68 years. In patients younger than this the incidence was only 2 per cent. These results indicate that conservative treatment may be appropriate for some younger patients, but the advantages of this approach must be compared with the medical, social and economic benefits of early mobilization that the relatively simple operative procedure permits.

Age Factors↗
PubMed1988

Custom titanium plating for failed nonunion or delayed internal fixation of femoral fractures.

Eight patients with either failed internal fixation of nonunions of the femur (six) or delayed treatment of extensively comminuted femoral fractures (two) were treated with customized titanium plates for internal fixation. All eight patients had fixation problems that surpassed treatment by intramedullary nailing or standard plate osteosynthesis. Custom titanium plates were individually designed from roentgenograms and/or computed axial tomographic (CAT) scans. Plate dimensions were altered to increase strength, height, length, and placement of screw holes to enhance stabilization of the individual femoral anatomy. At an average follow-up period of 33 months, all fractures united; there were no complications, including fatigue or loosening of the custom implants. The implants were well tolerated and provided excellent fixation of difficult fracture problems.

Adult↗