[Factors determining mortality in elderly patients with femoral fractures at the hip].
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Age Factors↗
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Prognostic factors for the elderly with proximal femoral fracture.
A prospective study of 125 elderly patients (over 65 years) with proximal femoral fracture was carried out to compare pre-fracture sociomedical factors with the local and general complications following surgical treatment, in predicting mortality and length of stay. A poor pre-fracture mental state was more important than associated physical illness in predicting mortality. Pre-fracture mobility state was the most useful early prognostic predictor of length of hospitalization. Post-operative general complications were the most significant in predicting mortality and length of hospitalization, and more important than failure of operative technique.
Aged↗
Endoprosthesis as treatment for necrosis and pseudarthrosis after transcervical femoral fractures. A clinical review.
This report concerns 105 patients who developed painful necrosis or pseudarthrosis after nailed transcervical femoral fractures and were treated by Moore's arthroplasty. The mean age at the time of secondary arthroplasty was 68 years, the operation being performed on average 2 years after the fracture and nailing. The mortality within 6 weeks of operation was 3 per cent. Complications not producing late sequelae were seen in 11.4 per cent of cases, and complications producing late sequelae occurred in 5.7 per cent. At the follow-up examination 2 to 8 years after arthroplasty (mean 3.7 years), 37 per cent of the patients were completely free from pain, and the functional result was acceptable in 91 per cent. The remaining 9 per cent had other debilitating illnesses. The results are compared with other reports in the literature.
Adult↗
Morphology of the femur in proximal femoral fractures.
We studied the morphology of the contralateral femur in 10 patients with subcapital fractures, 10 with trochanteric fractures and 10 with unilateral osteoarthritis. We found that the patients with trochanteric fractures had a significantly shorter femoral neck (4.5 +/- 0.5 cm) than patients with subcapital fractures or osteoarthritis (5.4 +/- 0.4 cm). It may be that this difference in femoral neck length is related to the site at which a proximal femoral fracture occurs.
Aged↗
Does the level of an intracapsular femoral fracture influence fracture healing after internal fixation? A study of 411 patients.
The aim of the study was to determine if the level of an intracapsular femoral fracture influences the risk of non-union or avascular necrosis occurring after internal fixation. An observer blinded to the outcome of the treatment (fracture union, non-union or avascular necrosis) reviewed the radiographs of 411 patients with an intracapsular fracture, which had been treated by internal fixation. The level of the fracture was determined by two methods, a direct distance measurement and a ratio method. In addition, the diameter of the femoral head was measured. Results indicated that none of the methods for determining the fracture level had any relationship to the risk of non-union or avascular necrosis occurring. Undisplaced fractures were found to be more proximally located than displaced fractures. We conclude that the level of an intracapsular fracture should not be used as a method of deciding if the femoral head should be preserved or replaced. The level of an intracapsular fracture may determine if the fracture displaces at the time of injury.
Aged↗
Retrograde fixation of distal femoral fractures: results using a new nail system.
OBJECTIVES: To investigate the management and outcome of distal femur fractures treated with retrograde nailing. DESIGN: Prospective. SETTING: Unfallkrankenhaus Berlin, level I trauma center. PATIENTS: A consecutive series of 47 patients with 48 fractures of the distal femur (37 fractures AO type A and 11 fractures type C) operated on between May 1999 and June 2000. OUTCOME MEASURES: Outcome was assessed by using standard radiographic criteria of time to union, incidence of infection, malunion, and knee function (Leung score). RESULTS: After an average time of 33 months (range 12-37 months), 44 patients were reexamined. Three patients were lost to follow-up. The average age was 44 years (range 17-92 years). Of patients, 19 sustained polytrauma, and 10 had associated soft tissue damage. A total of 34 patients underwent primary definitive osteosynthesis within 12 hours after trauma. All fractures healed after an average of 12.6 weeks (range 9-17 weeks). Seven complications were noted-three related to severity of injury (one deep venous thrombosis, two leg length shortenings of 1.5 cm and 2.5 cm) and four related to the operation (insufficient counterboring of the nail in two patients, one malreduction, one iatrogenic fracture of femur shaft). There was no relevant difference between type A and type C fractures in functional, clinical, or radiographic outcomes. CONCLUSIONS: Retrograde nailing is recommended as an alternative method to plate osteosynthesis in stabilizing distal femoral fractures, particularly in type C fractures.
Adolescent↗
Congenital contractural arachnodactyly and femoral fracture in a newborn infant: a causal relationship or a coincidence?
Congenital contractural arachnodactyly (CCA, Beals syndrome) is an autosomal-dominant connective tissue disorder characterized by multiple flexion contractures, arachnodactyly, severe kyphoscoliosis, abnormal pinnae, and muscular hypoplasia. Although it is a connective tissue disorder affecting bone structure and formation, coexistence of bony fractures in CCA patients have not been reported before. In this article we report a newborn infant diagnosed with CCA who developed a femoral fracture possibly due to abnormal bone structure and birth injury in spite of cesarean delivery.
Adult↗
High indices of remodelling in iliac trabecular bone predict reduced forearm cortical bone mass indices in patients with proximal femoral fractures.
To investigate whether high bone turnover could be a predictor of cortical bone loss and a candidate risk factor for fractures of the proximal femur, 33 7.5-mm transiliac biopsies taken at fracture fixation from 48 patients who participated in a study of potential risk factors have been quantitated. Twenty-four of the 33 patients made good recoveries and about 6 weeks postoperatively consented to bone densitometry of the forearm midshaft. Forearm bone density correlated negatively (r = 0.77, P = 0.001) with the surface of trabecular bone covered with osteoid, which in osteoporotic patients with crush fractures of the vertebrae was previously shown to relate both to rates of bone formation and resorption. An important minority of these femoral fracture patients appeared to be suffering from high rates of iliac trabecular bone resorption. Thus, high bone remodelling activity could lead to excessive cortical thinning. This has pathogenetic implications which may be clinically important.
Aged↗
Repair of bilateral supracondylar. Femoral fractures in a cat.
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Animals↗
[Management of hip-joint-proximal femoral fractures].
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Adult↗
Tibial physeal closure and genu recurvatum after femoral fracture: occurrence without a tibial traction pin.
Two cases of premature closure of the anterior portion of the proximal tibial physis with associated genu recurvatum deformity in adolescent males who had sustained a closed femur fracture are reported. In both cases, physeal closure occurred without use of a proximal tibial traction pin. In one patient, treatment included distal femoral pin traction; the other patient was treated with skin traction followed by spica cast. We believe that development of recurvatum of the tibia after femoral fracture in children is not necessarily iatrogenic and related to a tibial traction pin, but instead may result from physeal injury incurred at the time of the original trauma.
Child↗
The uncemented total hip arthroplasty. Intraoperative femoral fractures.
Intraoperative fractures of the proximal femur occurred in 40 (38 patients) of 630 (6.3%) biological ingrowth total hip arthroplasties performed between January 1984 and July 1986. Twenty-three of these fractures occurred during 131 revision arthroplasties (17.6%) and 17 during 499 primary arthroplasties (3.5%). All but two of the fractures were recognized during surgery. Thirty-seven were treated with either Parham bands or cerclage wires. Bone graft was added to the fracture site in 31 fractures. All of the fractures healed. Three of the patients failed to achieve stable fixation and have required revision surgery. An additional patient has thigh pain with 2 mm of subsidence noted with serial roentgenographs. Femoral fractures can be prevented by preoperative templating of roentgenograms containing markers to measure magnification, routine overreaming of the femoral canal when implanting long-stemmed prostheses, and prophylactically applying wires or bands to femurs requiring the removal of screws.
Bone Cements↗
[POSSIBILITIES OF OSTEOSYNTHESIS IN FEMORAL FRACTURES NEAR THE HIP].
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Femoral Fractures↗
How elderly patients with femoral fracture develop pressure sores in hospital.
The routine hospital management of 100 consecutive elderly patients was studied to determine the reason for the high incidence of pressure sores among patients admitted to hospital for femoral fractures. Of these patients, 66 developed sores, 83% occurring by the fifth day in hospital. This was due to the long periods that patients were immobilised on high pressure surfaces in the casualty department, wards, and theatres before repair of the fracture and restoration of their weight bearing function. Sores are not simply a ward or nursing problem, but an unintended consequence of hospital treatment. To reduce the incidence of sores elderly patients should be treated on low pressure patient support systems from the point of entry to hospital until mobility is restored.
Aged↗
Stimulation of the inflammatory system by reamed and unreamed nailing of femoral fractures. An analysis of the second hit.
It has been suggested that reamed intramedullary nailing of the femur should be avoided in some patients with multiple injuries. We have studied prospectively the effect of femoral reaming on the inflammatory process as implicated in the pathogenesis of acute respiratory distress syndrome (ARDS) and multiple-organ failure (MOF). We studied changes in the levels of serum interleukin-6 (IL-6) (proinflammatory cytokine), neutrophil CD11b (C3) receptor expression (activated neutrophil adhesion molecule), serum soluble intracellular adhesion molecule (s-ICAM-1), serum soluble E-selectin (the soluble products of endothelial adhesion molecules) and plasma elastase (neutrophil protease) in a series of patients with femoral fractures treated by nailing. We have also compared reamed nailing with unreamed nailing. We found that the levels of serum IL-6 and elastase rose significantly during the nailing procedure indicating a measurable 'second hit'. There was no clear response in leukocyte activation and no difference in the release of endothelial adhesion molecule markers. There was no significant difference between groups treated by reamed and unreamed nailing. Although clinically unremarkable, the one patient who died from ARDS was shown to be hyperstimulated after injury and again after nailing, suggesting the importance of an excessive inflammatory reaction in the pathogenesis of these serious problems. Our findings have shown that there is a second hit associated with femoral nailing and suggest that the degree of the inflammatory reaction may be important in the pathogenesis of ARDS and MOF.
Adolescent↗
Retrograde intramedullary nailing of supracondylar femoral fractures.
As an alternative to standard AO/Association for the Study of Internal Fixation plate and screw techniques, retrograde intramedullary locked nailing of supracondylar and intracondylar (AO/Association for the Study of Internal Fixation Type 33) fractures is reviewed. This includes a historic review, the technique for knee arthrotomy, fracture reduction and nail insertion, and the reported clinical and biomechanical results. The retrograde intramedullary locked nail is a viable alternative for the treatment of AO/Association for the Study of Internal Fixation Type 33-A and some C supracondylar femoral fractures and should be part of the internal fixation armamentarium, however, it does not replace the standard biologic plate and screw techniques for most fractures.
Bone Nails↗
Primary total hip replacement for displaced subcapital femoral fractures.
A retrospective study of 48 patients, in whom total hip arthroplasty was undertaken as the primary management of displaced subcapital femoral fracture, has established that results are sufficiently good to merit a prospective trial of total arthroplasty against hemi-arthroplasty for his condition. Prosthetic dislocation occurred in 7 patients and was the major complication, but successful results were not thereby precluded.
Adult↗
Conservative or surgical management of distal femoral fractures. A retrospective study with a minimum five year follow-up.
We report the outcome of conservative and surgical management in 50 skeletally mature patients (average age 64.6 years, 36 females patients) with 51 supracondylar femoral fractures treated in our unit between June 1991 and December 1993. Thirty-six fractures were caused by low-energy trauma, and 15 were due to high-energy trauma. Open fractures occurred in 5 patients. Of the 34 patients (35 fractures) treated conservatively, 15 (46%) achieved a satisfactory result. Of the 16 patients treated by internal fixation, 10 (62%) reached a satisfactory outcome. Osteoporosis, severe comminution of the fracture, involvement of the knee joint, and soft tissue injury in open fractures were associated with unsatisfactory results. Conservative management of these fractures is associated with a lesser chance of achieving a good functional result. With the advent of new fixation devices and our experience that conservative management can actually lead to many complications, the proportion of patients operated upon is likely to increase.
Activities of Daily Living↗