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PubMed2006

Hypocalcemic seizures and secondary bilateral femoral fractures in an adolescent with primary vitamin D deficiency.

Nutritional rickets and osteomalacia are reemerging in Western societies, particularly in young children and in adolescents of African or Asian descent. Hypocalcemic seizures resulting from vitamin D deficiency are rare in adolescents, whereas fractures caused by seizures without evidence of direct trauma have not yet been reported in this population. We present an unusual case of secondary bilateral femoral fractures caused by hypocalcemic seizures in a 17-year-old boy with primary vitamin D deficiency. We examine the epidemiology and the clinical presentation of rickets and osteomalacia in the adolescent population, the risk of secondary injuries in patients with seizures, and the evaluation and management of hypocalcemic seizures and primary vitamin D deficiency.

Adolescent↗
PubMed1991

Interlocking nailing of distal femoral fractures. 28 patients followed for 1-2 years.

We treated 28 fractures of the distal femur with a Grosse-Kempf interlocking nail, and the patients were followed for at least 1 year. Five fractures did not unite, and the rest healed after 5 (3-7) months. Nail breakage was the most serious complication; and the more distal the fracture was, the more easily the nail broke. With the addition of a cast brace and protected weight bearing, a locked nail is a good type of fixation for distal femoral fractures down to 4 cm above the condyles.

Adolescent↗
PubMed1996

[Leg length inequality after childhood femoral fractures--permanent or temporary phenomenon?].

Leg length inequality is the most common complication reported after femoral shaft fractures in childhood. Most authors agree that significant overgrowth occurs in the first two years after injury and will not be further corrected. We reviewed 221 patients (166 boys, 44 girls) with a fracture of the femoral shaft. The mean age at the time of fracture was 6.5 years (range 11 months to 12 years); 123 patients were treated conservatively, 96 by skin traction, 11 by skeletal traction, and 16 by immediate cast bracing. In 98 patients the fracture was stabilized by osteosynthesis. In 5 fractures located in the distal third of the femur we used crossed Kirschner wires. Fifty-nine patients were treated by intramedullary nailing, without problems regarding trochanteric apophyseal arrest or alteration in the collum angle. Thirty-four patients were treated by plate fixation, this being associated with high rates (9%) of implant-breakage. A total of 127 patients were interviewed and examined; they were skeletally mature at the time of reexamination. A leg-length discrepancy was found in 45 patients. Shortening from 10 to 30 mm (mean 14.3 mm) occurred in 7 patients; 38 patients had lengthening from 10 to 25 mm (mean 14.1 mm). Overgrowth significantly depended on the age at trauma (4-9 years; P = 0.04), number of repositions (2 or more; P = 0.0005) and degree of axial deviation (> 10 degrees; P = 0.04). Delayed surgical treatment (> 48 h; P = 0.0035), especially plate fixation (P = 0.0003) induced overgrowth as well. Forty-six patients had previously been reevaluated 12 years before (1981). In 12 patients 13 years or older at the time of the first review, no change in leg-length difference occurred. At the first review 34 patients were younger than 13 years. Eight of them had no leg-length discrepancy. In 16 patients the growth rate of the affected femur decreased, so that leg-length discrepancy diminished after the 2-year period posttraumatically in a range from 5 to 15 mm. Overgrowth of the femur continued in 7 cases ranging from 5 to 10 mm. No change occurred in 3 patients. Thus, there is a further change in length inequality more than 2 years post-traumatically.

Adolescent↗
PubMed1992

Proximal femoral fractures: prevalence in different racial groups.

This paper describes the methodology and the results of a study performed in Central England. The predominant racial group here is "White European" (Europid). There are smaller numbers of people of Indian origin (Indids) and still smaller numbers of Afro-Caribbean and of Mongolian ancestry (Mongoloids). We found no significant differences in the incidence of hip fractures in the first two groups. The study population was 1600 consecutive patients with proximal femoral fractures (PFF). The difficulties of racial classification are discussed. To elucidate the predisposing factors for PFF, large scale collaborative studies between medical centres in the major European, Asian, African and American conurbations are suggested. Racial burden may be one such factor; osteoporosis may be another.

Africa↗
PubMed2001

Femoral fractures in children from 4 years to 10 years: conservative treatment.

Some authors have widened the indications for surgical management of isolated femoral shaft fractures in children between 4 years and 10 years of age. We address this study to evaluate the results of such femoral fractures treated conservatively in 41 children. All fractures were closed, isolated, and diaphyseal. The mean age was 6.5 years (standard deviation, 1.7 years) and the mean follow-up was 2.3 years (standard deviation, 1.7 years). All fractures were managed conservatively with skin traction (mean hospitalization time, 20.7 days), alignment of the fragments was serially followed by X-ray, and a spica cast was applied (9.7 weeks), usually without a general anesthesia. Angular deformity was assessed by measurement of the fracture-site diaphyseal angle as well as by measurement of the interphyseal angle described by Wallace and Hoffman. No significant complications were recorded regarding leg-length discrepancy, deformity, refractures, etc. Mean cost is not a factor in determining method of treatment at our hospital. We feel that this type of fracture in the 4 years to 10 years age group can be safely treated with a conservative approach.

Casts, Surgical↗
PubMed1995

Intercondylar distal femoral fracture. An unreported complication of posterior-stabilized total knee arthroplasty.

In an attempt to study the incidence of intraoperative femoral intercondylar fractures, two large series of posterior-stabilized total knee arthroplasty (TKA) systems were reviewed. Eight hundred ninety-eight nonconsecutive primary posterior-stabilized TKAs were compared with a second nonconsecutive series of 532 posterior-stabilized TKAs. Unique to the secondary TKA system is an intercondylar sizing guide to aid in verification of the intercondylar resection size. In the initial series, 40 distal femoral intercondylar fractures were noted (rate = 1:22; nondisplaced, 35; displaced, 5). In the secondary series, one displaced distal femoral intercondylar fracture occurred (rate = 1;532). The difference in the rate of fracture between the two populations was statistically significant (P<.001). Intraoperative distal femoral intercondylar fracture represents a potential complication of TKA and can be avoided with careful resection technique and size verification. No change in the postoperative rehabilitation program is required, however, for those patients identified with nondisplaced and intraoperative-stabilized displaced distal femoral intercondylar fractures.

Aged↗
PubMed1999

[Treatment of diaphyseal femoral fractures in children: a clinical study].

UNLABELLED: Many therapeutic modalities have been reported for the management of femoral shaft fractures in children and young adolescents but there is no consensus on the preferable method. PURPOSE: To compare the malunion rate of femoral shaft fractures in children treated either by traction and spica cast or traction and functional brace. MATERIAL AND METHODS: Between 1982 and 1984 a prospective study was carried out in a tertiary pediatric university hospital on 43 patients (24 boys, 19 girls) with a closed femoral shaft fracture. The patient's age ranged from 5 to 13 years old. Open, pathologic, subtrochanteric and physeal fractures were excluded. Fifteen (15) patients were treated by a functional brace and 28 were treated by a spica cast. Clinical and radiological assessments of all patients were performed 5 years or more after the fracture by an independent observer. A malunion occurred if one of these criteria were met: an angulation > or = 10 degrees in the coronal plane, an angulation > or = 15 degrees in the sagittal plane, a malrotation > or = 15 degrees by opposition to the other leg, and a discrepancy > or = 10 mm between femur's length. RESULTS: A malunion was found in 17 patients, 6 in the functional brace and 11 in the spica cast group (p > 0.05). The leg length discrepancy was the most common type of malunion. The length of stay was not significantly different between both treatment groups. The functional brace was worn longer than the spica cast. CONCLUSION: There was no statistical difference between the malunion rate of children treated by traction-spica cast and traction-functional brace. The functional brace appears to be a good alternative for the treatment for femoral shaft fracture in children allowing an earlier ambulation than spica cast.

Adolescent↗
PubMed1993

Clostridium septicum gangrene complicating a closed femoral fracture.

One of the basic principles of orthopedic surgery is that gas gangrene does not develop in closed fractures. That there are exceptions to this rule is demonstrated by the following report of an extremely rare case. Clostridium septicum myonecrosis developed after surgical treatment of a closed femoral fracture in a fit 45-year-old man, treated by antibiotics. The patient survived after having a right hip disarticulation and administration of high doses of intravenous penicillin. Prophylactically administered cephalosporins failed to prevent the Clostridial infection.

Clostridium↗
PubMed1999

[The use of the Richard's dynamic hip screw and hip Zespol fixator in the treatment of proximal femoral fracture].

A series of 49 patients (27 females, 22 males) aged 24-82 operated on due to proximal end of the femur fracture between 1990 and 1995 were included in this study. There were 23 femoral neck fractures and 26 trochanteric fractures. DHS was used in 35 patients and Zespol hip fixator in 14 cases. Good results have been achieved in 85.7%. Neither method proved superior to the other. Poor results occurred in subcapital neck fractures. DHS seems to offer advantage in trochanteric fractures and Zespol method in femoral neck fractures.

Adult↗
PubMed1998

Combination therapy by external fixation and functional bracing for infected open femoral fracture.

It is well-known that an infected open fracture needs careful management. If the infected organisms are antibiotic-tolerant species such as Pseudomonas aeruginosa or methicillin-resistant Staphylococcus aureus (MRSA), treatment becomes quite difficult. Here we report that an open femoral fracture infected by these organisms was satisfactorily treated by the combination of external fixation and functional bracing without residual osteomyelitis.

Adult↗
PubMed1999

Nutritional differences in patients with proximal femoral fractures.

BACKGROUND: The reason why elderly human hips tend to break in one of two anatomical regions is uncertain. Nutritional factors may affect the site of fracture. OBJECTIVE: To assess possible nutritional differences in patients with proximal femoral fractures. DESIGN: Prospective observational cohort study. SETTING: University teaching hospital. SUBJECTS: 119 consecutive patients over the age of 65 with a hip fracture admitted to the trauma wards in a single centre. METHODS: One researcher measured triceps, biceps and supra-iliac skinfold thickness, and mid upper arm circumference on admission and on the fifth post-operative day. Body mass index was calculated for each patient, and used to classify patients as severely, moderately or mildly malnourished, normal, overweight or obese. Logistic regression was used to determine the influence of various factors on fracture site. RESULTS: According to their body mass index, 31% of patients were classified as malnourished and 11% as severely malnourished. Patients with intracapsular fractures were significantly more malnourished than patients with trochanteric fractures (P < 0.008). Nutritional status was not related to post-operative complications. Ability to weigh a patient on the fifth post-operative day was the single most important prognostic indicator for complications. CONCLUSIONS: Patients with intracapsular fractures are more malnourished. Those with trochanteric fractures tend to be overweight.

Aged↗
PubMed1996

The influence of osteoarthritis on the pattern of proximal femoral fractures.

The relationship between subcapital and trochanteric fractures and osteoarthritis was investigated to test the hypothesis that the presence of osteoarthritis would predetermine the site of the fracture. The authors reviewed 429 pelvic radiographs of patients with proximal femoral fractures. Osteoarthritis was found in 18 patients (4.2%). Sixteen patients followed the predicted fracture pattern of subcapital fracture and osteoarthritis of the other hip, or trochanteric fracture and osteoarthritis of the same hip. These results were statistically significant, supporting the hypothesis that patients with osteoarthritis of the hip who fall are likely to sustain a contralateral subcapital fracture or an ipsilateral trochanteric fracture.

Hip Fractures↗
PubMed1991

Allo-implant reconstruction of a femoral fracture following osteomyelitis.

A complicated, segmented fracture of the femoral diaphysis in a dog is presented. Complications arose from multiple surgeries and subsequent osteomyelitis. Repair was staged by firstly removing all implants, secondly treating the osteomyelitis with appropriate antibiotics while spanning the cortical-deficient fracture site with a Kirschner external fixator, and finally rigid fixation of the fracture with incorporation of an ethylene oxide-sterilised intercalary cortical allo-implant. Principles of bone grafting are reviewed.

Journal Article↗