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PubMed2006

[Preventing malrotation during intramedullary nailing of femoral fractures].

BACKGROUND: The problem of preventing malrotation after closed intramedullary nailing of femoral shaft fractures has not been solved yet. As clinical tests and radiologic criteria for intraoperative use provide little accuracy, the theoretical basis for a C-arm-based measurement of the femoral antetorsion was analysed. METHODS: The directions of femoral neck axis and condylar axis can be identified by the radiologic views "knee joint, lateral view" and "hip joint, axial view". The rotation of the C-arm in relation to a horizontal axis to achieve these views can be measured in degrees. Theoretically, the difference between these rotation angles could be used to calculate the antetorsion. Intact plastic femora (Sawbone) and a femoral shaft fracture model were used to research optical and geometrical phenomena that influence a direct measuring technique. RESULTS: Several geometrical phenomena were observed, making direct measurement with arithmetic corrective factors not recommendable. For practical reasons, a data table was created, correlating the difference between the two C-arm angles with true antetorsion. In an interobserver trial with 18 trauma surgeons, the method proved to achieve high accuracy with a maximum interobserver variation of 5 degrees. CONCLUSIONS: The method is easily reproducible, reliable and can be recommended to every surgeon. Due to the wide range of physiological antetorsion angles in different individuals, fair results can be expected controlling the rotation with standard value tables, and excellent results can be expected using bilateral measurement.

Femoral Fractures↗
PubMed1992

[The open femoral fracture in war--173 external fixators applied to the femur (Afghanistan war)].

During the three years 1988 through 1990, more than 700 external skeletal fixations (AO/ASIF Tubular System) were utilized at the ICRC Hospital for Afghan War Wounded in Peshawar, Pakistan, 173 of which were for femoral fractures. 13% of the fractures were open grade II, and 71% open grade III, mostly due to high velocity gunshot or shrapnel injuries. Usually, the external fixator was left in place until consolidation of the fracture. The average time of external fixation was 128 days. Three major groups of complications have been observed: fracture complications, implant complications, and residual loss of function of the knee joint, probably the most significant permanent complication to the patient. In order to improve the functional results in treating open fractures of the femur, three measures are recommended: unilateral frame with posterolateral insertion of Schanz screws, postoperative positioning of the patient with 90 degrees of flexion of hip and knee joints and mobilization of the patient as soon as possible (on the first or second postoperative day).

Afghanistan↗
PubMed1976

[Diabetes mellitus and femoral fractures in close proximity to the hip joint in multimorbid patients of old age (author's transl)].

From a great number of patients with femoral fractures in close proximity to the hip joint with an average age of 78.3 years, all diabetics were compared to persons with a normal metabolism in terms of concomitant diseases, causes of death, complications, and fracture healing. Although no differences with regard to fracture healing and subsequent functional results in later years could be established in patient put on the correct diet and insulin dose, as compared to the control group, the clinical complication rate and the mortality rate were significantly higher among patients of old age with Diabetes mellitus. To bring about a possible change, operating techniques providing the possibility of an early mobilisation and optimal physiotherapeutical after--care are recommended.

Aged↗
PubMed1997

Subfascial plate fixation of comminuted diaphyseal femoral fractures: a report of three cases utilizing biological osteosynthesis.

Internal fixation with preservation of tissues and vascularization, as in intramedullary fixation and bridging plate osteosynthesis, so-called biological osteosynthesis, has become increasingly popular. Our experiences, in three patients, using a technique of internal fixation of comminuted diaphyseal femoral fractures with an AO plate in subfascial position without exposure of the fracture site is presented. Though based on unorthodox mechanical principles, the safety and efficacy of bridging plates, even when applied in unusual situations, are illustrated.

Adolescent↗
PubMedDate not supplied

Carer burden after proximal femoral fracture.

This carer study forms part of a wider study which compares accelerated rehabilitation after proximal femoral fracture with conventional care. Two measures of burden on family caregivers were used; social worker's assessment of overall burden and an index of disruption to carers' lives. Participants were carers of 200 patients interviewed at five periods up to 12 months after fracture. Carer burden prior to the fracture was the strongest predictor of subsequent burden, with carers of patients in nursing homes and patients with a cognitive or physical disability being more burdened. Carer burden may increase or decrease after the patient's injury, irrespective of randomization group. There is no simple relationship between burden and randomized group. Accelerated rehabilitation does not impact greatly on carer burden, but already severely burdened carers may benefit from additional counselling/information. Specific ways in which carers; lives were disrupted are reported.

Aged↗
PubMed1981

The use of modified Neufeld traction in the management of femoral fractures in polytrauma.

The choice of treatment modalities for the fractured femur in the polytrauma patient is a continuing dilemma. Prevention and treatment of respiratory complications requires maximum patient mobility. Conventional traction methods restrict turning in bed and preclude moving the patient out of bed. Immediate open reduction results in additional blood loss, tissue trauma, and a higher rate of infection and nonunion. Immediate closed intramedullary nailing is an excellent method but requires special equipment and surgical expertise. To meet the mobilization requirements of good pulmonary care and avoid the problems of early open reduction, before the availability of immediate closed nailing, we adopted the use of modified Neufeld single-rope roller traction for the initial treatment of closed, Grade I open, and some Grade II open femur fractures. In 30 cases, the traction was used to maintain the fracture for 7 to 14 days preceding delayed internal fixation, while in another 22 cases of the traction was used as the definitive treatment modality in conjunction with case bracing. Sixty patients with femoral fractures were treated with this traction methods. Eight patients died, the other 52 were followed to fracture healing. There was one delayed union. There were no nonunions and no wound infections in either the internal fixation or continued traction groups. This traction system is an effective way to meet the needs of the polytrauma patient with a femur.

Adolescent↗
PubMed1987

Bilateral traumatic dislocation of the hips with ipsilateral femoral fracture.

A rare case of bilateral traumatic dislocation of the hip with ipsilateral femoral shaft fractures occurred in a 29-year-old man. Reduction was achieved by manipulation, despite the presence of a femoral shaft fracture on one side. A review of the literature reveals reports of three similar cases.

Accidents, Traffic↗
PubMed2002

Femoral neck fractures.

Femoral neck fractures in the geriatric patient continue to represent a therapeutic challenge. Despite advances in surgical techniques and medical care, the risk of nonunion and osteonecrosis after fixation have not changed appreciably in the last 50 years. Considerable debate continues to occur with respect to the relative merits of internal fixation versus arthroplasty. The relative benefits and complications of unipolar and bipolar hemiarthroplasty, as well as total hip replacement, continue to be poorly understood. The next decade will bring advances in the prevention and treatment of osteoporosis that may finally decrease the incidence of these fractures. Advances in the use of bone graft substitutes may finally improve the outcome of internal fixation.

Accidental Falls↗
PubMed1998

[Minimally invasive method for treatment of supra-diacondylar femoral fractures].

The "gold standard" treatment modality for extra-articular and combined intra-, extra-articular fracture of the distal femur is the condylar blade plate (CP). Large exposure of the distal femur with unavoidable iatrogenic trauma to the soft tissue surrounding the fracture site and perhaps the lack of stiffness of the eccentric lateral cortical location of the CP has been suggested to play a role in the high rate of infections and pseudarthrosis reported in the literature. In an effort to overcome some of the difficulties with the condylar blade plate and to reduce complications, an unreamed, titanium, solid nail, locked proximally with two locking screws and distally with a screw and twisted blade was developed (DFN). The nail was designed for minimal invasive reduction through a small median parapatellar arthrotomy of the articular fracture (percutaneous screw) and of the supracondylar fracture. The DFN is a modular system sharing many components and almost all instrumentation with the AO-UFN and it is expected that the nail is much better in axial stiffness and strength than the condylar blade plate. The treatment of supracondylar femoral fractures should be improved by providing early weight bearing and accelerated fracture healing with a reduced incidence of delayed unions and infections.

Adult↗
PubMed2003

Gene expression in older rats with delayed union of femoral fractures.

BACKGROUND: Fracture-healing slows with age. While six-week-old rats regain normal bone biomechanics at four weeks after a fracture, one-year-old rats require more than twenty-six weeks. The objective of this study was to examine the possible role of altered mRNA gene expression in this delayed union. METHODS: Closed midshaft femoral fractures were created in six-week-old and one-year-old Sprague-Dawley female rats. The animals were killed at zero-time (unfractured) or at 0.4, one, two, three, four, or six weeks after the fracture. mRNA levels were measured by reverse transcription-polymerase chain reaction in the fracture callus for twenty-seven matrix, cytokine, and cytokine-receptor genes for the seven animals per time-point per age-group. RESULTS: The younger rats healed radiographically by four weeks after the fracture, whereas none of the older rats had healed by the sixth week. Despite the difference in healing rates, the levels of mRNA gene expression, in general, followed the same pattern in both age-groups. The mRNA expression levels increased to a peak at one to two weeks after the fracture and then decreased to very low or undetectable levels at four and six weeks after the fracture for both age-groups. Significantly lower levels of mRNA for Indian hedgehog (Ihh) and bone morphogenetic protein-2 (BMP-2) were detected in the fracture calluses of the older rats (p < 0.01 and p < 0.05, respectively). CONCLUSIONS: All genes studied were up-regulated by the fracture in both age-groups. Thus, the failure of the older rats to heal promptly was not due to the lack of expression of any of the studied genes. The increase in mRNA for Ihh and BMP-2 in the older rats was smaller than that in the younger rats, which may contribute to slower fracture repair. The return of mRNA gene expression to baseline in the older rats prior to healing may contribute to the delayed union. The slower healing response of the older rats did not stimulate a negative-feedback increase in the mRNA expression of stimulatory cytokines.

Age Factors↗
PubMed1996

Treatment of supracondylar femoral fractures with a retrograde intramedullary nail.

From August 1992 to January 1995, 24 patients with 26 supracondylar femoral fractures were treated with a retrograde intramedullary nail. There were 22 patients with 24 nails available for review. Eight fractures were open and 13 were intraarticular fractures. There were a significant number of associated injuries. The average followup interval was 18 months (range, 4-36 months). All fractures healed by 4 months, (average, 3 months). Only 1 patient required bone grafting. There were no implant failures or superficial or deep infections. One malunion occurred. Average knee range of motion was 104 degrees. A previously described rating scale was used to evaluate function. There were 4 excellent, 16 good, 2 fair, and 2 poor results. The supracondylar nail provides rigid internal fixation for rapid healing and comparable functional outcomes to lateral fixation devices with significantly less soft tissue dissection.

Adult↗
PubMed1993

[Osteosynthesis of subtrochanteric femoral fractures with the dynamic condyle screw].

The dynamic condyle screw was originally designed for osteosynthesis of distal femoral fractures. Because of more favourable biomechanical facilities compared with the condyle plate we have been used the implant since 1987. This investigation is based on 40 patients with pertrochanteric, subtrochanteric as well as proximal diaphyseal fractures. The majority of the patients were mobilized early and reached full weight bearing latest after 3 months according to the fracture type. The most severe complications appeared with subtrochanteric fractures with lack of medial cortical support. There was a broken plate in 2 cases and a secondary spongiosa plastic was necessary in 3 cases to ensure bony consolidation. As the point of this investigation we will see a wider indication for primary spongiosa plastic and early secondary spongiosa plastic.

Adult↗