SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
A case is presented of traumatic aneurysm of the profunda femoris artery following spontaneous unscrewing of the nut at the nail--plate junction of a two-piece nail plate which was used for internal fixation of an intertrochanteric femoral fracture. Methods of avoiding this complication during hip operations are described, together with a short review of the literature.
Explore the source record for details and available documents.
A total of 125 patients with pertrochanteric or subtrochanteric fractures were treated by means of internal fixation with dynamic hip screws (DHS), and 77 were reviewed both clinically and radiologically after an average period of 29 months (6-69 months). This study included group A 2 fractures (with a large lesser trochanter fragment) and group A 3 fractures (pertrochanteric region) according to the ASIF classification, and also fractures of the proximal femoral shaft. With proper surgical technique only 5 cases of early infection (4%) were recorded. Early mobilization of these patients was possible owing to stable implants. There were 7 patients (5.6%) who died while still in hospital. Of the 77 patients in whom follow-up was possible, 76 had results falling in the very good or good categories according to the Merle d'Aubigné scheme. During this follow-up period 3 cases of implant fracture were encountered. In all other cases progression to bone union was uneventful. These results show that the use of DHS is a reliable method of stabilizing unstable pertrochanteric and subtrochanteric fractures.
Based on two cases and a review of the literature, we describe a rare injury in childhood, intertrochanteric femoral fracture. Because of the insertion and traction of muscles at the proximal femur, conservative treatment is difficult. The hip muscles pull the proximal fragment into flexion, abduction and external rotation. In our opinion, surgical stabilization is the therapy of choice. We use an angular stable, locking compression plate for the stabilization of these fractures. Postoperatively, mobilization with full weight bearing is possible.
Explore the source record for details and available documents.
Geriatric patients, fracture of the femur proximal to the hip joint, frequency of intercurrent complications, surgical complications, fracture of the neck of the femur. The assessment of data of over 1,7000 cases of patients with fractures of the femur proximal to the hip joint is used to establish the frequency of intercurrent complications such as general, potentially fatal conditions and technical incidents during operations. Multidimensional biostatistical methods of evaluation are used to discuss the causes and interrelationships involved and to draw conclusions for the treatment of such fractures in elderly patients, especially among the oldest of this age group.
OBJECTIVE: Intra-operative fluoroscopy is a valuable tool for visualizing underlying bone, implant, and surgical tool positions in orthopedics. It has brought about the minimally invasive surgical technique of intramedullar nailing to fix femoral shaft fractures. However, the limited field of view and two-dimensional property of fluoroscopic images aggravate intra-operative control of surgical parameters. The purpose of this article is to introduce a surgical navigation system based on fluoroscopy that provides missing information for the procedure of femoral fracture fixation. MATERIALS AND METHODS: Optoelectronic markers are placed on a surgical drill, involved bone fragments, the femoral nail, and the fluoroscope to track their positions. Projection properties of the fluoroscope are acquired through an initial precalibration. The relative positions of bone fragments, implants, and surgical tools are displayed superimposed simultaneously and in real time on multi-planar intra-operative fluoroscopic images. This is achieved by computer simulation of X-ray projections that have taken place with acquisition of the fluoroscopic images. In addition, a method has been developed that allows contactless measurement of three-dimensional anatomic landmarks, based on their representation in fluoroscopic images. In combination with optoelectronic tracking, this enables dynamic calculation of important surgical parameters such as femoral antetorsion. RESULTS: A pilot surgery showed that fracture reduction can benefit from the developed computer-assisted method. An in-vitro study on computer-assisted measurement of femoral antetorsion demonstrated the high degree of precision of this technique.
Intra-articular vertical axis dislocations are rare injuries, which mostly occur after blunt trauma. In this type of dislocation, the patella rotates along its vertical axis, bringing the articular surface to face medially or laterally. A 13-year-old boy sustained an intra-articular lateral patellar dislocation with a 90 degrees vertical axis medial rotation, which resulted in the articular surface facing laterally, the medial edge of the patella pointing posteriorly, and the lateral edge of the patella pointing anteriorly. As a result, the patella was wedged between the medial and lateral femoral condyles. He also sustained an ipsilateral closed distal femoral shaft fracture. Closed reduction of the dislocation was not successful. Subsequently an A-O reduction clamp was used percutaneously to reduce the patellar dislocation. The femoral fracture was then stabilized by internal fixation using a dynamic compression plate. Isolated vertical and horizontal dislocations have been previously described, but the presence of an ipsilateral femoral shaft fracture makes this a unique case. The percutaneous method used for reduction of the patella has not been previously described. A focused review of the literature, pathoanatomy, and methods of treatment of this condition are presented.
Explore the source record for details and available documents.
A modified custom-designed long gamma nail (LGN10) and the long gamma nail (LGN11) were evaluated in a prospective trial for operative treatment of proximal femoral fractures. Between May 1998 and January 2000, 50 patients (mean age 79 years) were alternately treated with LGN10 or LGN11. The femoral antecurvature varied from 6 degrees to 10 degrees, with a maximum of 14 degrees, as evidenced by lateral radiograms. The need for intramedullary reaming in LGN10 cases was significantly less ( p=0.046). Other significant differences between the two study groups were not observed. One cranial cut out of the lag screw in the LGN10 group was observed. Other complications were not recorded during hospital treatment. Follow-up results are not yet complete. Using LGN10 seems to reduce intramedullary damage to the femur and make insertion of the nail easier.
Hip fracture, which is often due to osteoporosis or other conditions affecting bone strength, can lead to permanent disability, pneumonia, pulmonary embolism, and/or death. Great effort has been directed toward developing noninvasive methods for evaluating proximal femoral strength (fracture load), with the goal of assessing fracture risk. Previously, computed tomographic scan-based, linear finite element (FE) models were used to estimate proximal femoral fracture loads ex vivo in two load configurations, one approximating joint loading during single-limb stance and the other simulating impact from a fall. Measured and computed fracture loads were correlated (stance, r=0.867; fall, r=0.949). However, precision for the stance configuration was insufficient to identify subjects with below average fracture loads reliably. The present study examined whether, for this configuration, nonlinear FE models could be used to identify these subjects. These models were found to predict fracture load within +/-2.0 kN (r=0.962). This level of precision is sufficient to identify 97.5% of femora with fracture loads 1.3 standard deviations below the mean as having below average fracture loads. Accordingly, 20% of subjects with below average fracture loads, i.e. those with the lowest fracture loads and likely to be at greatest risk of fracture, would be correctly identified with at least 97.5% reliability. This FE modeling method will be a powerful tool for studies of hip fracture.
The purpose of this study was to assess the impact of deep wound infection after surgery for proximal femoral fracture (PFF) on the patient in terms of mortality and social consequences, and on the National Health Service in terms of financial burden. Sixty-one cases of PFF over a six-year period were complicated with deep surgical wound infection. These cases were compared with a matched control group of 122 patients without infection. Infected cases had greatly increased hospital stay (P<0.001), were 4.5 times less likely to survive to discharge (P=0.002), and if they survived, were three times less likely to return to their original residence (P=0.05). The total cost of treatment per infected case was 24,410 pound sterling compared with 7210 pound sterling for controls (P<0.001). Meticillin-resistant Staphylococcus aureus (MRSA) infection increased admission length and cost compared with non-MRSA infection (P=0.02). Deep wound infection after PFF is a devastating and costly complication for both the patient and the healthcare services. The cost consequences should be considered when allocating resources to trauma services to ensure adequate provision to minimize infection risks and to accommodate treatment costs in this vulnerable group.
In an eight year period, 31 patients with proximal femoral fractures resulting from sports accidents were treated by implantation of either a Gamma nail or a dynamic hip screw. Return to work or sports and the time to bone healing did not differ very much between the treatments. Gamma nailing was clearly the best with regard to stability and time to full mobilisation (4.5 days), but required 39 minutes to perform compared with insertion of a dynamic hip screw (27 minutes). The incidence of complications and malalignments did not differ very much between the two, although, when Gamma nailing was first used in the authors' clinic, more intraoperative complications occurred than with the dynamic hip screw. Stable pertrochanteric fractures may be treated with a dynamic hip screw. Unstable pertrochanteric or subtrochanteric fractures are treated with a Gamma nail at the authors' institution.
Explore the source record for details and available documents.
The effect of head injury on systemic physiology, including bone healing is still a topic of vivid discussion. Whether the observed changes genuinely represent accelerated fracture healing or are a form of local heterotopic ossification remains unclear. We aimed to investigate whether in patients with long bone fractures the presence of head injury is associated with accelerated bone healing and excessive callus formation. In total 67 patients were studied 17 with head injury and 50 without head injury (25 treated with reamed and the other 25 with the unreamed nailing technique). Both groups were comparable in terms of age, sex, ISS. All underwent stabilisation of their femoral fracture with intramedullary nailing. The quantification of fracture healing response was estimated by taking the radiological ratio of the largest diameter of callus formed into two planes and the adjacent normal diameter of femoral canal. The minimum follow up of the patients was 12 months. In patients with head injury, the mean time to fracture union was significantly shorter than either the reamed or unreamed group (10.5 weeks compared with 20.5 and 26.9 weeks, p<0.001). The difference between the mean callus to diaphyseal ratio was statistically significant for both the AP and Lateral projections (AP: mean difference 0.462, 95% CI 0.312 to 0.602, p<0.0001, LAT: mean difference 0.289, 95% CI 0.142 to 0.436, p<0.001) with the head injured patients having more florid callus compared to the control group.
OBJECTIVES: To evaluate the clinical results of intramedullary nailing of femoral shaft fractures using a rigid intramedullary nail placed through the lateral aspect of the greater trochanter in older children and adolescents. DESIGN: A retrospective study was carried out evaluating all skeletally immature patients with femoral shaft fractures treated using a modified rigid humeral intramedullary nail. PATIENTS/PARTICIPANTS: Fifteen children and adolescents with displaced femoral diaphyseal fractures and open physes. INTERVENTION: Femoral shaft fractures in children and adolescents were stabilized using a modified humeral intramedullary nail placed through the lateral aspect of the greater trochanter. MAIN OUTCOME MEASUREMENTS: Patients were evaluated to determine time to union, final fracture alignment, hospital stay, complications, clinical outcome, and proximal femoral changes including avascular necrosis or proximal femoral valgus with femoral neck narrowing. RESULTS: Fifteen patients were followed for a minimum of 1 year (range 70-157 weeks). The average age of the patients was 12 years and 5 months (range 8 years and 2 months-17 years and 1 month). All fractures healed at a mean of 7 weeks (range 5-14 weeks) after fracture. The average hospital stay for patients with isolated femur fractures (8/15) was 2.8 days (range 1-5 days). At an average follow-up of 141 weeks (range 70-326 weeks), no patient had developed avascular necrosis, femoral neck valgus, femoral neck narrowing, or other complications. CONCLUSIONS: The technique of intramedullary nailing in children through the lateral aspect of the greater trochanter seems to be safe, effective, and well tolerated by patients.
Explore the source record for details and available documents.
We investigated the serial change of the extent of sliding of the compression screw in 42 intertrochanteric femoral fractures fixed with a sliding screw system. Neither age, gender, bone density, fracture type nor quality of fracture reduction could accurately predict healing time. There was a significant correlation between the extent of sliding at union and healing time (correlation coefficient r = 0.505). The average healing time in group B (the extent of sliding at union of 8 mm or greater) was 13.8 weeks postoperatively, and that in group A (the extent of sliding at union of less than 8 mm) was 8.9 weeks. There was a significant difference in the average healing time between groups A and B (P = 0.0004). The extent of sliding at union had a influence on the healing time. The phenomenon of sliding progressed mainly during the first 2 weeks postoperatively. There was a significant positive correlation between the extent of sliding at union and the extent of sliding at 2 weeks postoperatively (r = 0.977). An assessment using the extent of sliding at 2 weeks postoperatively can accurately predict the extent of sliding at union and the healing time. It is important to examine the phenomenon of sliding during the early postoperative course, especially until 2 weeks postoperatively, in order to predict fracture repair.