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Results for “FEMORAL FRACTURES”

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At least 649 records · Page 36Linked to original sources
PubMed1992

A comparison of elderly patients with proximal femoral fractures and a normal elderly population: a case control study.

AIM: To assess the importance of bone density and other risk factors in elderly subjects with hip fractures. METHOD: Thirty-six subjects with femoral neck fracture were compared with 72 community controls in this case control study. Variables compared included: history of falls, previous fracture, body mass index, hand grip strength, blood pressure, medication use, cigarette smoking, alcohol intake, visual acuity, age at menopause, mental status quotient, mobility index and mid thigh circumference. Bone mineral density was measured at the hip (DPA absorptiometer) in the 36 subjects with hip fracture and 36 community controls. RESULTS: Fracture patients had significantly (p < 0.01) reduced bone mineral density at femoral neck (0.64 vs 0.74 g/cm2) and trochanteric regions (0.55 vs 0.66 g/cm2). They also had significantly (p < 0.05) lower body mass index, weaker hand grip strength, smaller mid thigh circumference, reduced mobility and more previous fractures. After controlling for age and sex stepwise logistic regression identified handgrip strength, mobility status and falls in that ranking as risk factors for fracture. Bone mineral density was correlated with mobility status and grip strength. CONCLUSION: Patients with hip fracture have lower bone mineral density than controls. Mobility, grip strength and muscle bulk appear to be important in fracture aetiology and could operate either through bone density or risk of falling.

Accidental Falls↗
PubMed2005

Surgical treatment of femoral fractures in obese children: does excessive body weight increase the rate of complications?

BACKGROUND: In light of the increasing rate of obesity among children in the United States, this study examines whether obese children have an increased rate of complications following surgical treatment of femoral shaft fractures. METHODS: A retrospective review of the charts of children between six and fourteen years of age who were treated operatively for a femoral shaft fracture was performed, and complications were identified. RESULTS: One hundred and three children (104 fractures), with a mean age at the time of injury of 9.3 years, were identified. Fifty-nine fractures were treated with external fixation, and forty-five were treated with an intramedullary rod. Six children (6%) were considered obese, with a weight for age at the 95th percentile or higher. An additional four children were extremely heavy at the 90th to the 94th percentile of weight for age. Three complications occurred in the six obese children, and one complication occurred in the four extremely heavy children. Eleven (12%) of the remaining ninety-three children had a complication. When examined according to treatment groups, the complication rate for heavier children was higher for both the group managed with an intramedullary rod and the group that had external fixation (p = 0.004). CONCLUSIONS: Obese children have an increased rate of postoperative complications compared with children who are not obese. Therefore, parents of obese children should be warned that such children may have a potentially increased risk of complications associated with surgical management of a femoral fracture.

Adolescent↗
PubMed1996

[Experiences with the classic nail in management of per-/subtrochanteric femoral fractures in elderly patients].

In the department of trauma and reconstructive surgery at the University Hospital of Hamburg-Eppendorf (UKE) the surgical treatment of unstable per- and subtrochanteric femoral fractures (AO 31A2 and 31A3) in elderly patients with severe osteoporosis includes the implantation of dynamic hip screws (DHS) and gamma nails, as well as the straighter "classic nails". Using 43 short and 15 long classic nails, 58 fractures in seven women and 51 men, respectively, with an average age of 85 years (65-98 years) were stabilized over the last 2 years with good results (98.3% primary full weight bearing). In order to facilitate implantation of the longer nails, additional antetorsion of the femoral neck screw and improvement of the distal interlocking have been developed by the manufacturer.

Aged↗
PubMed1996

The effect of femoral neck fractures on femoral head blood flow.

Treatment of femoral neck fractures remains a significant clinical challenge. The choice between femoral head replacement and internal fixation must take into account the patient's age, activity level, degree of osteoporosis, and medical condition. If open reduction and internal fixation is chosen, an understanding of the vascular pathophysiology of femoral neck fractures is helpful to insure the best clinical result. Osteonecrosis of the femoral head and non-union of the femoral neck fracture are the two most common complications following fixation of a femoral neck fracture. The vascular damage from the fracture itself significantly reduces femoral head perfusion. Therefore, a careful and anatomic (or slightly valgus) reduction, followed by rigid fixation with three pins, three screws, or a hip screw construct, is advised. There is experimental and clinical evidence that "emergent" open reduction and internal fixation and capsulotomy may lessen the vascular insult from the femoral neck fracture itself.

Adult↗
PubMed2001

Internal fixation implants for intracapsular proximal femoral fractures in adults.

BACKGROUND: Numerous different implants with screws, pins and side plates have been used for the internal fixation of intracapsular hip fractures. OBJECTIVES: To determine from randomised trials which implant is superior for the internal fixation of intracapsular proximal femoral fractures. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group specialised register. The date of the most recent search was December 2000. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing different implants for the internal fixation of intracapsular hip fractures in adults. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality, by use of a ten item scale, and extracted data. Additional information was sought from trialists. After grouping by implant type, comparable groups of trials were subgrouped and where appropriate, data were pooled using the fixed effects model. MAIN RESULTS: Twenty-seven studies involving 5269 participants (5274 fractures) were included in the study. Considerable variation in the quality of methodology between studies was found and biases due to familiarity with some of the implants were noted. None of the implants tested were found to be significantly superior for any of the outcome measures related to fracture healing complications or mortality. The sliding hip screw was found to take longer to insert and to have an increased operative blood loss compared with multiple screws or pins. REVIEWER'S CONCLUSIONS: No clear conclusions can be made on the choice of implant for internal fixation of intracapsular fractures from the available evidence within randomised trials.

Bone Nails↗
PubMed1994

Proximal femoral fractures: a biomechanical study to compare intramedullary and extramedullary fixation.

This study assesses the rigidity and strength of fixation provided by intramedullary and extramedullary devices for proximal femoral fractures. Stable and unstable intertrochanteric fractures were studied in paired femora after internal fixation with the Gamma nail and Richards 135 degrees classic hip-screw implants; in subtrochanteric fractures, the 95 degrees Richards condylar screw was studied in addition. Subsidence of the sliding screw within the plate and nail constructs was measured. Fixation of subtrochanteric fractures with the intramedullary Gamma nail was significantly stronger and more rigid than that with the extramedullary screw plate devices. Under conditions of simulated protected weight bearing, the 95 degrees condylar screw plate provided more rigid fixation than did the 135 degrees hip screw. There was no significant difference in the strength of fixation of stable and unstable intertrochanteric fractures between the Gamma nail and the hip screw, although the Gamma nail provided more rigid fixation.

Aged↗
PubMed1985

[Reconstructive interventions following femoral fractures].

The complex and simple fractures seen in polytrauma patients after initial treatment sometimes show signs of poor setting and non-union with possible unfavourable functional consequences making reconstructive surgery necessary. In this report characteristic posttrauma problems and reconstructive surgery of the proximal femur, the femoral shaft and the distal femur are discussed. Possibilities other than prothesis or joint fusion, especially in the hip or knee joint, should be considered.

Bone Plates↗
PubMed1995

Wound drains in proximal femoral fracture surgery: a randomized prospective trial of 177 patients.

We report on a prospective randomized trial on the effect of wound drains on wound healing following surgery for proximal femoral fractures. One hundred and seventy-seven consecutive patients admitted to Queen's Medical Centre Nottingham, undergoing AO dynamic hip screw (DHS) or hemiarthroplasty were randomized whether or not to receive wound drainage. Wound healing was assessed in terms of ultrasound examination, the ASEPSIS wound score system and overt infection rates. All patients were followed up at 6 weeks and 6 months. Ultrasound examinations showed that drains were indeed ineffective in preventing haematoma formation, the first time this has been demonstrated objectively. However, using drains failed to prevent late seroma formation. Patients who received wound drainage showed statistically better wound healing on the ASEPSIS wound scoring system and a reduced infection rate. The ASEPSIS scores on day 2 and 5 postoperatively proved an accurate predictor of poor wound healing. This study conflicts with previous smaller studies which failed to show an effect of wound drainage upon wound healing, and strongly supports the use of wound drains.

Aged↗
PubMed2002

Proximal femoral fractures.

Fractures of the proximal femur include fractures of the head, neck, intertrochanteric, and subtrochanteric regions. Head fractures commonly accompany dislocations. Neck fractures and intertrochanteric fractures occur with greatest frequency in elderly patients with a low bone mineral density and are produced by low-energy mechanisms. Subtrochanteric fractures occur in a predominantly strong cortical osseous region which is exposed to large compressive stresses. Implants used to address these fractures must be able to accommodate significant loads while the fractures consolidate. Complications secondary to these injuries produce significant morbidity and include infection, nonunion, malunion, decubitus ulcers, fat emboli, deep venous thrombosis, pulmonary embolus, pneumonia, myocardial infarction, stroke, and death.

Aged↗